38122 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

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, 485, and 

491 

[CMS–1385–P] 

RIN 0938–AO65 

Medicare Program; Proposed 

Revisions to Payment Policies Under 

the Physician Fee Schedule, and Other 

Part B Payment Policies for CY 2008; 

Proposed Revisions to the Payment 

Policies of Ambulance Services Under 

the Ambulance Fee Schedule for CY 

2008; and the Proposed Elimination of 

the E-Prescribing Exemption for 

Computer-Generated Facsimile 

Transmissions 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Proposed rule. 

SUMMARY: This proposed rule would 

address certain provisions of the Tax 

Relief and Health Care Act of 2006, as 

well as make other proposed changes to 

Medicare Part B payment policy. 

We are proposing these changes to 

ensure that our payment systems are 

updated to reflect changes in medical 

practice and the relative value of 

services. This proposed rule 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 authorized by section 

413 of the Medicare Prescription Drug, 

Improvement and Modernization Act of 

2003 (MMA); conforming and clarifying 

changes for comprehensive outpatient 

rehabilitation facilities (CORFs); a 

process for updating the drug 

compendia at section 1861(t)(2)(B) of 

the Social Security Act (the Act); 

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; issues 

related to therapy services; revisions to 

the ambulance fee schedule; the 

ambulance inflation factor for CY 2008; 

and the proposal to eliminate the 

exemption for computer-generated 

facsimile transmissions from the 

National Council for Prescription Drug 

Programs (NCPDP) SCRIPT standard for 

transmitting prescription and certain 

prescription-related information for Part 

D eligible individuals. 

DATES: To be assured consideration, 

except for comments on section II.M.10 

of the preamble, comments must be 

received at one of the adresses provided 

below, no later than 5 p.m. on Friday, 

August 31, 2007. 

Comments on section II.M.10 

‘‘Alternative Criteria for Satisfying 

Certain Exceptions’’, of the preamble 

must be received by no later than 5 p.m. 

on Friday, September 7, 2007. 

ADDRESSES: In commenting, please refer 

to file code CMS–1385–P. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

four ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http:// 

www.cms.hhs.gov/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 regular mail. You may mail 

written comments (one original and two 

copies) to the following address ONLY: 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Attention: CMS–1385– 

P, P.O. Box 8018, Baltimore, MD 21244– 

8018. 

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–P, 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– 

7195 in advance to schedule your 

arrival with one of our staff members. 

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201; or 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

(Because access to the interior of the 

HHH Building is not readily available to 

persons without Federal Government 

identification, commenters are 

encouraged to leave their comments in 

the CMS drop slots located in the main 

lobby of the building. A stamp-in clock 

is available for persons wishing to retain 

a proof of filing by stamping in and 

retaining an extra copy of the comments 

being filed.) 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period. 

Submission of comments on 

paperwork requirements. You may 

submit comments on this document’s 

paperwork requirements by mailing 

your comments to the addresses 

provided at the end of the ‘‘Collection 

of Information Requirements’’ section in 

this document. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: Pam 

West (410) 786–2302 for issues related 

to practice expense and changes to the 

comprehensive outpatient rehabilitation 

facility. 

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. 

Karen Rinker (410) 786–0189 for 

issues related to the drug compendia. 

David Walczak (410) 786–4475 for 

issues related to reassignment and 

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Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38123 

physician self-referral rules for 

diagnostic tests and beneficiary 

signature for ambulance transport. 

Lisa Ohrin (410) 786–4565 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 quality reporting 

system for physician payment for CY 

2008. 

Mary 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 

cap. 

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 all issues 

set forth in this rule to assist us in fully 

considering issues and developing 

policies. You can assist us by 

referencing the file code [CMS–1385–P] 

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. 

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 

1. Work RVUs 

2. Practice Expense Relative Value Units 

(PE RVUs) 

3. Resource-Based Malpractice RVUs 

4. Refinements to the RVUs 

5. Adjustments to RVUs Are Budget 

Neutral 

B. Components of the Fee Schedule 

Payment Amounts 

C. Most Recent Changes to Fee Schedule 

II. Provisions of the Proposed Regulation 

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 

1. Requests for Adding Services to the List 

of Medicare Telehealth Services 

2. Submitted Requests for Addition to the 

List of Telehealth Services 

E. Specific Coding Issues Related to PFS 

1. Reduction in the Technical Component 

(TC) for Imaging Services Under the PFS 

to the Outpatient Department (OPD) 

Payment Amount 

2. Application of Multiple Procedure 

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. Additional Codes From the 5-Year 

Review of Work RVUs 

5. Anesthesia Coding (Part of 5-Year 

Review) 

6. 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 TC of Physician 

Pathology Services (§ 414.510) 

2. New Clinical Diagnostic Laboratory Test 

(§ 414.508) 

H. Proposed Revisions Related to Payment 

for Renal Dialysis Services Furnished by 

End-Stage Renal Disease (ESRD) 

Facilities 

1. CY 2005 Revisions 

2. CY 2006 Revisions 

3. CY 2007 Updates 

4. Provisions of This Proposed Rule 

I. Independent Diagnostic Testing Facility 

(IDTF) Issues 

1. Proposed Revisions of Existing IDTF 

Performance Standards 

2. Proposed 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 OffLabel 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. Changes to Reassignment and Physician 

Self-Referral Rules Relating to Diagnostic 

Tests (Anti-Markup Provision) 

2. Burden of Proof 

3. In-Office Ancillary Services Exception 

4. Obstetrical Malpractice Insurance 

Subsidies 

5. Unit-of-Service (per click) Payments in 

Space and Equipment Leases 

6. Period of Disallowance for 

Noncompliant Financial Relationships 

7. Ownership or Investment Interest in 

Retirement Plans 

8. ‘‘Set in Advance’’ and Percentage-Based 

Compensation Arrangements 

9. Stand in the Shoes 

10. Alternative Criteria for Satisfying 

Certain Exceptions 

11. Services Furnished ‘‘Under 

Arrangements’’

N. Beneficiary Signature for Ambulance 

Transport Services 

O. Update to Fee Schedules for Class III 

DME for CYs 2007 and 2008 

1. Background 

2. Proposed 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 (§ 413.84) 

4. Diagnostic X-Ray Tests, Diagnostic 

Laboratory Tests, and Other Diagnostic 

Tests: Conditions (§ 410.32(a)(1)) 

R. Percentage Change in the Medicare 

Economic Index (MEI) 

S. Other Issues 

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1. Recalls and Replacement Devices 

2. Therapy Standards and Requirements 

3. Proposed Elimination of 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 

T. 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 Anemia 

Quality Indicators (§ 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 

6. Section 108—Payment Process Under 

the Competitive Acquisition Program 

(CAP) 

III. Fee Schedule for Payment of Ambulance 

Services Update for CY 2007; Ambulance 

Inflation Factor Update for CY 2008; and 

Proposed Revisions to the Publication of 

the Ambulance Fee Schedule (§ 414.620) 

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. Proposed Revisions to the Publication of 

the Ambulance Fee Schedule (§ 414.620) 

IV. Collection of Information Requirements 

V. Response to Comments 

VI. 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 

2008 

Addendum C—Codes for Which We 

Received PERC Recommendations on PE 

Direct Inputs 

Addendum D—Proposed 2008 Geographic 

Adjustment Factors (GAFs) 

Addendum E—Proposed 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 

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 

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)) 

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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 

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 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘BACKGROUND’’ at the 

beginning of your comments.] 

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 

payment methodology for anesthesia 

services. 

We establish physician work RVUs for 

new and revised codes based on 

recommendations received from the 

American Medical Association’s (AMA) 

Specialty Society Relative Value Update 

Committee (RUC). 

2. Practice Expense Relative Value Units 

(PE RVUs) 

Section 121 of the Social Security Act 

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

enacted on October 31, 1994, amended 

section 1848(c)(2)(C)(ii) of the Act and 

required us to develop resource-based 

PE RVUs for each physician’s service 

beginning in 1998. We were to consider 

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 resourcebased 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 

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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 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 

evaluate 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 all 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 this 

proposed rule contains certain 

additional proposals relating to the third 

5-Year Review). 

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: 

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. 

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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 22, 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, it 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 Proposed 

Regulation Related to the Physician Fee 

Schedule 

A. Resource-Based Practice Expense 

(PE) Relative Value Units (RVUs) 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘RESOURCE-BASED PE RVUs’’

at the beginning of your comments.] 

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 stated that the revised PE 

methodology must consider the staff, 

equipment, and supplies used in the 

provision of various medical and 

surgical services in various settings 

beginning in 1998. The Secretary has 

interpreted this to mean that Medicare 

payments for each service would be 

based on the relative PE resources 

typically involved with 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 

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 provide 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 June 29, 2006 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 November 1, 2002 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) (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 

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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 

proposing to use the 2006 procedurespecific 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 

allocation would be (0.75/0.25) = 3.0. 

The indirect percentage factor is then 

applied to the service level adjusted 

indirect practice expense 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 performed independently or by 

different providers. When services have 

TC, PC, and global components that can 

be billed separately, the payment for the 

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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 

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 the 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. 

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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 proposed rule. 

(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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Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38131 

TABLE 1.—CALCULATION OF PE RVU

S

UNDER

PROPOSED

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 

nonfacility 

Chest x-ray 

nonfacility 

Chest x-ray 

nonfacility 

ECG, 

complete 

nonfacility 

ECG, 

tracing 

nonfacility 

ECG, report 

nonfacility 

(1) Labor cost (Lab) ... Step 1 ....................... AMA .......................... ................................... $ 13.44 $ 77.74 $ 5.74 $ 5.65 $ $ 6.12 $ 6.12 $ (2) Supply cost (Sup) Step 1 ....................... AMA .......................... ................................... $ 2.94 $ 7.60 $ 3.39 $ 3.34 $ $ 1.19 $ 1.19 $ (3) Equipment cost 

(Eqp).

Step 1 ....................... AMA .......................... ................................... $ 0.19 $ 0.64 $ 8.18 $ 8.05 $ $ 0.12 $ 0.12 $ 

(4) Direct cost (Dir) .... Step 1 ....................... ................................... = (1) + (2) + (3) ........... $ 16.37 $ 85.34 $ 17.31 $ 17.54 $ $ 7.60 $ 7.60 $ (5) Direct adjustment 

(Dir Adj).

Steps 2–4 ................. See footnote* ............ ................................... 0.584 0.584 0.584 0.584 0.584 0.584 0.584 0.584 

(6) Adjusted labor ...... Steps 2–4 ................. = Lab*Dir Adj ............. = (1) * (5) .................... $ 7.85 $ 45.40 $ 3.35 $ 3.30 $ $ 3.57 $ 3.57 $ (7) Adjusted supplies Steps 2–4 ................. = Sup*Dir Adj ............ = (2) * (5) .................... $ 1.72 $ 4.44 $ 1.98 $ 1.95 $ $ 0.70 $ 0.70 $ (8) Adjusted equipment. Steps 2–4 ................. = Eqp*Dir Adj ............ = (3) * (5) .................... $ 0.11 $ 0.37 $ 4.77 $ 4.70 $ $ 0.07 $ 0.07 $ (9) Adjusted direct ...... Steps 2–4 ................. ................................... = (6) + (7) + (8) ........... $9.56 $ 49.84 $ 10.11 $ 10.24 $ $ 4.44 $ 4.44 $ (10) Conversion Factor (CF). Step 5 ....................... MFS .......................... ................................... $34.1350 $34.1350 $34.1350 $34.1350 $34.1350 $34.1350 $34.1350 $34.1350 (11) Adj. labor cost 

converted.

Step 5 ....................... = (Lab*Dir Adj)/CF .... = (6)/(10) ................... 0.23 1.33 0.10 0.10 .................... 0.10 0.10 ....................

(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) ..... 0.28 1.46 0.30 0.30 .................... 0.13 0.13 ....................

(15) Wrk RVU* Wrk 

Scaler.

Setup File ................. MFS .......................... ................................... 0.81 29.66 0.19 .................... 0.19 0.15 .................... 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% 59.4% 59.4% 59.4% 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) .................... 0.55 3.02 0.43 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 29.66 0.29 0.10 0.19 0.25 0.10 0.15 

(22) Indirect Allocator 

(1st + 2nd).

Step 8 ....................... ................................... = (19) + (21) ............... 1.36 32.68 0.72 0.53 0.19 0.47 0.32 0.15 

(23) Indirect Adjustment (Ind Adj). Steps 9–11 ............... See footnote** .......... ................................... 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 ... ................................... 0.49 11.83 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 ...... ................................... 0.966 0.941 1.060 1.060 1.060 1.237 1.237 1.237

(26) Adjusted Indirect Step 17 ..................... = Adj. Ind Alloc*PCI .. = (24) * (25) ................ 0.48 11.13 0.28 0.21 0.07 0.21 0.14 0.07 (27) PE RVU .............. Steps 18–19 ............. = (Adj Dir + Adj Ind) 

*budn.

= ((14) + (26)) *budn .. 0.75 12.56 0.57 0.50 0.07 0.34 0.27 0.07 

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

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38132 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

g. Discussion of Equipment Usage 

Percentage 

We continue to receive comments 

regarding our use of the equipment 

usage assumption of 50 percent. 

MedPAC continues to support an 

unspecified higher utilization rate. 

Several interested parties, including the 

AMA RUC, have requested that we 

refine this usage percentage to 

somewhere in the range of 70 to 80 

percent. Other interested parties 

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. We do not want to 

create disincentives for the use of 

equipment by arbitrarily increasing the 

equipment usage percentage. 

Conversely, we do not want to create 

incentives for the acquisition and 

potential over-utilization of equipment 

by arbitrarily decreasing the equipment 

usage percentage. 

Although we acknowledge the acrossthe-board 50 percent usage rate we 

currently apply for all equipment does 

not capture the actual usage rates for all 

equipment, we do not believe that we 

have sufficient empirical evidence to 

justify an alternative proposal on this 

issue. We are interested in receiving 

comments relating to alternative 

percentages and approaches that 

differentially classify equipment into 

mutually exclusive categories with 

category-specific usage rate 

assumptions. We are committed to 

continuing our work with the physician 

community to examine equipment usage 

rate assumptions that ensure 

appropriate payments and encourage 

appropriate utilization of equipment. 

Additionally, we would welcome any 

empirical data that would assist us in 

these efforts. 

h. Equipment Interest Rate (Discussion) 

As part of our calculation of the PE 

equipment costs, we take into 

consideration 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 resourcebased 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. 

The current interest rate of 11 percent 

was assigned in 1997 based upon 

information provided by the Small 

Business Administration (SBA). This 

prevailing rate was based upon data 

regarding prevailing loan rates for small 

businesses from both national and 

regional lending associations. Although 

the SBA offered various interest rates, 

we believed that the 11 percent interest 

rate was most relevant for fee schedule 

services as this rate was based on 

equipment cost of over $25,000 with a 

useful life of over 7 years. 

We have analyzed 2007 SBA data on 

loans and applicable interest rates. 

According to the SBA, loans are based 

on the prime rate plus a fixed 

percentage based upon the amount of 

the loan and the usable life of the 

equipment purchased. The prime plus 

rates ranged from 9.4 percent to 13 

percent. Using the same criteria as was 

used in 1997 (that is, equipment cost 

over $25,000 with a useful life of over 

7 years), the interest rates ranged from 

10.1 percent to 13 percent. 

Based upon our analysis of the 

revised SBA interest rate data, we 

believe 11 percent continues to be an 

appropriate assumption; therefore, we 

will retain the interest rate used in the 

calculation of equipment costs at 11 

percent and no proposal is being made 

to adjust this rate. 

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 agree 

that ACR’s approach more appropriately 

identifies the PE/HR for radiology. 

For these reasons, we propose to 

revise the PE/HR associated with 

radiology using the survey data 

weighted by practice size. See Table 2 

which identifies the PE/HR for all 

specialties, as well as both the current 

and proposed revisions to the PE/HR for 

radiology. 

TABLE 2.—2008 SMS AND SUPPLEMENTAL SURVEY PE/HR INFLATED TO 2005 BASED UPON MEI GROWTH FACTORS

[Includes proposed revision to radiology PE/HR] 

Specialty Clinical 

labor 

Clerical 

payroll 

Office 

expense 

Supplies 

expense 

Equipment 

expense 

Other 

expense 

Total 

expense 

ALL PHYSICIANS .................................... 15.68 19.64 24.74 9.44 4.08 14.66 88.23 

ALLERGY/IMMUNOLOGY ....................... 65.88 56.33 65.88 22.49 6.26 31.08 247.93 

ANESTHESIOLOGY ................................ 14.41 4.72 7.52 0.51 0.51 7.52 35.19 

CARDIAC/THORACIC SURGERY .......... 24.38 22.50 21.50 2.63 2.63 17.75 91.38 

CARDIOVASCULAR DISEASE ............... 59.55 53.33 52.67 25.90 18.58 25.02 235.05 

DERMATOLOGY ..................................... 40.63 51.45 78.82 15.38 11.03 28.22 225.55 

DIAGNOSTIC TESTING FACILITY ......... 111.57 155.49 121.18 54.96 302.47 189.48 935.15 

EMERGENCY MEDICINE ....................... 4.21 19.64 2.55 0.89 0.13 14.66 42.08 

GASTROENTEROLOGY ......................... 30.16 39.56 48.41 8.20 5.90 13.33 145.55 

GENERAL INTERNAL MEDICINE .......... 11.99 18.36 22.82 7.78 2.68 8.42 72.04 

GENERAL SURGERY ............................. 9.18 19.89 21.42 4.34 2.55 12.62 70.00 

GENERAL/FAMILY PRACTICE ............... 18.87 19.00 22.57 10.07 3.95 11.22 85.68 

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Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38133 

TABLE 2.—2008 SMS AND SUPPLEMENTAL SURVEY PE/HR INFLATED TO 2005 BASED UPON MEI GROWTH FACTORS—

Continued 

[Includes proposed revision to radiology PE/HR] 

Specialty Clinical 

labor 

Clerical 

payroll 

Office 

expense 

Supplies 

expense 

Equipment 

expense 

Other 

expense 

Total 

expense 

INDEPENDENT LAB ............................... 84.79 25.76 19.09 19.84 8.83 21.60 179.93 

NEUROLOGICAL SURGERY .................. 10.97 32.64 36.47 2.30 1.79 20.53 104.68 

NEUROLOGY .......................................... 10.58 29.33 24.86 6.63 5.61 11.86 88.87 

OBSTETRICS/GYNECOLOGY ................ 20.91 23.97 31.49 9.31 4.08 14.28 104.04 

ONCOLOGY ............................................ 68.06 44.22 43.86 21.53 9.48 53.76 240.91 

OPHTHALMOLOGY ................................ 32.00 32.90 43.48 13.77 10.71 26.90 159.76 

ORTHOPEDIC SURGERY ...................... 21.17 36.34 37.87 13.13 4.85 24.35 137.70 

OTHER SPECIALTY ................................ 11.86 16.58 24.61 6.25 2.42 11.22 72.93 

OTOLARYNGOLOGY .............................. 21.93 32.13 41.95 9.56 7.14 21.93 134.64 

PATHOLOGY ........................................... 14.28 17.85 15.17 8.67 2.55 26.78 85.30 

PEDIATRICS ............................................ 15.81 16.45 24.10 13.01 2.17 10.97 82.49 

PHYS MED/RHEUMATOLOGY ............... 19.00 30.22 39.14 8.29 7.91 15.56 120.11 

PHYSICAL THERAPY ............................. 13.25 8.21 17.11 3.05 2.70 9.85 54.15 

PLASTIC SURGERY ............................... 19.13 25.88 41.31 23.59 7.27 32.13 149.30 

PSYCHIATRY .......................................... 2.17 6.50 13.39 0.51 0.51 9.18 32.26 

PULMONARY DISEASE .......................... 8.80 15.81 20.02 3.32 2.04 8.80 58.78 

RADIATION ONCOLOGY ........................ 68.82 32.38 48.83 6.38 39.33 32.85 228.59 

RADIOLOGY ............................................ 29.07 37.81 23.93 11.26 27.32 44.80 174.18 

*RADIOLOGY .......................................... *32.62 *42.29 *28.95 *14.15 *39.62 *47.24 *204.86 

UROLOGICAL SURGERY ....................... 27.90 42.33 53.79 14.43 11.25 23.45 173.14 

VASCULAR SURGERY ........................... 25.79 23.04 22.56 4.06 5.78 14.50 95.73 

*Proposed revision to radiology PE/HR. 

b. RUC Recommendations for Direct PE 

Inputs and Other PE Input Issues 

The following discussions are 

proposals 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. 

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.) 

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 

At the recent April RUC meeting, the 

PERC considered recommendations for 

the family of CPT codes 93501 through 

93556 for cardiac catheterization. The 

American College of Cardiology, in 

cooperation with the Society of Cardiac 

Angiography and Interventions and the 

Cardiovascular Outpatient Center 

Alliance, developed PE inputs for the 

nonfacility setting for 13 of the 28 CPT 

codes in this family. The PERC 

considered the proposed new or 

updated PE input recommendations for 

13 cardiac catheterization CPT codes. 

• Of these 13 codes, 8 were not 

previously valued in the nonfacility 

setting (as recommended at the January 

2002 PEAC meeting), including CPT 

codes 93539, 93540, 93542, 93543, 

93544, 93545, 93555, and 93556. 

• The recommended revised PE 

inputs for the other 5 codes (last valued 

in the nonfacility setting at the January 

2004 PEAC meeting), included CPT 

codes: 93501, 93505, 93508, 93510, and 

93526. 

We are proposing 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. 

The specialty societies recommended 

that the remaining 15 codes in the 

cardiac catheterization family remain 

carrier-priced, or be assigned an ‘‘NA’’

for the practice expense in the office 

setting. It was noted that these codes 

were rarely if ever performed in the 

office setting and the specialties 

recommended no direct PE inputs. 

Assigning these CPT codes as ‘‘NA’’ for 

PE in the nonfacility setting would 

conform to PFS policy for other services 

without PE inputs. Therefore, we are 

proposing 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. 

Obstetric/Gynecologic PE 

The PERC recommended changes to 

the content and the price of the pack, 

pelvic exam (supply code SA051) 

valued at $0.95. We agreed with the 

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. In addition, we accepted 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. 

Dual Energy X-Ray Absorptiometry 

(DEXA) 

The PERC considered revisions to the 

direct PE inputs for CPT codes 77080, 

77081, and 77082 that contained 

recommendations established by 5 

distinct specialty organizations. These 

recommended inputs were revised to 

comply with established PERC 

standards, such as removing some labor 

inputs for CPT code 77082 because this 

procedure is always performed with 

CPT code 77081 and all revisions were 

agreed to by the presenting specialty. 

The resulting recommended inputs 

more appropriately reflect the resources 

used to furnish these services and were 

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38134 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

adopted by the PERC. We agree with the 

PERC and have made adjustments to the 

PE database. 

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. 

In addition to the above, the PERC 

also addressed the following issues: 

Nuclear Medicine Services 

The specialty society representing 

nuclear medicine recommended that the 

direct PE inputs for 2 CPT codes 

contained CPEP inputs and needed to be 

updated to agree with 2004 PEACapproved inputs. The PERC 

recommended that the PE database 

reflect these changes and we agreed. 

However, we discovered that there were 

4 other related codes which also had 

CPEP inputs. 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 7 CPT codes required the revision 

of x-ray related supplies, including the 

number of x-ray films, developer 

solution, and film jackets. The PERC 

forwarded these recommendations and 

we have made the appropriate changes 

to the PE database for the following CPT 

codes: 78600, 78601, 78605, 78606, 

78607, 78610 and 78615. 

Transcatheter Placement of Stent(s) 

At the request of the specialty 

societies representing radiology and 

interventional radiology, the PERC 

agreed to consider the direct PE inputs 

for the nonfacility setting for 3 CPT 

codes, 37205, 37206, and 75960, for 

transcatheter placement of stent(s). 

These PE inputs to value these 

procedures in the nonfacility setting 

were approved by the PERC. 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 which was forwarded by the 

specialty society that indicated that 1 

stent was typical for the procedure of 

CPT code 37205. Absent any further 

verification from the specialty, we have, 

therefore, included only 1 stent in this 

code. 

The complete PERC recommendations 

and the revised PE database can be 

found on the CMS Web site at http:// 

cms.hhs.gov/PhysicianFeeSched/ 

PFSFRN/ (under CMS–1385–P). 

(ii) Remote Cardiac Event Monitoring 

As discussed 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 which represents 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 are asking for 

comments on the appropriateness of the 

above mentioned direct PE inputs. In 

addition, we invite 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. 

(iii) Prothrombin Time, International 

Normalized Ratio (PT/INR) 

In the CEM discussion in the CY 2007 

PFS final rule with comment period, we 

included some minor PE revisions on an 

interim basis for PT/INR services 

represented by Healthcare Common 

Procedure Coding System (HCPCS) 

codes, G0248, Demonstration, at initial 

use, of home INR monitoring for patient 

with mechanical heart valve(s) who 

meets Medicare coverage criteria, under 

the direction of a physician; includes: 

Demonstrating use and care of the INR 

monitor, obtaining at least one blood 

sample, provision of instructions for 

reporting home INR test results, and 

documentation of patient ability to 

perform testing and 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. Based on comments 

received and subsequent discussions 

with entities that furnish these PT/INR 

services, we have adjusted the time in 

use for the home monitor equipment for 

G0249 to 1440 minutes to reflect that 

the monitor is dedicated for use 24 

hours a day and unavailable for others 

receiving this service. We invite 

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. 

(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 agree with the specialty 

society that the PE database labor inputs 

for these 3 PET codes are incorrect and 

have made the appropriate adjustments 

to the PE database. 

(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 propose to accept these 

direct PE input corrections and have 

revised our PE database accordingly. 

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(vi) Arthroscopic Procedure Nonfacility 

Inputs 

During the CY 2007 PFS rulemaking, 

we noted that at the October 2006 RUC 

meeting a proposal was discussed for 

the establishment of nonfacility direct 

PE inputs for the arthroscopic 

procedures represented by CPT codes 

29805, 29830, 29840, 29870, and 29900. 

At this October 2006 RUC meeting, the 

orthopedic specialty society declined to 

consider the valuation of these 

procedures for the nonfacility setting, 

based on the belief that these 

procedures are not safely performed in 

the physician office. The RUC agreed at 

that time and no recommendations were 

issued. Subsequent to the publication of 

the CY 2007 PFS final rule with 

comment period in which we supported 

the RUC recommendation, we again 

discussed this valuation with 

physicians who are currently 

performing these procedures in the 

office. Because we believe that the RUC 

process is the most appropriate to 

provide these nonfacility inputs, we 

again referred the physicians providing 

these services to work with the RUCrepresented orthopedic specialty 

society; however, they informed us that 

the orthopedic specialty society had 

recently again declined to support them 

in bringing the direct PE inputs to the 

April 2007 RUC/PERC meeting for 

consideration in valuing these services 

in the nonfacility setting. 

Absent specific recommendations 

from the RUC and because some 

physicians are already performing these 

procedures in the office setting, we are 

seeking comments regarding the 

appropriateness of establishing 

nonfacility PE inputs for these 

arthroscopic procedures when they are 

provided in the office setting. We also 

invite 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 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. 

(vii) Nonfacility Inputs for CPT Code 

52327 

We received comments from the 

society representing urologists 

requesting 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; 

it is specific to the pediatric population; 

and, as such, is always performed with 

general anesthesia. We agree with the 

specialty society that this procedure is 

incorrectly valued for the nonfacility 

setting and propose to accept their 

recommendation to remove the 

nonfacility direct PE inputs and have 

revised the PE database accordingly. 

(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. We have asked the 

specialty society to provide the supply 

pricing information with appropriate 

documentation and also to provide 

accurate time-in-use data for each 

equipment item for each procedure. 

However, 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. For each equipment 

item, we propose to cap each time-inuse to 25 minutes until specific 

information is received regarding the 

actual time-in-use. See Table 3 for the 

outstanding supply prices and Table 4 

for the equipment time-in-use 

information that is needed. 

TABLE 3.—MAXILLOFACIAL PROSTHESIS SUPPLIES NEEDING PRICING AND SUPPORTING DOCUMENTATION

Supply item CPT codes associated with supply item 

paper, articulating ............................................... 21076, 21079, 21081, 21082, 21083, 21084, and 21085. 

paste, registration ............................................... 21076, 21079, 21080, 21081, 21082, 21083, 21084, and 21085. 

alloy framework, laboratory processing .............. 21076, 21079, 21080, 21081, 21082, 21083, 21084, and 21085. 

paste, pressure indicator .................................... 21076, 21079, 21080, 21081, 21082, 21083, 21084, and 21085. 

wax, boxing ......................................................... 21076, 21077, 21079, 21081, 21082, 21083, 21084, 21085, 21086 and 21087. 

triad tray material ................................................ 21076, 21082, 21083 and 21084. 

wire, orthodontic ................................................. 21076, 21079, 21080 and 21085. 

reline material, Trusoft ........................................ 21076, 21079, 21081, 21082, 21083 and 21084. 

silicone ................................................................ 21077, 21086 and 21087. 

adhesive, facial ................................................... 21077, 21080, 21086 and 21087. 

wax, baseplate .................................................... 21077, 21079, 21080, 21081, 21082, 21083, 21084, 21085, 21086 and 21087. 

impression material, final .................................... 21077, 21080, 21081, 21082, 21083, 21084, 21085, 21086 and 21087.

monoplex eye ..................................................... 21077, 21080, 21086 and 21087. 

syringe, impression ............................................. 21077, 21079, 21080, 21081, 21082, 21083, 21084, 21085, 21086 and 21087. 

acrylic, dental ...................................................... 21077, 21079, 21080, 21081, 21082, 21082, 21083, 21084, 21085, 21086 and 21087. 

polyurethane sheets (quantity as rolls) .............. 21077, 21080, 21086, and 21087. 

burs, dental ......................................................... 21079, 21080, 21081, 21082, 21083, 21084 and 21085. 

teeth set .............................................................. 21079, 21080 and 21081. 

Greenstick compound ......................................... 21080, 21081, 21082, 21083, 21084 and 21085. 

* CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 

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TABLE 4.—EQUIPMENT TIME-IN-USE INFORMATION NEEDED FOR MAXILLOFACIAL PROSTHESIS CODES PROCEDURES

NOTED BELOW WITH AN X 

Equipment Item 

CPT 

code 

21076 

CPT 

code 

21077 

CPT 

code 

21079 

CPT 

code 

21080 

CPT 

code 

21081 

CPT 

code 

21082 

CPT 

code 

21083 

CPT 

code 

21084 

CPT 

code 

21085 

CPT 

code 

21086 

CPT 

code 

21087 

Articulator ......................................... X X X X X X X X X X X 

Chair, dental w-upholstery ............... X X X X X X X X X X X 

Compressor air ................................. X X X X X X X X X X X 

Convection oven .............................. ............ X ............ ............ ............ ............ ............ ............ ............ X X 

Delivery unit ..................................... X X X X X X X X X X X 

Dust collecting unit ........................... X X X X X X X X X X X 

Grinding and polishing unit .............. X X X X X X X X X X X 

Handpiece, highspeed ..................... X ............ X X X X X X X ............ ............

Handpiece, laboratory ...................... X X X X X X X X X X X 

Handpiece, slow speed .................... X ............ X X X X X X X ............ ............

Light curing unit ................................ X X X X X X X X X X X 

Light, dental, ceiling mount .............. X X X X X X X X X X X 

Steamer, portable ............................. X X X X X X X X X X X 

Triad unit .......................................... X X X X X X X X X X X 

Trimmer, dental model ..................... X X X X X X X X X X X 

Ultrasonic cleaning unit .................... X ............ X X X X X X X ............ ............

Washout and curing unit .................. X ............ X X X X X X X ............ ............

Whip mix combo unit ....................... X X X X X X X X X X X 

Whip mixer ....................................... X X X X X X X X X X X 

* CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 

(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 are 

proposing to accept the new price of 

$1,245 for the hysteroscopic implant kit 

due to the changes made in the 

modified model and have made this 

change in the PE database. 

(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 5: Supply Items Needing 

Specialty Input for Pricing and Table 6: 

Equipment Items Needing Specialty 

Input for Pricing). During the CY 2007 

PFS rulemaking, 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 proposed rule. The items listed 

in Tables 6 and 7 represent the 

outstanding items from CY 2007 and 

new items added from the current RUC 

recommendations. 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. We are 

also requesting that specialty societies 

review the direct inputs in PE database 

for the procedures performed by the 

specialty to verify that all supplies and 

equipment contain prices. For supplies 

or equipment that have previously 

appeared on this list, and for which we 

received no or inadequate 

documentation, we are proposing to 

delete these items unless we receive 

adequate information to support current 

pricing by the conclusion of the 

comment period for this proposed rule. 

TABLE 5.—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 set, dialysis, 

17g.

item .... ................ Dermatology .............. 36522 ............ Yes .......... Specialty to submit 

asap.

B 

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

93510, 

93526.

Yes .......... Specialty to submit 

asap.

B, C 

SL119 .. Sealant spray ............ oz ....... ................ Radiation Oncology ... 77333 ............ Yes .......... Specialty to submit

price per ounce, 

asap.

B 

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TABLE 5.—SUPPLY ITEMS NEEDING SPECIALTY INPUT FOR PRICING—Continued 

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) 

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

93510, 

93526.

Yes .......... Specialty to submit 

asap.

B, C 

Stent, vascular, deployment system.Kit ...... $1,645 Radiology, Interventional Radiology.37205, 37206 No ............ Specialty to submit 

price, kit contents 

and typical quantity 

needed.

A 

* CPT codes and descriptions only are copyright 2007 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, website 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 6.—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 ...... Interim price of $1920 

basis maintained, pending receipt of documentation.

A, E 

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 ...... Specialty to submit, asap A, E 

Dermoscopy attachments 650 Dermatology ..................... 96904 ... Yes ...... Specialty to submit, asap A, E 

EQ008 .. ECG signal averaging 

system.

8,250 Cardiology, IM .................. 93278 ... Yes ...... Interim price of $17,900 

basis maintained, pending receipt of documentation.

A, E 

Lens, macro, 35–70mm ... .................. Dermatology ..................... 96904 ... Yes ...... Specialty to submit, asap A, E 

plasma pheresis machine 

w/UV light source.

37,900 Radiology, Dermatology .. 36481, 

G0341.

Yes ...... Specialty to submit, asap A, E 

ED039 ... Psychology Testing 

Equipment.

.................. Psychology ....................... 96101, 

96102.

No ........ Specialty to submit, asap A, E 

ER070 ... Portal imaging system (w/ 

PC work station and 

software).

377,319 Radiation oncology .......... 77421 ... Yes ...... Specialty to submit, asap A, E 

Strobe, 400watts (Studio)(2).1500 Dermatology ..................... 96904 ... Yes ...... Specialty to submit, asap A, E 

* CPT codes and descriptions only are copyright 2007 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, website 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. 

B. Geographic Practice Cost Indices 

(GPCIs) 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘GEOGRAPHIC PRACTICE 

COST INDICES (GPCIs)’’ at the 

beginning of your comments.] 

We are required by section 

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

develop separate Geographic Practice 

Cost Indices (GPCIs) to measure 

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resource cost differences among 

localities; and, to review and, if 

necessary, adjust the GPCIs at least 

every 3 years. We have completed the 

review of GPCIs for CY 2008 and are 

proposing new GPCIs. These proposed 

GPCIs are published in Addendum E. 

We note that the physician work GPCIs 

listed in Addendum E do not reflect the 

1.000 floor that was in place during 

2006 and 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. 

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 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, 2006. The 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. In 2008, we have 

calculated the GPCI using rents in the 

50th percentile for the physician office 

rent proxy. We are proposing 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 are therefore more volatile than the 

wage (Census) data. While commenters 

have 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 

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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 2008 MP update 

reflects the most recent premium data 

available. The physician work and PE 

GPCIs are being updated at the same 

time. 

The periodic review and adjustment 

of GPCIs is mandated by section 

1848(e)(1)(C) of the Act. At each update, 

the proposed GPCIs are published in our 

PFS proposed rule the year before they 

would take effect in order to provide an 

opportunity for public comment and 

further revisions in response to 

comments prior to implementation. As 

mentioned above, these proposed GPCIs 

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 MP 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 onequarter 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 marker 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 county 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). Before adoption of 

the current structure, there were 210 

separate payment localities under the 

PFS. The 1997 payment locality revision 

was based and built upon the prior 

locality structure. The 22 then-existing 

statewide localities remained statewide 

localities. Localities were established in 

the remaining 28 States by comparing 

the area cost differences of the localities 

within these States. We ranked the 

existing localities within these 

remaining 28 States by costs in 

descending order. The GAF of the 

highest cost locality within a State was 

compared to the weighted average GAF 

of lower price localities. If the difference 

between these GAFs exceeded 5 

percent, the highest locality remained a 

distinct locality. If the GAFs associated 

with all the localities in a State did not 

vary by at least 5 percent, the State 

became a statewide locality. If the 

highest-priced locality remained a 

distinct locality, the process was 

repeated for the second highest price 

locality and so on until the variation 

among remaining localities fell below 

the 5 percent threshold. This ensured 

that the statewide or residual State 

locality has relatively homogenous 

resource costs. Subsequent to this 

process, 3 additional States with 

multiple localities were converted to 

statewide localities. Currently, there are 

89 separate payment localities of which 

34 are statewide. Recognizing that the 

GPCIs are necessarily proxies, this 

revision to the locality structure 

accomplished our major goals of 

appropriately paying for services 

furnished to Medicare beneficiaries, and 

simplifying payment areas. 

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 

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, BN 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 

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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. But, we are 

also concerned about the redistributive 

effects of locality changes since changes 

must be applied in a budget neutral 

manner (and under the current locality 

system, BN results in aggregate 

payments within each State remaining 

the same). 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. Therefore, we 

have identified and are soliciting 

comments on three possible locality 

reconfigurations, each of which strikes a 

different balance between intralocality 

variations and redistributive impacts. 

We are considering adopting one of 

these approaches for California in the 

final rule. Because of the importance of 

striking an appropriate balance with any 

such locality revisions, we want to 

proceed cautiously and evaluate the 

impacts in California before considering 

applying the policy more broadly in the 

future. We also seek comments about 

other potential approaches to locality 

revisions and about using a transition to 

phase-in changes in a new locality 

structure blending new and revised 

payments. We note that a transition 

could be complicated to administer, 

particularly with a concurrent 2-year 

phase in of the new GPCI data. The 

three options 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 that 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 counties. 

This approach focuses on counties for 

which there is the biggest difference 

between the county GAF and the 

locality GAF. Since we are considering 

applying this approach initially in 

California, Table 7 shows the impact for 

each of the counties and the Rest of 

California payment and Marin/Napa/ 

Solano payment localities. 

TABLE 7.—OPTION 1—APPLY 5 PERCENT THRESHOLD TO REMOVE COUNTIES FROM THEIR CURRENT PAYMENT

LOCALITIES, CALIFORNIA IMPACT

Locality name County name 

New CY 

2009 GAF, 

no locality 

change 

New CY 

2009 GAF, 

with locality 

change 

Percent 

change, due 

to locality 

change 

Santa Cruz ................................................................................ Santa Cruz ....................................... 1.017 1.100 7.59% 

Monterey ................................................................................... Monterey ........................................... 1.017 1.080 5.83% 

Sonoma ..................................................................................... Sonoma ............................................ 1.017 1.076 5.51% 

Marin ......................................................................................... Marin ................................................. 1.112 1.173 5.19% 

Napa/Solano ............................................................................. Solano .............................................. 1.112 1.066 ¥4.33% 

Napa/Solano ............................................................................. Napa ................................................. 1.112 1.066 ¥4.33% 

Rest of California ...................................................................... ........................................................... 1.017 1.012 ¥0.49% 

This proposal is similar to the policy 

we previously proposed in the CY 2006 

PFS proposed rule (70 FR 45784) (but, 

as discussed above in this section, we 

did not adopt in the final rule) to 

address the counties with GAFs that are 

most different from their current locality 

designation. At that time, we only 

considered the two counties with the 

greatest difference between the county 

and locality GAF—Santa Cruz and 

Sonoma. Given the new GAF data, we 

are again considering this approach to 

address locality issues, but we would 

make adjustments to any county in 

California in which the county GAF 

exceeds the locality GAF by more than 

5 percent. Table 7 shows the impacts 

using fully phased-in CY 2009 GPCIs 

that would apply using the new GPCI 

data discussed in this proposed rule. 

The table compares the changes that 

would occur in CY 2009 under the 

current locality structure with those that 

would occur under option 1. The table 

shows that compared to the fully 

phased-in CY 2009 GAFs that would 

occur under the current locality 

structure, under this option, the GAFs 

for Santa Cruz, Monterey and Sonoma 

would increase by 7.59 percent, 5.83 

percent, and 5.51 percent respectively, 

and the GAF for the Rest of California 

locality would decrease by 0.49 percent. 

The GAF for Marin would increase by 

5.19 percent while the GAF for Napa/ 

Solano would decrease by 4.33 percent. 

The GAFs for all other California 

localities would not change. 

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. These three 

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. In addition, it creates fewer 

localities which is administratively 

simpler for both the Medicare program 

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and for physicians who might practice 

in multiple localities. 

Again, since we are considering 

applying this approach initially in 

California, Table 8 shows the impact, 

using fully phased-in CY 2009 GPCIs, 

for each of the new localities and for the 

localities that would remain. The table 

shows that compared to the fully 

phased-in CY 2009 GAFs that would 

occur under the current locality 

structure, under this option, the GAFs 

for the new Santa Cruz/Sonoma/ 

Monterey locality would increase by 6.3 

percent, and the GAF for the Marin 

County locality would increase by 5.19 

percent. The GAFs would decrease by 

0.49 percent for the Rest of California 

locality and by 4.33 percent for the 

Napa/Solano locality. 

TABLE 8.—OPTION 2—APPLY FIVE PERCENT THRESHOLD TO REMOVE COUNTIES FROM THEIR CURRENT PAYMENT

LOCALITIES, CALIFORNIA IMPACT, CREATE TWO NEW LOCALITIES

Locality name County name CY 2009 

county GAF 

CY 2009 

GAF, no 

locality 

change 

CY 2009 

GAF, with 

locality 

change 

Percent 

change, CY 

2009 GAF, 

with locality 

change 

Marin ............................................................. Marin ..................................................... 1.173 1.112 1.173 5.19 

Napa/Solano ................................................. Napa ..................................................... 1.080 1.112 1.066 ¥4.33 

Napa/Solano ................................................. Solano ................................................... 1.053 1.112 1.066 ¥4.33 

Santa Cruz/Monterey/Sonoma ..................... Santa Cruz ............................................ 1.100 1.017 1.082 6.03 

Santa Cruz/Monterey/Sonoma ..................... Sonoma ................................................. 1.076 1.017 1.082 6.03 

Santa Cruz/Monterey/Sonoma ..................... Monterey ............................................... 1.080 1.017 1.082 6.03 

Rest of California .......................................... ............................................................... 1.017 1.017 1.012 ¥0.049 

Option 3: Apply a methodology 

similar to that used in the 1997 locality 

revisions, 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 iterative 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 methodology is also 

described in the CY 2006 PFS final rule 

with comment period (70 FR 70151). 

This approach would group counties 

within a State into localities based on 

similarity of GAFs even if the counties 

were not geographically contiguous. 

This is a numerical organization of 

payment localities based on costs which 

will reduce the number of payment 

localities in California from 9 to 6 

localities and will create a structure 

where areas with similar costs will be 

grouped together. 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. 

However, Table 9 shows that for most of 

the counties in California, geographic 

relationships are maintained within 

payment groups. 

While this option groups counties 

with similar costs together, it does not 

address the issue of a county or locality 

that has costs very different from those 

of an adjoining county or locality. 

Under this option, it will still be 

possible for neighboring counties or 

localities to have significantly different 

cost structures and the associated 

problems such as incentives to relocate 

across county lines would still exist. 

This option is the most 

administratively burdensome option for 

CMS to implement because of the 

significant systems changes and 

provider education that would be 

required to reconfigure the California 

localities in this manner. It will also 

place a greater burden on practicing 

physicians who are more likely to 

experience a change in his or her 

practice’s locality. We are seeking 

comments on the extent of the 

administrative burden. 

Since we are considering applying 

this approach initially in California, 

Table 9 shows the impact, using fully 

phased-in CY 2009 GPCIs, for each of 

the California counties. Table 9 shows 

that this approach would result in 6 

total California payment localities. The 

changes would have a variety of impacts 

depending upon the counties involved. 

The changes are illustrated in Table 9. 

TABLE 9.—OPTION 3—REVISION OF PAYMENT LOCALITIES

County Current Medicare locality Current 

county GAF 

Proposed 

Medicare 

locality 

Proposed 

locality GAF 

Current 

locality GAF 

Percent 

difference 

San Mateo ........................... San Mateo, CA .................................. 1.204 1 1.197 1.204 ¥0.6 

San Francisco ...................... San Francisco, CA ............................ 1.201 1 1.197 1.201 ¥0.3 

Marin .................................... Marin/Napa/Solano, CA ..................... 1.170 1 1.197 1.112 7.6 

Santa Clara .......................... Santa Clara, CA ................................ 1.148 2 1.119 1.148 ¥2.5 

Contra Costa ....................... Oakland/Berkeley, CA ....................... 1.134 2 1.119 1.131 ¥1.0 

Alameda ............................... Oakland/Berkeley, CA ....................... 1.129 2 1.119 1.131 ¥1.0 

Orange ................................. Anaheim/Santa Ana, CA ................... 1.128 2 1.119 1.128 ¥0.8 

Ventura ................................ Ventura, CA ....................................... 1.121 2 1.119 1.121 ¥0.2 

Los Angeles ......................... Los Angeles, CA ................................ 1.112 2 1.119 1.112 0.6 

Santa Cruz ........................... Rest of California ............................... 1.098 3 1.061 1.012 4.9 

Napa .................................... Marin/Napa/Solano, CA ..................... 1.077 3 1.061 1.112 ¥4.6 

Monterey .............................. Rest of California ............................... 1.077 3 1.061 1.012 4.9 

Sonoma ............................... Rest of California ............................... 1.074 3 1.061 1.012 4.9 

San Diego ............................ Rest of California ............................... 1.053 3 1.061 1.012 4.9 

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TABLE 9.—OPTION 3—REVISION OF PAYMENT LOCALITIES—Continued 

County Current Medicare locality Current 

county GAF 

Proposed 

Medicare 

locality 

Proposed 

locality GAF 

Current 

locality GAF 

Percent 

difference 

Santa Barbara ..................... Rest of California ............................... 1.053 3 1.061 1.012 4.9 

Solano .................................. Marin/Napa/Solano, CA ..................... 1.051 3 1.061 1.112 ¥4.6 

Sacramento ......................... Rest of California ............................... 1.047 4 1.023 1.012 1.2 

El Dorado ............................. Rest of California ............................... 1.033 4 1.023 1.012 1.2 

San Bernardino .................... Rest of California ............................... 1.023 4 1.023 1.012 1.2 

Placer ................................... Rest of California ............................... 1.021 4 1.023 1.012 1.2 

Riverside .............................. Rest of California ............................... 1.017 4 1.023 1.012 1.2 

San Luis Obispo .................. Rest of California ............................... 1.015 4 1.023 1.012 1.2 

San Joaquin ......................... Rest of California ............................... 1.006 4 1.023 1.012 1.2 

Yolo ...................................... Rest of California ............................... 0.995 5 0.962 1.012 ¥4.9 

Stanislaus ............................ Rest of California ............................... 0.979 5 0.962 1.012 ¥4.9 

Mono .................................... Rest of California ............................... 0.977 5 0.962 1.012 ¥4.9 

Nevada ................................ Rest of California ............................... 0.975 5 0.962 1.012 ¥4.9 

Kern ..................................... Rest of California ............................... 0.973 5 0.962 1.012 ¥4.9 

San Benito ........................... Rest of California ............................... 0.971 5 0.962 1.012 ¥4.9 

Sierra ................................... Rest of California ............................... 0.967 5 0.962 1.012 ¥4.9 

Amador ................................ Rest of California ............................... 0.967 5 0.962 1.012 ¥4.9 

Fresno .................................. Rest of California ............................... 0.963 5 0.962 1.012 ¥4.9 

Mendocino ........................... Rest of California ............................... 0.960 5 0.962 1.012 ¥4.9 

Madera ................................. Rest of California ............................... 0.960 5 0.962 1.012 ¥4.9 

Tuolumne ............................. Rest of California ............................... 0.959 5 0.962 1.012 ¥4.9 

Alpine ................................... Rest of California ............................... 0.957 5 0.962 1.012 ¥4.9 

Mariposa .............................. Rest of California ............................... 0.956 5 0.962 1.012 ¥4.9 

Tulare ................................... Rest of California ............................... 0.950 5 0.962 1.012 ¥4.9 

Butte .................................... Rest of California ............................... 0.950 5 0.962 1.012 ¥4.9 

Merced ................................. Rest of California ............................... 0.949 5 0.962 1.012 ¥4.9 

Calaveras ............................. Rest of California ............................... 0.949 5 0.962 1.012 ¥4.9 

Humboldt ............................. Rest of California ............................... 0.947 5 0.962 1.012 ¥4.9 

Lake ..................................... Rest of California ............................... 0.947 5 0.962 1.012 ¥4.9 

Imperial ................................ Rest of California ............................... 0.945 5 0.962 1.012 ¥4.9 

Plumas ................................. Rest of California ............................... 0.945 6 0.938 1.012 ¥7.3 

Lassen ................................. Rest of California ............................... 0.944 6 0.938 1.012 ¥7.3 

Sutter ................................... Rest of California ............................... 0.942 6 0.938 1.012 ¥7.3 

Yuba .................................... Rest of California ............................... 0.942 6 0.938 1.012 ¥7.3 

Colusa .................................. Rest of California ............................... 0.940 6 0.938 1.012 ¥7.3 

Del Norte ............................. Rest of California ............................... 0.940 6 0.938 1.012 ¥7.3 

Modoc .................................. Rest of California ............................... 0.938 6 0.938 1.012 ¥7.3 

Shasta .................................. Rest of California ............................... 0.937 6 0.938 1.012 ¥7.3 

Kings .................................... Rest of California ............................... 0.935 6 0.938 1.012 ¥7.3 

Inyo ...................................... Rest of California ............................... 0.935 6 0.938 1.012 ¥7.3 

Siskiyou ............................... Rest of California ............................... 0.934 6 0.938 1.012 ¥7.3 

Trinity ................................... Rest of California ............................... 0.933 6 0.938 1.012 ¥7.3 

Tehama ................................ Rest of California ............................... 0.932 6 0.938 1.012 ¥7.3 

Glenn ................................... Rest of California ............................... 0.930 6 0.938 1.012 ¥7.3 

We are soliciting comments on these 

options, as well as other approaches to 

refining localities both from the 

perspective of implementing one of 

these approaches in California in CY 

2008, and also from the perspective of 

their applicability more broadly. 

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

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘MALPRACTICE’’ at the 

beginning of your comments.] 

In the CY 1992 PFS final rule (56 FR 

59527), we described in detail how 

malpractice (MP) RVUs are calculated 

for CPT codes and, when professional 

liability insurance (PLI) is not available, 

how we crosswalk or assign RVU values 

to codes. Following the initial 

calculation of resource-based MP RVUs, 

the MP RVU are then subject to review 

by CMS at 5-year intervals. Reviewing 

the MP RVUs every 5 years ensures that 

MP RVU values reflect any marketplace 

changes in the physician community’s 

ability to acquire PLI. Alternatively, 

there are some technical services which 

have assigned MP RVU values that have 

never been part of the review process. 

Consequently, the MP RVU values 

assigned to these technical services have 

not been revised since their initial 

assignment. The reason these services 

have never been reviewed is directly 

related to a lack of suitable data on the 

cost of PLI for technical staff or imaging 

centers. 

In response to our review of the MP 

RVUs of services, the RUC’s PLI 

Workgroup brought to our attention the 

fact that there are approximately 600 

services that have a technical 

component MP RVU that is greater than 

the professional component MP RVU. 

The RUC has asked CMS to change the 

technical component MP RVU values, 

stating that, as physicians have to pay 

the larger PLI premiums, there should 

be higher RVUs associated with the 

professional portions of these services. 

In the RUC’s comments to CMS, the 

RUC made two alternative suggestions: 

1. CMS should ‘‘flip’’ the MP RVUs 

associated with each of the component 

parts, so the technical component MP 

RVUs are assigned the value of the 

professional component RVUs, and the 

professional component are assigned the 

MP RVUs of the technical component 

MP RVUs; or 

2. CMS should make the RVUs of the 

technical component MP RVUs equal to 

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the MP RVUs of the professional 

component. 

We are not accepting the first 

suggestion. The professional portion of 

the MP RVUs have undergone review 

and are derived from actual data, and 

are an integral part of our resourcebased methodology. We do not believe, 

in the absence of evidence, that our data 

or conclusions for the professional MP 

RVUs are inaccurate. It would not be 

consistent with our resource-based fee 

schedule methodology to make changes 

in the professional RVUs that are not 

supported by actual data. 

Because no data have been offered to 

demonstrate that the malpractice costs 

for the technical portion of these 

services are the same as for the 

professional portion of these services, 

we also do not believe it would be 

appropriate to accept the second 

suggestion at this time. To ensure that 

any changes we make to any MP RVUs 

are resource-based, we need more 

information from the affected 

community. Specifically, we would like 

to better understand how, and if, 

technicians employed by facilities 

purchase PLI or how their professional 

liability is insured. In addition, we are 

soliciting comments on what types of 

PLI are carried by facilities that perform 

technical services. 

We appreciate the RUC’s 

recommendation and are interested in 

addressing their concerns. Ideally, we 

would like to develop a resource-based 

methodology for the technical portion of 

the MP RVUs. However, at this time we 

do not have data that would support 

such a change. Therefore, we are 

soliciting comments on how we could 

obtain the necessary data to create 

resource-based RVUs for these services. 

D. Medicare Telehealth Services 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘MEDICARE TELEHEALTH 

SERVICES’’ at the beginning of your 

comments.] 

1. Requests for Adding Services to the 

List of Medicare Telehealth Services 

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. 

In the December 31, 2002 Federal 

Register (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 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, CNS, 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/. 

2. Submitted Requests for Addition to 

the List of Telehealth Services 

We received the following requests for 

additional approved services in CY 

2006: (1) Subsequent hospital care; (2) 

neurobehavioral status exam; and (3) 

neuropsychological testing. The 

following is a discussion of the requests 

submitted in CY 2006. 

a. Subsequent Hospital Care 

The American Telemedicine 

Association (ATA) submitted a request 

to add subsequent hospital care (as 

represented by HCPCS codes 99231 

through 99233). The ATA mentioned 

that the AMA CPT panel deleted the 

codes for follow-up inpatient 

consultation (as described by HCPCS 

codes 99261 through 99263) and that 

the codes for subsequent hospital care 

are used instead of the deleted codes. 

The requestor described two scenarios 

in which subsequent hospital care 

services could be furnished as a 

telehealth service. The first scenario 

would involve a specialty physician 

who furnishes an inpatient consultation 

as a telehealth service and follows the 

specific problem (for which the 

consultation was requested) with 

subsequent hospital care (inpatient 

visits). 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 requester explained that the 

ability to provide health care services 

when the practitioner is not onsite is 

critical to the survival of many rural and 

critical access hospitals (CAHs). The 

requestor believes that subsequent 

hospital care should be considered a 

category 1 service because it is similar 

to an inpatient consultation (which is 

currently on the list of telehealth 

services) and that an inpatient 

consultation is a more complex service 

than subsequent hospital care. 

Additionally, an individual 

practitioner explained that the complete 

diagnostic and therapeutic plan cannot 

be established for an infectious disease 

patient in a single consultation and 

noted that follow-up inpatient 

consultations were previously allowed 

as telehealth services. The practitioner 

believes that telehealth is appropriate 

for allowing the physician or 

practitioner at the distant site to be a 

‘‘primary care giver’’ (in the inpatient 

hospital setting); however, stated that 

supporting data is needed. 

CMS Review 

As mentioned by the requestors, the 

AMA deleted 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. As 

such, a conforming change was made to 

remove these codes from the list of 

Medicare telehealth services. CPT 

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instructs physicians and practitioners to 

use subsequent hospital care instead of 

the deleted codes. However, subsequent 

hospital care describes a broader set of 

services than the deleted codes (followup inpatient consultation). 

In the CY 2005 PFS proposed rule (69 

FR 47511), we discussed a previous 

request to add subsequent hospital care 

to the list of Medicare telehealth 

services. Given the potential acuity of 

the patient (patients tend to be more 

acutely ill in the hospital setting), we 

concluded that subsequent hospital care 

was not similar to existing telehealth 

services (for example, an office visit, 

office psychology, or consultation). 

Therefore, we indicated that we 

considered subsequent hospital care as 

a category 2 service. We were not able 

to approve subsequent hospital care for 

telehealth because no comparative 

analyses were submitted indicating that 

the use of a telecommunications system 

is an adequate substitute for subsequent 

hospital care furnished in-person 

(which is a requirement for category 2 

services). 

Given the potential acuity level of the 

patient in the hospital setting, we 

continue to believe that many services 

furnished within the scope of the 

subsequent hospital service codes are 

not similar to current telehealth 

services. We continue to have concerns 

about using a telecommunications 

system as a substitute for the on-going 

(in person) evaluation and management 

(E/M) of a hospital inpatient. Therefore, 

we propose to not add subsequent 

hospital care as described by HCPCS 

codes 99231 through 99233 to the list of 

Medicare telehealth services. 

We recognize that in deleting the 

codes for follow-up inpatient 

consultation services, CPT instructs 

physicians to use the codes for 

subsequent hospital care instead of 

those for follow-up inpatient 

consultation. Therefore, we are 

considering the possibility of approving 

subsequent hospital care with specific 

limitations; for example, approving 

subsequent hospital care for telehealth 

only when the codes are used for 

follow-up inpatient consultation (and 

not for inpatient visits). As such, we are 

requesting specific comments as to what 

conditions (or requirements) we could 

apply to subsequent hospital care, so 

that subsequent hospital care reflects a 

follow-up inpatient consultation. 

b. Neurobehavioral Status Exam and 

Neuropsychological Testing 

The ATA also submitted a request to 

add neurobehavioral status exam (as 

described by HCPCS code 96116) and 

neuropsychological testing (HCPCS 

codes 96118 through 96120) to the list 

of Medicare telehealth services. The 

requestor explained that these services 

are provided during testing of the 

cognitive function of the central nervous 

system (CNS). The requestor believes 

that the HCPCS codes currently 

approved for telehealth are not 

appropriate for reporting 

neurobehavioral status exam and 

neuropsychological testing, and that 

these services are category 1 services. 

The requestor also explained that the 

neurobehavioral status exam and 

neuropsychological testing are provided 

to patients located in a physician’s or 

practitioner’s office, CAH, rural health 

clinic (RHC), or Federally qualified 

health center (FQHC), and that 

physicians and clinical psychologists 

are typically the practitioners who 

furnish these services. 

CMS Review 

Neurobehavioral Status Exam 

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). Therefore, we 

propose to add neurobehavioral status 

exam as represented by HCPCS code 

96116 to the list of Medicare telehealth 

services. 

We would revise § 410.78 and 

§ 414.65 to include neurobehavioral 

status exam as a Medicare telehealth 

service. 

Neuropsychological Testing 

We believe that neuropsychological 

testing services are category 2 services 

because, as explained further below in 

this section, the roles of and interaction 

among the physician or practitioner at 

the distant site and beneficiary at the 

originating site are not similar to 

existing telehealth services (for 

example, office visits, consultation, and 

office psychiatry). We currently do not 

include the administration of other CNS 

tests on the list of telehealth services. 

Neuropsychological testing is 

typically used to predict the presence 

and possible causes of brain damage 

using a complex battery of tests such as 

the Halstead-Reitan Neuropsychological 

Battery, Wechsler Memory Scales, and 

Wisconsin Card Sorting Test. These are 

a unique series of test instruments that 

are not similar to other services on the 

list of telehealth services. For example, 

neuropsychological testing evaluates a 

broad range of brain and nervous system 

functioning such as attention span and 

memory; visual, auditory, and tactual 

input; verbal communication; spatial 

perception; the ability to analyze 

information, form mental concepts, and 

make judgments. The comprehensive 

evaluation and assessment of brain and 

nervous system functioning is typically 

not a component of the services 

currently on the list of telehealth 

services. Moreover, neuropsychological 

testing requires administration by a 

trained professional and involves a 

unique interactive dynamic between the 

physician, practitioner (or technician) 

who administers the test and the 

patient. For example, to assess tactual 

performance the patient may be 

blindfolded for portions of the test; to 

assess sensory perception, the 

practitioner who administers the test 

touches the patient’s fingers, assigning a 

number to each finger. In some cases a 

significant amount of time is necessary 

to complete a neuropsychological test 

battery (for example, the HalsteadReitan Neuropsychological Battery 

could take up to 5 or 6 hours to 

complete). 

Because we consider 

neuropsychological testing to be a 

category 2 service, we need to evaluate 

whether this is a service for which 

telehealth can be an adequate substitute 

for a face-to-face encounter. The 

requestor did not provide any 

comparative analyses illustrating that 

the use of a telecommunications system 

is an adequate substitute for the inperson administration of 

neuropsychological testing. Instead, the 

requestor submitted various summaries 

of studies and case reports addressing 

clinical consultation, psychotherapy, 

enrollment and consent of psychiatric 

research participants, health promotion, 

and health education. One comparison 

study between psychiatric services 

furnished in person and via an 

interactive audio and video 

telecommunications system was 

submitted. However, the study focused 

on the use of telehealth to furnish 

consultation and short-term 

psychotherapy (which are currently 

approved as Medicare telehealth 

services). Therefore, the information 

submitted was not sufficient to enable 

us to determine whether the use of a 

telecommunications system would 

affect the diagnosis or treatment plan as 

compared to a face-to-face delivery of 

neuropsychological testing services. 

In furnishing neuropsychological 

testing as a telehealth service, it is our 

understanding that the physician, or 

practitioner (or technician) who actually 

administers the test would be located at 

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the distant site (rather than being 

present with the patient, in-person, and 

‘‘hands on’’ at the originating site). We 

are interested in receiving comments as 

to whether the administration of a 

neuropsychological test battery could be 

furnished adequately when the 

practitioner is not physically present 

with the patient. 

Moreover, we understand that in 

some cases neuropsychological testing 

is administered by a computer with a 

qualified health care professional 

present (for example, in administering 

the Wisconsin Card Sorting Test). 

However, we question whether a patient 

with suspected or confirmed brain 

damage or mental illness such as 

schizophrenia can be taught how to use 

a computer by a practitioner who is in 

a remote location. Therefore, we also 

request specific comments as to whether 

a neuropsychological patient could be 

instructed and supervised adequately to 

take the Wisconsin Card Sorting Test 

through an interactive audio and video 

telecommunications system. We are 

proposing not to add 

neuropsychological testing (as described 

by HCPCS codes 96118 through and 

99620) to the list of Medicare telehealth 

services. 

E. Specific Coding Issues related to PFS 

1. Reduction in the Technical 

Component (TC) for Imaging Services 

Under the PFS to the Outpatient 

Department (OPD) Payment Amount 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘CODING—REDUCTION IN TC 

FOR IMAGING SERVICES’’ at the 

beginning of your comments.] 

As we noted in the CY 2007 PFS final 

rule with comment period (71 FR 

69624), 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)(2) of the DRA 

exempts the estimated reduced 

expenditures from this provision from 

the PFS BN requirement. Section 

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

services as ‘‘imaging and computerassisted imaging services, including Xray, 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. As we 

indicated in the CY 2007 PFS final rule 

with comment period (71 FR 69659), in 

general, we believe that imaging 

services are those that provide visual 

information regarding areas of the body 

that are not normally visible, thereby 

assisting in the diagnosis or treatment of 

illness or injury. We began by 

considering the CPT 7XXXX series 

codes for radiology services, and then 

added other CPT codes and alphanumeric HCPCS codes that describe 

imaging services. We then excluded 

nuclear medicine services that were 

non-imaging diagnostic or treatment 

services. We also excluded all codes for 

unlisted procedures since we would not 

know in advance of any specific clinical 

scenario whether or not the unlisted 

procedure was an imaging service. 

We excluded all mammography 

services, consistent with the statute. We 

excluded radiation oncology services 

that were not imaging or computerassisted imaging services. We also 

excluded all HCPCS codes for imaging 

services that are not separately paid 

under the OPPS since there would be no 

corresponding OPPS payment to serve 

as a TC cap. We excluded any service 

where the CPT code describes a 

procedure for which fluoroscopy, 

ultrasound, or another imaging modality 

is included in the code whether or not 

it is used, or for which an imaging 

modality is employed peripherally in 

the performance of the main procedure, 

for example, CPT code 31622, 

bronchoscopy with or without 

fluoroscopic guidance and CPT code 

43242, upper gastrointestinal endoscopy 

with transendoscopic ultrasound-guided 

intramural or transmural fine needle 

aspiration/biopsy(s). In these cases, we 

are unable to clearly distinguish 

imaging from non-imaging services 

because, for example, a specific 

procedure may or may not utilize an 

imaging modality, or the use of an 

imaging technology cannot be 

segregated from the performance of the 

main procedure. Note that we included 

carrier-priced services since these 

services are within the statutory 

definition of imaging services and are 

also within the statutory definition of 

PFS services (that is, carrier-priced TCs 

of PET scans). 

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 propose 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 codes that identify 

imaging services defined by the DRA 

OPPS cap provision was published in 

Addendum F of the CY 2007 PFS 

proposed rule (71 FR 49249 through 

49252). We will update the list through 

program instructions to our contractors. 

To the extent that the same imaging 

service is coded differently under the 

PFS and the OPPS, we crosswalked the 

code under the PFS to the appropriate 

code under the OPPS that could be 

reported for the same service provided 

in the hospital outpatient setting. 

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38146 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

2. Application of Multiple Procedure 

Payment Reduction for Mohs 

Micrographic Surgery (CPT codes 17311 

through 17315) 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘CODING—MULTIPLE 

PROCEDURE PAYMENT REDUCTION 

FOR MOHS SURGERY’’ at the 

beginning of your comments.] 

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 -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, the 

CPT Editorial Panel removed the Mohs 

procedure from the -51 modifier list. 

The code descriptors for Mohs surgery 

codes were developed to take into 

account the different level of physician 

work intensity based on anatomic site. 

The RVUs associated with the codes for 

each anatomic location were assigned, 

as they are for other procedures, after a 

thorough discussion by the RUC of all 

aspects of the service. RVUs were 

developed for each Mohs surgery base 

code based on an assumption that each 

code is performed separately. Because 

the 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 are proposing to eliminate 

the modifier -51 exemption and apply 

the multiple procedure payment 

reduction rules to these codes. 

3. Payment for Intravenous Immune 

Globulin (IVIG) Add-On Code for 

Preadmission-Related Services 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘CODING—PAYMENT FOR 

IVIG ADD-ON CODE’’ at the beginning 

of your comments.] 

Intravenous immune globulin (IVIG) 

is a unique product derived from blood 

plasma. Since its production depends 

on plasma collection, there may be 

constraints on the amount produced. 

There have been reported fluctuations 

in supply of this product and, in recent 

years, the demand for this product has 

grown because of off-label uses. 

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 the concerns about the 

supply of IVIG. We have continued to 

improve the codes for reporting IVIG, 

including creating four new codes for 

liquid non-lyophilized IVIG for use 

effective July 1, 2007. In addition, as 

noted below in this section, we 

established a temporary additional 

payment for IVIG preadministration 

services to compensate physicians for 

the extra resources required to be 

expended due to market conditions in 

order to locate and obtain the 

appropriate IVIG products and to 

schedule patient infusions. 

In 2006, we created the HCPCS code 

G0332, Preadministration-related 

services for intravenous infusion of 

immunoglobulin, per infusion encounter 

and established RVUs for the code based 

on the nonfacility PE RVUs for code 

G0319 (1.90 PE RVUs). Code G0319 

describes ESRD-related services during 

the course of treatment, for patients 20 

years of age and over; with one face-toface physician visit per month. 

The rationale for the PE valuation was 

that we believed the additional 

physician practice resources expended 

for preadministration-related services, 

particularly clinical labor, are 

comparable to the PE for the ESRD 

management code. 

In 2007, we established RVUs for code 

G0332 based on a blend of the PE RVUs 

for ESRD codes G0319 and G0318. The 

RVUs were set at 1.97, a slight increase 

in the PE RVUs assigned to the code. 

For a discussion of the RVUs 

established for these services, see the 

CY 2007 PFS final rule with comment 

period (71 FR 69679). 

The OIG recently published a report 

in April 2007 titled, ‘‘Intravenous 

Immune Globulin: Medicare Payment 

and Availability’’ (OEI–03–05–00404). 

The CMS comments on this report were 

included in Appendix B. We believe 

this report provides information on the 

availability and pricing for this product 

and sets the stage for further review of 

key issues that can bring greater 

understanding of the marketplace for 

this product. 

We acknowledge the finding in the 

OIG report that increasing numbers of 

physicians are able to purchase IVIG 

below the Medicare ASP+6 percent 

payment rates. In the third quarter of 

2006, 59 percent of sales to physicians 

were at prices lower than the Medicare 

payment rate, a substantial increase over 

the prior 3 quarters. We consider this to 

be an important development, as it 

suggests that although the OIG could not 

determine the underlying reasons that 

physicians have had issues with IVIG 

product availability, Medicare payment 

rates under the ASP+6 percent payment 

system have, over time, adjusted to 

substantial increases in IVIG market 

prices. 

We have also requested that the OIG 

further study some of the issues we 

raised in our comments so that we can 

better understand the IVIG market. 

We are concerned that the existence 

of the preadministration fee could 

further distort the market and provide 

inappropriate incentives for IVIG 

utilization. Despite these concerns, we 

want to ensure that beneficiaries 

continue to have access to IVIG. 

Therefore, we are proposing to continue 

payment for G0332 only through CY 

2008 at the same level of PE RVUs as CY 

2007. We invite comments on this 

policy. 

4. Additional Codes from the 5-Year 

Review of Work RVUs 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘CODING—ADDITIONAL 

CODES FROM 5-YEAR REVIEW’’ at the 

beginning of your comments.] 

As discussed in the CY 2007 PFS final 

rule with comment period, we deferred 

the decisions on proposed changes to 

the work RVUs for a number of codes 

from the 5-Year Review for a year, either 

because we had not yet received the 

RUC recommendation or because we 

were suggesting that the RUC reevaluate 

the original recommendation. As we 

stated in that same rule, these additional 

codes are still considered part of the 5- 

Year Review. Table 10 shows the 

remaining codes, the requested and 

recommended RVUs, and CMS’s 

proposal on the codes. We are proposing 

to accept all of the RUC 

recommendations, with the exception of 

CPT code 93325 which we are 

proposing to bundle (that is, work RVUs 

would be increasing for 33 codes, 

decreasing for 10 codes, and maintained 

for 15 codes). 

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TABLE 10.—REMAINING CODES FROM FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS

CPT 1/ 

HCPCS code Mod Descriptor 

2007 

work 

RVU 

Requested 

work 

RVU 

RUC 

REC 

CMS 

proposal 

(agree/ 

disagree) 

2008 

Proposed 

work 

RVU 2

19301 ................ ............................ Partial mastectomy ............ 6.03 10.00 10.00 Agree ................ 10.00 

33207 ................ ............................ Insertion of heart pacemaker.9.05 8.00 8.00 Agree ................ 8.00 

45300 ................ ............................ Proctosigmoidoscopy dx .... 0.38 1.00 0.80 Agree ................ 0.80 

45303 ................ ............................ Proctosigmoidoscopy dilate 0.44 1.50 1.50 Agree ................ 1.50 

45305 ................ ............................ Proctosigmoidoscopy w/bx 1.01 1.25 1.25 Agree ................ 1.25 

45307 ................ ............................ Proctosigmoidoscopy fb ..... 0.94 1.70 1.70 Agree ................ 1.70 

45308 ................ ............................ Proctosigmoidoscopy removal.0.83 1.40 1.40 Agree ................ 1.40 

45309 ................ ............................ Proctosigmoidoscopy removal.2.01 1.50 1.50 Agree ................ 1.50 

45315 ................ ............................ Proctosigmoidoscopy removal.1.40 1.80 1.80 Agree ................ 1.80 

45317 ................ ............................ Proctosigmoidoscopy bleed 1.50 2.00 2.00 Agree ................ 2.00 

45320 ................ ............................ Proctosigmoidoscopy ablate.1.58 1.78 1.78 Agree ................ 1.78 

45321 ................ ............................ Proctosigmoidoscopy volvul 1.17 1.75 1.75 Agree ................ 1.75 

45327 ................ ............................ Proctosigmoidoscopy w/ 

stent.

1.65 2.00 2.00 Agree ................ 2.00 

46600 ................ ............................ Diagnostic anoscopy .......... 0.50 0.79 0.55 Agree ................ 0.55 

46604 ................ ............................ Anoscopy and dilation ....... 1.31 1.25 1.03 Agree ................ 1.03 

46606 ................ ............................ Anoscopy and biopsy ........ 0.81 1.20 1.20 Agree ................ 1.20 

46608 ................ ............................ Anoscopy, remove for body 1.51 1.30 1.30 Agree ................ 1.30 

46610 ................ ............................ Anoscopy, remove lesion .. 1.32 1.28 1.28 Agree ................ 1.28 

46611 ................ ............................ Anoscopy ........................... 1.81 1.30 1.30 Agree ................ 1.30 

46612 ................ ............................ Anoscopy, remove lesions 2.34 1.50 1.50 Agree ................ 1.50 

46614 ................ ............................ Anoscopy, control bleeding 2.01 1.50 1.00 Agree ................ 1.00 

46615 ................ ............................ Anoscopy ........................... 2.68 1.50 1.50 Agree ................ 1.50 

92002 ................ ............................ Eye exam, new patient ...... 0.88 0.88 0.88 Agree ................ 0.88 

92004 ................ ............................ Eye exam, new patient ...... 1.67 1.82 1.82 Agree ................ 1.82 

92012 ................ ............................ Eye exam established pat 0.67 0.92 0.92 Agree ................ 0.92 

92014 ................ ............................ Eye exam & treatment ....... 1.10 1.42 1.42 Agree ................ 1.42 

92557 ................ ............................ Comprehensive hearing 

test.

0.00 0.60 0.60 Agree ................ 0.60 

92567 ................ ............................ Tympanometry ................... 0.00 0.20 0.20 Agree ................ 0.20 

92568 ................ ............................ Acoustic refl threshold tst .. 0.00 0.29 0.29 Agree ................ 0.29 

92569 ................ ............................ Acoustic reflex decay test .. 0.00 0.20 0.20 Agree ................ 0.20 

92579 ................ ............................ Visual audiometry (vra) ...... 0.00 0.70 0.70 Agree ................ 0.70 

92601 ................ ............................ Cochlear implt f/up exam < 

7.

0.00 2.30 2.30 Agree ................ 2.30 

92602 ................ ............................ Reprogram cochlear implt 

< 7.

0.00 1.30 1.30 Agree ................ 1.30 

92603 ................ ............................ Cochlear implt f/up exam 7 

>.

0.00 2.25 2.25 Agree ................ 2.25 

92604 ................ ............................ Reprogram cochlear implt 

7 >.

0.00 1.25 1.25 Agree ................ 1.25 

93325 ................ ............................ Doppler color flow add-on 0.07 0.30 CPT Disagree ........... Bundled 

99304 ................ ............................ Nursing facility care, init .... 1.20 1.88 1.61 Agree ................ 1.61 

99305 ................ ............................ Nursing facility care, init .... 1.61 2.56 2.30 Agree ................ 2.30 

99306 ................ ............................ Nursing facility care, init .... 2.01 3.60 3.00 Agree ................ 3.00 

99307 ................ ............................ Nursing fac care, subseq ... 0.60 0.76 0.76 Agree ................ 0.76 

99308 ................ ............................ Nursing fac care, subseq ... 1.00 1.39 1.16 Agree ................ 1.16 

99309 ................ ............................ Nursing fac care, subseq ... 1.42 2.00 1.55 Agree ................ 1.55 

99310 ................ ............................ Nursing fac care, subseq ... 1.77 2.35 2.35 Agree ................ 2.35 

99318 ................ ............................ Annual nursing fac 

assessmnt.

1.20 1.88 1.71 Agree ................ 1.71 

99326 ................ ............................ Domicil/r-home visit new 

pat.

2.27 2.85 2.27 Agree ................ 2.27 

99327 ................ ............................ Domicil/r-home visit new 

pat.

3.03 3.75 3.03 Agree ................ 3.03 

99328 ................ ............................ Domicil/r-home visit new 

pat.

3.78 4.26 3.78 Agree ................ 3.78 

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

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

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

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

99343 ................ ............................ Home visit, new patient ..... 2.27 2.65 2.27 Agree ................ 2.27 

99344 ................ ............................ Home visit, new patient ..... 3.03 3.60 3.03 Agree ................ 3.03 

99345 ................ ............................ Home visit, new patient ..... 3.78 4.26 3.78 Agree ................ 3.78 

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TABLE 10.—REMAINING CODES FROM FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued 

CPT 1/ 

HCPCS code Mod Descriptor 

2007 

work 

RVU 

Requested 

work 

RVU 

RUC 

REC 

CMS 

proposal 

(agree/ 

disagree) 

2008 

Proposed 

work 

RVU 2

99347 ................ ............................ Home visit, est patient ....... 0.76 1.10 0.76 Agree ................ 0.76 

99348 ................ ............................ Home visit, est patient ....... 1.26 1.70 1.26 Agree ................ 1.26 

99349 ................ ............................ Home visit, est patient ....... 2.02 2.50 2.02 Agree ................ 2.02 

99350 ................ ............................ Home visit, est patient ....... 3.03 3.45 3.03 Agree ................ 3.03 

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2Proposed WRVU changes reflect E/M increases. 

In Table 10, work RVUs are being 

proposed for CPT codes 92557, 92567, 

92568, 92569, 92579, 92601, 92602, 

92603 and 92604. These codes 

previously had no work RVUs assigned 

to them. However, based on surveys 

conducted by relevant specialty 

societies, the RUC recommended work 

RVUs as noted in the table, which we 

propose to accept. 

We note that CPT code 93325, 

Doppler echocardiography color flow 

velocity mapping (List separately in 

addition to codes for echocardiography), 

was submitted by CMS to the RUC as 

part of the third 5-Year Review. 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. 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 performed 

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. Therefore, 

we agree with the RUC and since the 

services described in 93325 have 

become intrinsic to the performance of 

other echocardiography services, we are 

proposing 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). 

5. 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 codespecific 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 physician services. 

In the second 5-Year Review of 

anesthesia work implemented in 2002, 

the AMA RUC and the 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, postinduction anesthesia, and postanesthesia. 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 as 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 

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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 pos-induction period time. For 

example, for pre-anesthesia time, the 

methodology is as shown in Table 11. 

TABLE 11.—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 271 

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 estimate 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 no increase in 

the aggregate anesthesia PEs. Thus, no 

adjustment is being made to the PE 

share of the anesthesia service or to the 

anesthesia CF for this component. 

We are proposing to accept the RUC’s 

recommendation and increase the work 

of anesthesia services by 32 percent. 

Due to the proposed work RVU 

changes for the codes listed in Table 10 

and the proposed increases in the work 

of anesthesia services, we are proposing 

to revise the work adjustor to maintain 

budget neutrality. Based upon the 

increases, the proposed revised work 

adjustor is approximately 0.8816, which 

is discussed further in the impact 

section of this proposed rule. 

6. Reporting of Cardiac Rehabilitation 

Services 

For CY 2008, we are proposing 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). (There is no definition of ‘‘per 

session.’’) Therefore, to clarify the 

coding and payment for these services, 

we propose 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 believe the new codes that use a per 

hour descriptor will more accurately 

measure the services being provided 

and facilitate proper coding and 

payment. The current RVUs associated 

with CPT codes 93797 and 93798 will 

be crosswalked to HCPCS Codes Gxxx1 

and Gxxx1, respectively, because 1 hour 

of service was assumed in establishing 

the current RVUs. 

F. Part B Drug Payment 

1. Average Sales Price (ASP) Issues 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘ASP ISSUES’’ at the beginning 

of your comments.] 

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 proposed 

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 proposed changes to how 

manufacturers calculate and report ASP 

data to us. 

a. ASP Payment 

Section 303(c) of the 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. 

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We update the Part B drug payment 

amounts quarterly based on the data we 

receive. 

In this section of the preamble, we 

discuss our intent to establish further 

guidance regarding certain aspects of 

the calculation of manufacturers’ ASP 

data, and seek comments on issues 

related to bundled price concessions. 

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 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 its 

calculation of ASP, consistent with the 

general requirements and the intent of 

the Act, Federal regulations, and its 

customary business practices. Our 

intent in not being prescriptive in this 

area in the CY 2007 PFS final rule with 

comment period was to allow 

manufacturers the flexibility to adopt a 

methodology with regard to the 

treatment of bundled price concessions 

in the ASP calculation that, based on 

their particular circumstances, will best 

ensure the accuracy of the ASP 

calculation and not create inappropriate 

financial incentives. We also stated that 

we would be closely monitoring this 

issue and may provide more specific 

guidance in the future if we determine 

it is warranted. In addition, we 

encouraged stakeholders and the public 

to relay additional information or 

concerns to us on this issue. We 

specifically noted that MedPAC would 

be studying this issue, and that we 

looked forward to its work in this area. 

In its January 2007 Report to 

Congress, ‘‘Impact of Changes in 

Medicare Payments for Part B Drugs’’, 

MedPAC discusses the issue of how to 

allocate 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.’’ The full report is 

posted on the MedPAC’s Web site at 

(http://www.medpac.gov/publications/ 

congressional_reports/ 

Jan07_PartB_mandated_report.pdf). 

MedPAC’s report illustrates the 

potential effects that certain methods for 

allocating bundled price concessions 

may have on Medicare payment rates, 

physicians’ ability to choose a product 

based on clinical factors, and market 

availability of products. MedPAC notes 

that: 

Bundling arrangements take many forms. 

For example, some bundling arrangements 

may include only Part B drugs while others 

may include both Part B drugs and other 

products. Similarly, price concessions may 

be structured in numerous ways. For 

example, a discount on one or more drugs 

may be contingent on the purchase of other 

drugs or on meeting an aggregate expenditure 

target for a group of products. CMS’s policy 

on reporting discounts may need to change 

over time to reflect changing market practices 

but that should not slow down action in this 

area. [MedPAC. 2007. Report to Congress: 

Impact of Changes in Medicare Payments for 

Part B Drugs. Washington, DC: MedPAC: 

page 8] 

In its report, MedPAC discusses two 

alternative 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 

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 December 22, 2006 Medicaid 

Program: Prescription Drugs proposed 

rule (71 FR 77176), for purposes of 

calculating the average manufacturer 

price (AMP), we proposed that, the 

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 nine-digit 

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 

Medicaid Program: Prescription Drugs 

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 

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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 

Medicaid: Prescription Drugs proposed 

rule. However, our review of those 

comments and development of the final 

AMP calculation policies and rule are 

not complete, and therefore, we will 

respond to those comments in future 

rulemaking. 

In the CY 2007 PFS final rule with 

comment period, we stated that we may 

provide more specific guidance on 

bundled price concessions in the future 

if we determine it is warranted. 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 

believe specific guidance in the ASP 

context is warranted to provide for 

greater consistency in ASP reporting 

across manufacturers and enhancing the 

accuracy of the ASP payment system. 

We find MedPAC’s suggestion to not 

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. 

As we noted in the CY 2007 PFS final 

rule with comment period, there is a 

potential for great variation in the 

structure of bundling arrangements and 

in the characteristics of drugs included 

in those arrangements. Thus, we believe 

that, in establishing a specific 

methodology for allocating bundled 

price concessions for purposes of 

calculating ASP, we should seek to 

balance the desirability of a consistent 

methodology across manufacturers’ ASP 

calculations with the potential 

complexity that may be introduced by 

the designated approach. Our intention 

in proposing to adopt a specified 

approach for allocating bundled price 

concessions in the ASP context is to 

avoid greater computational complexity 

than necessary at this time primarily 

because it is unknown whether 

applicable data may be adequately 

known at quarterly reporting intervals 

for manufacturers to appropriately 

reflect the contingencies in purchasing 

contracts within their ASP calculations 

at the 11-digit NDC level. 

In addition, we believe that it is 

appropriate at this time to propose a 

specified method for treating bundled 

price concessions in the calculation of 

ASP which is consistent with our 

proposed approach for treating such 

discounts for purposes of the AMP 

calculation. Furthermore, because 

section 1847A(d) of the Act, as 

discussed elsewhere in this section, 

permits substitution of 103 percent of 

the AMP for the ASP-based payment 

limit in certain instances, we believe 

incorporating appropriate consistencies 

across the calculations of ASP and 

AMP, as allowable by statute, is 

rational. Although we are proceeding 

cautiously with such potential 

substitutions, we believe appropriate 

consistencies across the calculations of 

ASP and AMP will result in a lower 

potential for error and more accurate 

calculations of both prices. 

Although ASP and AMP serve similar, 

but not identical, purposes, differences 

between these calculations provide 

rationale for, and in some instances may 

require, minor differences between 

Medicaid and Medicare proposed 

regulations. For example, the Medicaid 

proposed rule proposes a definition of 

‘‘bundled sales’’ whereas we believe 

‘‘bundled arrangement’’ is more 

appropriate for purposes of the ASP 

context because, for ASP purposes, 

‘‘bundling’’ is most applicable in the 

context of price concessions. 

Furthermore, based on our experience 

with manufacturers’ ASP reporting, we 

believe other refinements are 

appropriate for purposes of ASP. We 

believe these differences are necessary 

to clarify certain aspects of a consistent 

approach for treatment of bundling, and 

will 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 propose 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 in the 

definition of bundled arrangement we 

are proposing at § 414.802. For 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 

propose 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 propose 

to define bundled arrangement at 

§ 414.802, and to specify in 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 making this proposal, we seek to 

establish a method for treating bundled 

price concessions for purposes of ASP 

that is consistent with the method 

proposed for AMP calculations while 

addressing existing program differences. 

We believe an overall consistent 

methodology for addressing bundling in 

both contexts will reduce the burden 

and the likelihood of errors for 

manufacturers calculating and reporting 

the ASP. We also believe that our 

proposed approach balances the need to 

provide clarification of how bundled 

price concessions are to be treated for 

purposes of calculating the ASP so that 

there is greater consistency across 

calculations of ASP with concerns that 

a more complex approach would 

present complicated implementation 

and monitoring challenges, as discussed 

by MedPAC and in our response to 

comments in the CY 2007 PFS final rule 

with comment period. 

As discussed previously in this 

section of the preamble, we propose to 

establish a method for the treatment of 

bundled price concessions that is 

appropriately consistent with proposed 

Medicaid policy for bundled sales, and 

we intend to remain consistent with the 

final policy adopted in the Medicaid 

final rule on this issue, as appropriate. 

However, we note that the final 

Medicaid AMP final rule is still under 

development, and the Medicaid policies 

on bundled sales may ultimately differ 

from our discussion of the topic in this 

section of the preamble. Because of the 

timing of the two proposed rules, the 

policy we ultimately adopt in this final 

rule 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 affect the calculation 

of ASP. 

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We note that the comment period on 

the Medicaid proposed rule is closed. 

Therefore, comments received in 

response to this proposed rule on the 

topic of bundled sales for purposes of 

AMP will be considered untimely for 

the purposes of the Medicaid final rule 

and outside of the scope of this 

rulemaking. 

We are soliciting comments on our 

proposed approach for requiring 

manufacturers to allocate the total value 

of all price concessions on all drugs sold 

under a bundled arrangement 

proportionately according to the dollar 

value of the units of each drug sold 

under the bundled arrangement for 

purposes of the calculation of ASP, and 

on our proposal to specify the method 

for treatment of bundling in the ASP 

context that is appropriately consistent 

with the treatment of bundling in the 

AMP context. We are specifically 

soliciting comments on how our 

proposed approach for treatment of 

bundled price concessions for purposes 

of calculating ASP may impact the 

estimation of lagged price concessions, 

whether manufacturers believe 

additional guidance on this topic is 

needed, and the nature of the potential 

additional guidance. Further, we are 

soliciting comments on potential 

alternative approaches for the treatment 

of bundled price concessions that are 

appropriate for the calculation of ASP, 

including the alternative approach 

discussed by MedPAC in its recent 

report as noted previously in this 

section of the preamble. In addition, we 

seek comments on how our proposed 

approach or an alternative approach 

would result in clear reporting 

requirements for allocating discounts 

that can be implemented by 

manufacturers in a timely fashion. 

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. In the CY 2007 PFS 

final rule with comment period, we 

announced that the furnishing fee for 

CY 2007 is $0.152 per unit clotting 

factor based on the percentage increase 

in the CPI of 4.1 percent for the 12- 

month period ending June 2006. 

The CPI data for the 12-month period 

ending in June 2007 is not yet available. 

In the CY 2008 PFS final rule with 

comment period, we will include the 

actual figure for the percent change in 

the CPI for medical care for the 12 

month period ending June 2007, and the 

updated furnishing fee for CY 2008 

calculated based on that figure. 

In the CY 2006 and CY 2007 PFS 

proposed and final rules, as well as in 

this proposed rule, we have included a 

discussion of the annual update of the 

blood clotting factor furnishing fee as 

specified in section 1842(o)(5)(C) of the 

Act. Because the update 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 the Bureau of Labor Statistics 

releases the applicable CPI data after our 

the proposed rule is published, we are 

not able to include the actual updated 

furnishing fee in the CY 2006 through 

CY 2008 proposed rules. Rather, we 

announced in these proposed rules that 

we intended to include the actual figure 

for the percent change in the applicable 

CPI, and the updated furnishing fee 

calculated based on that figure in the 

associated final rule. Given the timing of 

the availability of the applicable data 

and our timeframe for preparing 

proposed rules, this process is 

unavoidable and likely to remain 

unchanged in the future. 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. Because the 

furnishing fee update process is 

statutorily determined and is based on 

an index which is not affected by 

administrative discretion or public 

comment, we do not believe a 

subregulatory means of communicating 

the update will adversely affect 

stakeholders or the public. Therefore, 

for CY 2009 and thereafter until such 

time as the update methodology may be 

modified, we propose to announce the 

blood clotting furnishing fee using 

applicable program instructions and 

posting on the CMS Web site. We are 

soliciting comments on our proposal to 

announce the updated furnishing fees 

via program instructions. 

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 

the AMP for such drug or biological by 

the applicable threshold percentage (as 

defined in subparagraph (B)).’’ The 

applicable threshold is specified as 5 

percent for CY 2005. For CY 2006 and 

subsequent years, section 

1847A(d)(3)(B) of the Act establishes 

that the applicable threshold is ‘‘the 

percentage applied under this 

subparagraph subject to such 

adjustment as the Secretary may specify 

for the WAMP or the AMP, or both.’’ 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 propose 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 

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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. We 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. 

We welcome comments on our 

proposal to continue the applicable 

threshold at 5 percent for both the 

WAMP and AMP for CY 2008. 

2. Competitive Acquisition Program 

(CAP) Issues 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘CAP ISSUES’’ at the beginning 

of your comments.] 

In this section, we discuss the impact 

of new legislation 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. In subsequent 

subsections, we also seek comments 

regarding changes to other operational 

aspects of the CAP. 

This proposed rule will also be used 

to discuss comments related to 

transporting CAP drugs and the 

administrative burden of the CAP 

submitted in response to the 

Competitive Acquisition of Outpatient 

Drugs and Biologicals Under Part B; 

Interim Final Rule with Comment 

Period published in the July 6, 2005 

Federal Register (hereinafter referred to 

as the July 6, 2005 IFC). We are 

addressing these comments in this 

proposed rule because we plan to ask 

for additional comments on these areas 

to explore areas that might be developed 

in future rulemaking efforts. In the 

upcoming PFS final rule with comment, 

we intend to finalize the portions of the 

July 6, 2005 IFC that were not finalized 

in the CY 2006 PFS final rule with 

comment period. We also will respond 

to the other timely comments we 

received on the July 6, 2005 IFC that we 

have not responded to previously. 

This proposed rule implements 

conforming changes to the CAP 

regulations to reflect provisions of 

section 108 of the MIEA–TRHCA that 

made changes to the payment process of 

the CAP for Part B Drugs. 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 and July 6, 2005 

IFC (70 FR 10746 and 70 FR 39022, 

respectively), and 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. 

The program began on July 1, 2006. At 

that time, 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. 

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 requires 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 shall 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. 

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 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 payment to the physician 

under the ASP methodology in this 

situation. 

Claims processing procedures for the 

approved CAP vendor and the 

participating CAP physician, which 

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remain largely unchanged under the 

new statutory provision, are 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 verify 

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 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 also charged with recouping, 

offsetting, or collecting any 

overpayments found. The statute also 

authorizes us to conduct post-payment 

review using statistical sampling and to 

implement the post-payment 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. 

The post-payment review process 

uses statistical sampling to determine 

whether drugs were administered and if 

they 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 

be reviewed for medical necessity before 

they are paid. Therefore, the postpayment review includes verification of 

drug administration and a medical 

necessity review of a statistically valid 

sample of CAP claims. We note that in 

conducting the post-payment review, 

we will continue to monitor for fraud, 

waste, and abuse. All CAP transactions 

will remain eligible for review for 

medical necessity and verification of 

administration. We also anticipate that 

the post-payment review process will 

provide CMS with additional 

opportunities to monitor for the 

appropriate payment of drugs furnished 

under this program. 

As part of 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-bydose basis. If the CAP designated carrier 

is able to find a match between the two 

claims, this assists the carrier in 

determining that the beneficiary did 

receive the drug being billed for. The 

participating CAP physician claim may 

also contain information on any 

determination of medical necessity and 

coverage made by the local carrier. 

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 Medicare 

providers to be required to submit 

medical records to assist in 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 at the time he or she elects to 

join the program that he or she may be 

asked to supply medical records for 

post-payment review. Therefore, we are 

proposing to revise § 414.908(a)(3)(xi) 

and the physician election agreement 

form to make clear that medical records 

and certain information may be 

requested from CAP physician during 

the post-payment review process. The 

procedures being 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 and ask for 

his or her help in obtaining them. 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. It is also consistent with our 

practice in reviewing claims for 

postoperative treatment. For example, if 

post-operative services have been 

provided by two physicians, and 

payment was denied to one physician, 

and that physician appeals, the 

Medicare contractor may request 

medical records from the other 

physician that treated the beneficiary to 

document that there was no overlap in 

the services provided by each physician. 

If the contractor does not receive the 

medical record of the other physician 

within a specified amount of time the 

appeal would be denied because there 

was no way to document the services 

provided. A similar process is used 

when durable medical equipment 

(DME) is provided through third party 

suppliers. In these cases, the physician 

ordering the DME is required to provide 

the suppler medical records to support 

the necessity of the equipment he or she 

ordered. If the supplier does not obtain 

the records, then payment is denied. 

As we specified in the CAP 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 provided 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 will 

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check 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 so, the CAP designated carrier 

will reflect this decision in its postpayment 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 

will use the local carrier’s coverage 

determination policies when conducting 

medical review of the claim. 

e. Provisions for Collection of 

Beneficiary Coinsurance 

In the CY 2006 PFS final rule with 

comment period, we specified 

§ 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 their 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 have also been used 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 them of 

the statutory requirement and 

suggesting that they contact their 

participating CAP physician to verify 

that they received the dose of the drug 

for which they 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 

and we are proposing to clarify 

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

the following elements shall be 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. 

Also, as a result of changes mandated 

by section 108(a)(1) of the MIEATRHCA, we propose to revise 

§ 414.914(h)(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 are proposing that 

the approved CAP vendor must 

promptly refund any payment made by 

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CMS if the vendor has been paid for 

drugs that were not administered. We 

are proposing that promptly is defined 

as 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. 

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 the 

approved CAP vendor filed with the 

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, which provided 

party status to the approved CAP vendor 

on the participating CAP physician’s 

drug administration claim, 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, the approved CAP 

vendor’s claim and the participating 

CAP physician’s claim were matched in 

the system and the approved CAP 

vendor’s claim was authorized for 

payment. 

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) eliminates the approved 

CAP vendor’s dependency on a 

participating CAP physician’s filing of a 

drug administration claim before the 

approved CAP vendor may be paid for 

a CAP drug. Accordingly, there is no 

longer a need to afford party status to 

the approved CAP vendor for the drug 

administration claim submitted by the 

participating CAP physician. Instead, 

under the TRHCA legislation, the 

approved CAP vendor’s drug claim may 

be paid by the designated carrier once 

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 

thus, may request a redetermination and 

subsequent appeals consistent with the 

process established under 42 CFR Part 

405, Subpart I. 

The changes proposed to CAP claims 

processing in this proposed rule that 

conform to the TRHCA legislation 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 

designated carrier (based on information 

from the local carrier that the payment 

for the drug should be denied as 

excluded or non-covered); and (2) postpayment denials by the designated 

carrier based on the post-payment 

review process established under 

TRHCA. 

Therefore, we are proposing 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. 

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. 

However, we believe the local carrier is 

the most appropriate entity to review 

the prepayment denial since it is most 

familiar with the relevant coverage 

policies for that jurisdiction. 

• For the postpayment review 

process, if the designated carrier selects 

the drug claim for review, this 

constitutes a reopening of the initial 

determination. If the designated carrier 

cannot verify administration or cannot 

determine that the drug is covered or 

medically reasonable and necessary, the 

designated carrier issues a revised 

determination to deny coverage of the 

drug product claim. The designated 

carrier then determines whether an 

overpayment exists, and if so, seeks 

recovery of the overpayment. The 

approved CAP vendor, as a supplier, 

would then have the right to request a 

redetermination of the revised coverage 

determination, and the overpayment 

assessment. The designated carrier will 

process the redetermination. 

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 2006 PFS final rule with 

comment period (70 FR 70258), we 

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 § 414.914(h) are met) in 

§ 414.908(a)(5). We noted that in all 

these cases, while there is only one drug 

category for CAP, the participating CAP 

physician would be allowed to opt-out 

of the CAP altogether. 

The CAP became operational on July 

1, 2006. Since that time, we have been 

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contacted by a few participating CAP 

physicians requesting that they be 

permitted to cancel their election 

agreement. Some of these requests have 

come from physician practices that 

misunderstood the program but found 

the program structure workable after 

further education about the CAP. Other 

requests have come from participating 

CAP physicians who identified 

significant concerns within the first few 

weeks of their participation that could 

not be resolved through provider 

education. When we initially 

implemented the CAP, we believed that 

most issues raised by participating CAP 

physicians would relate to quality and 

service issues that could be resolved 

through the approved CAP vendor’s 

grievance process and the dispute 

resolution process conducted by the 

designated carrier. However, our 

experience with the initial operation of 

the CAP has demonstrated that there 

may be other business reasons a practice 

might wish to leave the program that are 

unrelated to the approved CAP vendor’s 

performance. Examples of these include 

a demonstration of financial hardship 

due to participation in the CAP, the 

practice’s inability to update its billing 

system despite a good faith effort, or 

that the practice relied on misleading 

information about the program from 

outside sources when making the 

decision to participate. Therefore, while 

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 that physicians 

would make a decision to participate in 

on an annual basis, consistent with 

section 1847B(a)(5)(A) of the Act, we are 

proposing to define an additional 

exigent circumstance for opting out of 

the CAP. Under this proposed exigent 

circumstances exception, a participating 

CAP physician would be able to submit 

a written request to terminate his or her 

CAP physician election agreement 

within 30 days of its effective date, and 

CMS would grant such a request if the 

participating CAP physician could 

demonstrate that remaining in the CAP 

would be a significant burden. 

The participating CAP physician 

would be required to submit a written 

request to terminate his or her 

participation in the CAP, along with a 

reason for the request to leave the CAP, 

within 30 days of the effective date of 

the election agreement. Examples of a 

significant burden include, but are not 

limited to the following: A 

demonstration of financial hardship due 

to participation in the CAP, the 

practice’s inability to update its billing 

system despite a good faith effort, or 

that the practice relied on misleading 

information about the program from 

outside sources when making the 

decision to participate and has proof of 

receiving such information. The request 

would be sent to the CAP-designated 

carrier under the dispute resolution 

process, and within 1 business day the 

designated carrier would determine 

whether the request was related to the 

service provided by the approved CAP 

vendor. If so, the CAP 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 issue the participating CAP 

physician had identified. The approved 

CAP vendor would have 2 business days 

to respond to the participating CAP 

physician’s concern, consistent with our 

regulations at § 414.914(f)(5). If the 

approved CAP vendor was unable to 

identify a solution, consistent with the 

CAP statute, regulations, contracts and 

guidance, and acceptable to the 

physician, for resolving the issue, the 

participating CAP physician would be 

referred back to the CAP designated 

carrier for assistance under the dispute 

resolution process. 

We propose that the participating 

CAP physician’s request would be 

handled under the dispute resolution 

process because procedures and defined 

time frames for handling participating 

CAP physician and approved CAP 

vendor complaints are already 

developed under the CAP dispute 

resolution process. If the designated 

carrier did not believe the participating 

CAP physician’s request was related to 

an issue that could be resolved by the 

approved CAP vendor, then the 

designated carrier would seek to resolve 

any other issues raised by the physician 

in the request to terminate CAP 

participation. The designated carrier 

would conduct an investigation into the 

physician’s request to terminate his or 

her CAP election agreement and attempt 

to resolve any issues. If the designated 

carrier is unable to resolve the situation 

to the physician’s satisfaction, within 2 

business days, the designated carrier 

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 an attempt to resolve the 

issue. We believe that 4 business days 

would be sufficient to conclude this 

process because it would give the carrier 

time to gather information from other 

affected parties, such as the 

participating CAP physician’s carrier, 

but still prepare a speedy summary of 

the issues involved in the physician’s 

request. After the 2-day or 4-day period, 

as applicable, the designated carrier 

would forward the physician’s request, 

along with its recommendation, to CMS. 

We would then review the 

recommendation and make a final 

decision within 2 business days of the 

date we received the request. 

If we agree that the participating CAP 

physician has demonstrated that 

remaining in the CAP is a significant 

burden, we would allow that physician 

to terminate his or her participation in 

the program. We would inform the CAPdesignated carrier of its decision and the 

decision would be communicated to the 

participating CAP physician in writing 

by the designated carrier. As part of this 

process, the physician’s termination 

date for his or her CAP election 

agreement would be determined and 

communicated to the all parties 

involved, including the physician’s 

local carrier. If we do not believe that 

the physician has demonstrated a 

significant burden, we would not allow 

the physician to terminate his or her 

participation in the CAP. We would 

inform the physician of such a decision 

and would include a recommendation 

for corrective action (such as education), 

and the right to request reconsideration 

as specified in § 414.917. 

If we agree to terminate the 

participating CAP physician’s CAP 

election agreement, the physician would 

be required to continue to cooperate in 

any post-payment review and appeals of 

claims for drugs that the approved CAP 

vendor had already provided to the 

physician 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 has 

inadvertently billed CMS for drugs that 

had not been administered to a 

beneficiary, the vendor would be 

required to correct the claim and return 

any overpayment. 

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, we described both comments that 

supported the idea of allowing 

participating CAP physicians to 

transport drugs to multiple office 

locations and comments that raised 

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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 should 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 were knowledgeable 

about drug stability and handling, and 

therefore, were capable of assuming this 

responsibility. Other commenters 

pointed out 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. 

These comments and our experience 

with the CAP thus far, have caused us 

to consider changing our position. 

Therefore in this proposed rule, we are 

seeking comment 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 are 

asking commenters to consider how 

such a policy could be constructed so 

that the approved CAP vendor could 

retain control over how drugs that it 

owns are handled (we remind 

commenters that CAP drugs are the 

approved CAP vendor’s property until 

they have been administered). We 

welcome comments on other issues that 

we should take into account as we 

consider the possibility of future 

changes to the regulation so that CAP 

drugs may be transported from one 

approved CAP physician’s practice 

location to another office location that is 

listed on the physician’s CAP election 

agreement form. We also welcome 

comments on 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. We are also seeking 

comments on whether any agreement 

allowing participating CAP physicians 

to transport CAP drugs to alternate 

practice locations should be voluntary, 

meaning 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. Finally, 

we are seeking comments on whether 

the agreement should be documented in 

writing, and whether it is necessary to 

create any restrictions on which CAP 

drugs could be transported. Again, we 

remind potential commenters that we 

are not making a specific proposal at 

this time, but we will use any 

information we receive to structure a 

future proposal, in the event we make 

one. 

i. Alternatives to the CAP Prescription 

Order Number 

We received a number of comments 

that we responded to in the July 6, 2005 

IFC (70 FR 39043 and 39049,) about 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. In response to the IFC, we 

have received additional comments on 

this issue. 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. To meet national 

electronic standards for the automated 

transfer of certain health care data 

mandated by the Health Insurance 

Portability and Accountability Act of 

1996 (Pub. L. 104–191) (HIPAA), 

Medicare claims that are submitted 

electronically must use a specific data 

format. Within this framework, the CAP 

prescription order number is captured 

in Loop 2410, REF02 (REF01=XZ) of the 

ANSI 4010A1 electronic claims 

transaction. This segment is designed to 

capture the assigned prescription 

number. 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 for; the 

approved CAP vendor sets the 

remaining characters. Typically, 15 or 

fewer total characters have been used by 

the approved CAP vendor. 

Each prescription order number is 

unique to a dose of a CAP drug that is 

being shipped for administration to a 

particular beneficiary. The approved 

CAP vendor is responsible for 

generating the prescription order 

number, 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 to facilitate 

claim matching and approved CAP 

vendor payment. Although the CAP 

prescription order number on the 

approved CAP vendor’s claim is no 

longer matched to the prescription order 

number on the participating CAP 

physician’s claim prior to claims 

payment, the prescription order is still 

used to track each dose of a drug that 

is shipped by the approved CAP vendor 

to the participating CAP physician and 

administered to the beneficiary. Prior to 

paying the approved CAP vendor’s 

claim for a drug 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 so, the CAP 

designated carrier will look to see 

whether the local carrier determined 

that the CAP drug administered by the 

participating CAP physician is covered 

and is medically necessary. If the 

participating CAP physician’s local 

carrier has not made a determination on 

the physician’s claim and the CAP drug 

claim, 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 

accompanies each dose of drug that is 

sent to a participating CAP physician. 

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. 

Under the claims matching system 

used when the CAP was implemented, 

the prescription order number was used 

to match an approved CAP vendor’s 

CAP drug claim to the participating CAP 

physician’s drug administration claim 

in the claims processing system prior to 

payment. The presence of a drug 

administration claim with a matching 

prescription order number indicated 

that the drug on the corresponding 

approved CAP vendor’s claim had been 

administered and a successful match 

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allowed the approved CAP vendor to be 

paid for that claim. 

At this time, 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 is still used to establish that the 

drug that is being billed for by the 

approved CAP vendor has been 

administered by the participating CAP 

physician and that the vendor’s claim is 

payable. Situations such as the 

frequency of recurring cyclic drug 

treatment regimens, the possibility of 

temporary interruption to these 

regimens, and the lack of agreement 

between the approved CAP vendor’s 

anticipated day of service and the actual 

date that the drug is administered make 

the use of an aid to assist accurate 

tracking of CAP drugs desirable. We 

believe that the prescription order 

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 CAP-participating physicians 

and approved CAP vendors. Therefore, 

we are seeking comment on alternative 

methods that could be used 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. We are 

not proposing to implement such a 

change at this time, but would like to 

receive comments on other methods that 

could be used to track CAP drug 

administration on a dose by dose basis. 

We may propose a change in future 

rulemaking. 

j. Prefilled Syringes 

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

we described public comments that 

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 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 are 

considering reassessing our policy on 

the use of prefilled syringes to 

determine whether it would be feasible 

to make the option of using prefilling 

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. We are seeking 

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. We are not proposing to make a 

change to our regulations at this time, 

but we are seeking additional 

information that might allow us to 

consider making such a change in the 

future. 

In considering whether to propose a 

change to our regulations in the future, 

we seek 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. At this time there is no 

specific requirement for approved CAP 

vendors to be pharmacies. Also, please 

note we are describing a specialized 

pharmacy function; we are not 

contemplating manufacturing of drug 

products under this program. 

We are also seeking comments on 

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. 

Furthermore, we are seeking comments 

on 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 

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of drugs and solutions intended for 

intravenous administration) should be 

allowed as well. 

We also seek comments on 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. We also seek comment on 

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). We also seek 

comments on whether the cost of 

preparing such product would be 

included in the CAP vendor’s bid price. 

Finally, we seek comments on whether 

any other important elements should be 

evaluated if we consider changing CAP 

policy on prefilled syringes 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 is desirable in order to bridge 

the gap between taking no action and 

suspension or termination of an 

approved CAP vendor for less serious 

but persistent problems. 

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, we are seeking comments on 

what types of potential contractual 

provisions that 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. 

Given that the CAP statute does not 

provide for the imposition of sanctions 

such as withholding payment or 

imposing other types of monetary 

penalties, we believe that building 

appropriate provisions into the 

approved CAP vendor’s contract to 

address noncompliance or expanding 

the approved vendor’s code of conduct 

by proposing more specific CMS 

requirements could be appropriate 

approaches. We are requesting 

comments on what type of contractual 

provisions would be suitable, for 

example, requests for specific or 

targeted reporting and monitoring 

activities in response to specific 

violations, etc. We are also looking for 

comments on 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. Finally, we invite 

comments on 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. We will use 

any information that we receive on 

these issues to possibly develop a future 

proposal. 

G. Issues Related to the Clinical 

Laboratory Fee Schedule 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘CLINICAL LABORATORY 

ISSUES’’ at the beginning of your 

comments.] 

1. Date of Service for the Technical 

Component of Physician Pathology 

Services (§ 414.510) 

In the CY 2007 PFS final rule with 

comment period (71 FR 69787), we 

added § 414.510 for the date of service 

of a clinical diagnostic laboratory test 

that uses a stored specimen. Generally, 

our policy states the date the specimen 

is collected is the date of service for 

claims review and adjudication. 

However, for a laboratory test that uses 

a stored specimen, the date of service is 

the date the specimen was obtained 

from the storage for a specimen that is 

stored for more than 30 days before 

testing. Specimens stored 30 days or 

less have a date of service of the date the 

test was performed only if—

(a) The test is ordered by the patient’s 

physician at least 14 days following the 

date of the patient’s discharge from the 

hospital; 

(b) The specimen was collected while 

the patient was undergoing a hospital 

surgical procedure; 

(c) It would be medically 

inappropriate to have collected the 

sample other than during the hospital 

procedure for which the patient was 

admitted; 

(d) The results of the test do not guide 

treatment provided during the hospital 

stay; and 

(e) The test was reasonable and 

medically necessary for the treatment of 

an illness. 

In addition, § 414.510(b)(3) specifies the 

conditions for the date of service for a 

chemosensitivity test. 

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 PFS or the hospital 

OPPS. As a result, for § 414.510, we are 

proposing to revise the section heading 

and introductory sentence to specify the 

provision applies to both clinical 

laboratory and pathology specimens. We 

are also revising § 415.130(d) to include 

a reference to § 414.510. 

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’’). 

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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 

‘‘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 

the new test code the local fee schedule 

amounts 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 amounts and NLA based on a 

blend of payment amounts for the 

existing test codes. For example, we 

may pay based on 75 percent of the 

payment amounts for one existing test 

code and 25 percent of the payment 

amounts for another existing test code. 

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 to determine a carrierspecific amount for use in the 1st year 

that the new code is effective. The 

sources of information that these 

carriers examine in determining carrierspecific 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. 

In the CY 2007 PFS final rule with 

comment period, we also explained that 

we notify our carriers when to use the 

gapfill method described with a 

program instruction which lists the 

specific new test code and the 

timeframes to establish carrier-specific 

amounts. Contractors are required to 

establish carrier-specific amounts on or 

before March 31 of the year. Contractors 

may revise their payment amounts, if 

necessary, on or before September 1 of 

the year. In this manner, a carrier 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. Under 45 CFR 

§ 162.1003, a code for a new test may be 

developed either by the AMA’s CPT 

Editorial Panel, which maintains and 

distributes the CPT codes, or HHS, 

which maintains and distributes the 

HCPCS codes. 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 tests 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. We also 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. Our contractors 

have many information system steps to 

complete during the months of 

November and December so that the 

updated clinical laboratory fee schedule 

is ready to pay claims effective January 

1 of the following calendar year. 

In response to the CY 2007 PFS 

proposed rule, we received several 

comments regarding the level of detail 

of information presented during the 

public meeting process. We responded 

that we did not believe that 

opportunities for information gathering 

on new tests have been fully utilized 

within the public meeting process and 

that 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. 

We also received some comments that 

suggested that the method used by 

contractors to determine their price for 

gapfilled tests should be more specific. 

We responded 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. 

We have discussed these issues with 

our contractors. We also plan to solicit 

comments on the gapfill process in the 

clinical laboratory public meeting 

scheduled on July 16, 2007. Although 

we encourage the public to suggest 

improvements to our gapfilling process 

at the upcoming clinical laboratory 

public meeting, we recommend that 

interested parties also submit written 

comments on the proposed changes for 

the gapfilling process contained in this 

rule. Written comments will be 

considered in the final rule to the extent 

that these comments relate to the issues 

discussed in this proposed rule. 

Discussions with our contractors and 

other interested parties revealed 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 addition, in response to the CY 

2007 PFS proposed rule, a commenter 

requested that we establish a formal 

review, or reconsideration process of a 

payment amount determination. In 

response to the comment, we revised 

§ 414.508(b)(3) to provide that if we 

gapfill a test, but determine after the 1st 

year of gapfilling that carrier-specific 

gapfilled amounts will not pay for the 

test appropriately, in the 2nd year we 

may use the crosswalk basis to establish 

fees for the test. We also stated that we 

expected to solicit comments on a 

potential reconsideration process in a 

future rulemaking. 

At § 414.509, we are proposing 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. We 

have strived 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. 

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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. 

For example, under § 405.1885, we may 

reopen a final agency determination 

regarding payment to a provider of 

services. 

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 for 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). 

We are proposing 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 

November. Under § 414.508, claims 

would be paid using this basis to 

calculate fees beginning January 1. We 

would accept written comments on this 

basis determination for 60 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. 

In addition, those members of the 

public who submitted a written 

comment within the 60-day comment 

period would also have the opportunity 

to present their comment orally at the 

next clinical laboratory public meeting 

and hear other comments during the 

public meeting. 

After considering the comments 

received and the information of the 

public meeting, we would post our 

decision as to whether we elected to 

reconsider our determination of the 

basis for payment. If we elect to 

reconsider the basis for payment, we 

would post our determination as to 

whether we would change of the basis 

for payment on the CMS Web site on or 

before January 1 of the next year. 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 the 

following 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. 

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. 

We are proposing 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. 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. We 

would accept 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. 

In addition, a commenter, who had 

submitted a written comment within the 

60-day comment period, would also be 

given the opportunity to present their 

comment orally at the next public 

meeting. 

After considering the comments 

received and the 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. 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 or before January 

1 of the next year. 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 the 

following 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 are proposing that 

these determinations of crosswalked 

payment amounts would not be subject 

to reconsideration. 

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 contractors to determine carrierspecific 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 are proposing 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. 

Interested parties would submit written 

comments to CMS on the carriermstockstill on PROD1PC66 with PROPOSALS2

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specific amounts within 60 days from 

the date of posting the carrier-specific 

amounts. In addition, those 

commenters, who had submitted a 

written comment within the 60-day 

comment period, would be given the 

opportunity to present their comments 

orally at the next clinical laboratory 

public meeting. 

Carriers would finalize carrierspecific amounts by September 30 and 

we would set the NLA be at the median 

of the carrier-specific amounts. 

However, based on the comments 

received, we would evaluate whether 

we should reconsider the carrierspecific amounts and NLA. If we elected 

no to reconsider the carrier-specific 

amounts and the NLA, we would post 

the carrier-specific amounts and NLA 

on the CMS Web site on or before 

January 1 of the next year. These 

amounts would be based on the carrierspecific amounts and NLA we had 

posted in September. Payment for the 

test would be made at the NLA on 

January 1 of the next year. This 

determination would be final and not 

subject to further reconsideration. 

If we elect to reconsider the carrierspecific 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. 

We are also proposing 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. 

In addition, we are proposing 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 believe that the 

more comprehensive reconsideration 

procedures we are proposing should 

apply to new or substantially revised 

HCPCS codes assigned after December 

31, 2007. 

d. Jurisdiction for Reconsideration 

Decisions 

We are proposing 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. 

3. Technical Revisions 

We are also proposing 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 are 

proposing to define the term ‘‘new test’’

under § 414.502 using the statutory 

definition. In addition, under § 414.506 

and § 414.508, we are proposing 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.’’

H. Proposed Provisions Related to 

Payment for Renal Dialysis Services 

Furnished by End-Stage Renal Disease 

(ESRD) Facilities 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘ESRD PROVISIONS’’ at the 

beginning of your comments.] 

Since August 1, 1983, payment for 

dialysis services furnished by ESRD 

facilities has been based on a composite 

rate payment system that provides a 

fixed, prospectively determined amount 

per dialysis treatment, adjusted for 

geographic differences in area wage 

levels. In accordance with section 

1881(b)(7) of the Act, separate 

composite rates have been established 

for hospital-based and independent 

ESRD facilities. The composite rate is 

designed to cover a package of goods 

and services needed to furnish dialysis 

treatments that include, but not be 

limited to, certain routinely provided 

drugs, laboratory tests, supplies, and 

equipment. Unless specifically included 

in the composite rate, other injectable 

drugs and laboratory tests medically 

necessary for the care of the dialysis 

patient are separately billable. The base 

composite rates per treatment, effective 

on August 1, 1983, were $123 for 

independent ESRD facilities and $127 

for hospital-based ESRD facilities. The 

Congress has enacted a number of 

adjustments to the composite rate since 

that time. The current 2007 base 

composite rates are $132.49 for 

independent ESRD facilities and 

$136.68 for hospital-based ESRD 

facilities. 

Section 623 of the MMA amended 

section 1881 of the Act to require 

changes to the composite rate payment 

methodology, as well as to the pricing 

methodology for separately billable 

drugs and biologicals furnished by 

ESRD facilities. 

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

added by the MMA, required the 

establishment of a basic case-mix 

adjusted prospective payment system 

(PPS) that would include the services 

comprising the composite rate and an 

add-on to the composite rate component 

for the difference between current 

payments for separately billed drugs 

and the revised drug pricing specified in 

the statute. In addition, section 

1881(b)(12) of the Act required that the 

composite rate be adjusted for a limited 

number of patient characteristics (casemix) and section 1881(b)(12)(D) of the 

Act gave the Secretary discretion to 

revise the wage indices and the urban 

and rural definitions used to develop 

them. Finally, section 1881(b)(12)(E) of 

the Act imposed a budget neutrality 

requirement, so that aggregate payments 

under the basic case-mix adjusted 

composite payment system for 2005 

would equal the aggregate payments 

that would have been made for the same 

period if section 1881(b)(12) of the Act 

did not apply. 

Before January 1, 2005, payment to 

both independent and hospital-based 

facilities for the anti-anemia drug, 

erythropoietin (EPO) was established 

under section 1881(b)(11) of the Act at 

$10.00 per 1,000 units. For independent 

ESRD facilities, payment for all other 

separately billable drugs and biologicals 

was based on the lower of actual charges 

or 95 percent of the average wholesale 

price (AWP). Hospital-based ESRD 

facilities were paid based on the 

reasonable cost methodology for 

separately billed drugs and biologicals 

(other than EPO) furnished to dialysis 

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patients. Changes to the payment 

methodology for separately billed ESRD 

drugs and biologicals that were 

established by the MMA and were 

effective January 1, 2005 are described 

in sections II.H.1. and II.H.2. These 

changes affected payments in both CY 

2005 and CY 2006. 

In addition, section 623(f)(1) of the 

MMA directs the Secretary to submit a 

Report to Congress detailing a bundled 

PPS for services furnished by ESRD 

facilities to Medicare beneficiaries. The 

bundled PPS would be a different way 

of paying for ESRD services since it will 

include not only composite rate 

services, but would also include 

separately billable drugs (including 

EPO), laboratory tests, and other 

separately billable items into one PPS 

payment rate. We expect to release the 

REPORT TO CONGRESS this summer. 

1. CY 2005 Revisions 

In the CY 2005 PFS final rule with 

comment period (69 FR 66319 through 

66334), we implemented section 1881(b) 

of the Act, as amended by section 623 

of the MMA, and revised payments to 

ESRD facilities. These revisions were 

effective January 1, 2005, included 

implementation of a case-mix adjusted 

payment system that incorporated 

services that comprise the composite 

rate; an update of 1.6 percent to the 

composite rate component of the 

payment system; and a drug add-on of 

8.7 percent to the composite rate for the 

difference between current payments for 

separately billable drugs and payments 

based on the revised drug pricing for 

2005 which used acquisition costs. The 

CY 2005 PFS final rule with comment 

period also implemented case-mix 

adjustments to the composite rate for a 

limited number of patient 

characteristics (that is, age, low body 

mass index (BMI), and body surface area 

(BSA)), effective April 1, 2005. 

In addition, to implement section 

1881(b)(13) of the Act, we revised 

payments for drugs billed separately by 

independent ESRD facilities, paying for 

the top 10 ESRD drugs based on 

acquisition costs (as determined by the 

OIG) and for other separately billed 

drugs at the average sales price +6 

percent (hereafter referred to as ASP+6 

percent). Hospital-based ESRD facilities 

continued to receive cost-based 

payments for all separately billable 

drugs and biologicals except for EPO 

which was paid based on average 

acquisition costs. 

2. CY 2006 Revisions 

In the CY 2006 PFS final rule with 

comment period (70 FR 70161), we 

implemented additional revisions to 

payments to ESRD facilities under 

section 623 of the MMA. For CY 2006, 

we further revised the drug payment 

methodology applicable to drugs 

furnished by ESRD facilities. All 

separately billed drugs and biologicals 

furnished by both hospital-based and 

independent ESRD facilities are now 

paid based on ASP+6 percent. 

We recalculated the 2005 drug add-on 

adjustment to reflect the difference in 

payments between the pre-MMA AWP 

pricing and the revised pricing based on 

ASP+6 percent. The recalculation did 

not affect the actual add-on adjustment 

applied to payments in 2005, but 

provided an estimate of what the 

adjustment would have been had the 

2006 payment methodology been in 

effect in 2005. The drug add-on 

adjustment was then updated to reflect 

the expected growth in expenditures for 

separately billable drugs in CY 2006. 

As of January 1, 2006, we also 

implemented a revised geographic 

adjustment authorized by section 

1881(b)(12) of the Act. As part of that 

change, we—

• Revised the labor market areas to 

incorporate the new CBSA designations 

established by the Office of Management 

and Budget (OMB); 

• Eliminated the wage index ceiling 

and reduced the floor to 0.8500; and 

• Revised the labor portion of the 

composite rate to which the geographic 

adjustment is applied. 

We also provided a 4-year transition 

from the previous wage-adjusted 

composite rates to the current wageadjusted rates. For CY 2006, only 25 

percent of the payment is based on the 

revised geographic adjustments, and the 

remaining 75 percent of payment is 

based on the old metropolitan statistical 

area-based (MSA-based) payments. 

In addition, section 5106 of the DRA 

provided for a 1.6 percent update to the 

composite rate component of the basic 

case-mix adjusted payment system, 

effective January 1, 2006. As a result, 

the base composite rate was increased to 

$130.40 for independent ESRD facilities 

and $134.53 for hospital-based facilities. 

For 2006, the drug add-on adjustment 

(including the growth update) was 14.5 

percent. 

3. CY 2007 Updates 

In the CY 2007 PFS final rule with 

comment period (71 FR 69681), we 

implemented the following updates to 

the basic case-mix adjusted payment 

system: 

• An update to the wage index 

adjustments to reflect the latest hospital 

wage data, including a BN adjustment of 

1.052818 to the wage index for CY 2007. 

• A method to annually calculate the 

growth update to the drug add-on 

adjustment required by section 

1881(b)(12) of the Act, as well as growth 

update to the drug add-on adjustment of 

0.5 percent for CY 2007. Therefore, 

effective January 1, 2007 the drug addon adjustment was increased to 15.1 

percent. 

In addition, section 103 of the MIEA–

TRHCA established a 1.6 percent update 

to the composite rate portion of the 

payment system, effective April 1, 2007. 

Therefore, the current base composite 

rate is $132.49 for independent facilities 

and $136.68 for hospital-based facilities. 

Also, the effect of this increase in the 

composite rate portion of the payment 

system was a reduction in the drug addon adjustment to 14.9 percent, effective 

April 1, 2007. Since the statutory 

increase only applied to the composite 

rate, this adjustment to the drug add-on 

percent was needed to maintain the 

drug add-on amount constant. 

4. Provisions of This Proposed Rule 

For CY 2008, we are proposing the 

following updates to the composite rate 

payment system: 

• A growth update to the drug add-on 

adjustment to the composite rates; and 

• An update to the wage adjustment 

to reflect the latest available wage data, 

and a revised budget neutrality 

adjustment. 

a. Proposed 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. 

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 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 

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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 CY 

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 

remained constant. 

(i) Estimating Growth in Expenditures 

for Drugs and Biologicals for CY 2008 

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

specifies that the drug update must 

reflect ‘‘the estimated growth in 

expenditures for drugs and biologicals 

(including erythropoietin) that are 

separately billable * * * ’’ By referring 

to ‘‘expenditures’’, we believe the 

statute contemplates that the update 

would account for both increases in 

drug prices, as well as increases in 

utilization of those drugs. 

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 are proposing to 

continue using this methodology to 

update the drug add-on adjustment. As 

we indicated in the CY 2007 PFS final 

rule with comment period, we believe 

the PPI is a reasonable measure of drug 

pricing growth, and when used in 

conjunction with an estimate of per 

patient growth in drug utilization, this 

measure provides a simple and accurate 

approach to updating the drug add-on 

that could be readily used in subsequent 

years. Moreover, using the PPI 

significantly reduces any data bias that 

is inherent in using historical drug 

expenditure data that do not reflect 

current drug payment methodologies. 

Therefore, we established a 

mechanism for estimating the annual 

growth in expenditures for ESRD drugs 

and biologicals using the PPI for 

prescription drugs as a measure of price 

increases in conjunction with 2 years of 

historical data as a basis for estimating 

utilization growth at the per patient 

level. 

As discussed in detail below in this 

section, we are proposing to estimate 

growth in per patient utilization of 

drugs for CY 2008 by using historical 

drug expenditure data from CY 2005 

and CY 2006. However, we are 

proposing to use only drug expenditures 

data from independent ESRD facilities 

because we are unable to determine 

utilization change in hospital-based 

dialysis facilities due to the changes in 

payment methodology for these types of 

dialysis facilities from 2005 to 2006. In 

2005, payments to hospital-based 

facilities were based on cost (or a 

percentage of charges), whereas 

payments to hospital-based facilities in 

2006 were based on ASP+6 percent. 

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 were 

not accurately reported on those bills. 

As such, we are 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 

considered applying the price 

differential factor for independent ESRD 

facilities between 2005 and 2006 to the 

ESRD hospital-based facility data, but 

the result was a negative utilization 

growth. Because we have no way of 

accurately determining what portion of 

the change in drug expenditures for 

hospital-based facilities between 2005 

and 2006 is attributable to price versus 

utilization, we do not believe it would 

be appropriate to assume that the same 

price differential applicable to 

independent ESRD facility data would 

be indicative of the price change for 

hospital-based facilities between 2005 

and 2006 where expenditures moved 

from cost-based to fee schedule 

payments. Given that the drug 

expenditure data for hospital-based 

ESRD facilities only represent about 9 

percent of the total ESRD drug data, and 

we can more accurately measure the 

price difference between 2005 and 2006 

for the independent ESRD facility 

expenditure data, we believe the best 

option would be to exclude the hospitalbased ESRD facility data from the 

computation of utilization growth 

between 2005 and 2006. Under this 

option, we would impute the same 

utilization growth for hospital-based 

ESRD facilities as estimated for 

independent ESRD facilities. 

(ii) Estimating Growth in Per Patient 

Drug Utilization 

To isolate and project the growth in 

per patient utilization of ESRD drugs for 

CY 2008, we need to remove the 

enrollment and price growth 

components from the historical drug 

expenditure data and consider the 

residual utilization growth. As 

discussed previously in this section, we 

propose 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 needed to estimate the total 

drug expenditures for independent 

ESRD facilities. For this proposed rule, 

we used the final CY 2005 ESRD claims 

data and the latest available CY 2006 

ESRD facility claims, updated through 

December 31, 2006 (that is, claims with 

dates of service from January 1 through 

December 31, 2006, that were received, 

processed, paid, and passed to the 

National Claims History File as of 

December 31, 2006). For the CY 2008 

PFS final rule, we plan to use more 

updated CY 2006 claims with dates of 

service for the same time period. This 

updated CY 2006 data file will include 

claims that are received, processed, 

paid, and passed to the National Claims 

History File as of June 30, 2007. 

While the December 2006 update of 

CY 2006 claims used in this proposed 

rule is the most recently available 

claims data, we recognize that it is not 

a fully complete year as claims with 

dates of service towards the end of the 

year have not all been processed. To 

more accurately estimate the update to 

the drug add-on, we need aggregate drug 

expenditures. Based on an analysis of 

the 2005 claims data, we inflated the CY 

2006 drug expenditures to estimate the 

June 30, 2007 update of the 2006 claims 

file. We used the relationship between 

the December 2005 and the June 2006 

versions of 2005 claims to estimate the 

more complete 2006 claims that will be 

available in June 2007. We applied that 

ratio to the 2006 claims data from the 

December 2006 claims file. We did this 

separately for EPO, the other top ten 

separately billable drugs, and the 

remaining separately billable drugs for 

independent and hospital-based ESRD 

facilities. All components were then 

combined to estimate aggregate CY 2006 

ESRD drug expenditures. The net 

adjustment to the CY 2006 claims data 

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was an increase of 12 percent to the 

2006 expenditure data. This adjustment 

allows us to more accurately compare 

the 2005 and 2006 data to estimate 

utilization growth. 

The next step is to remove the 

enrollment and price growth 

components from that total. As 

discussed previously in this section, in 

developing the per patient utilization 

growth for this proposed rule, we 

limited our analysis to the latest 2 years 

of available independent ESRD facility 

drug data (that is, 2005 and 2006). We 

believe that per patient utilization 

growth between these years would be a 

better proxy for future growth, as it best 

represents current utilization trends. 

To calculate the 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 2006 independent ESRD 

facility drug expenditure data. Table 12 

shows the 2006 weights for each of the 

top ten ESRD drugs billed by 

independent ESRD facilities. 

This process led to an overall 3 

percent reduction in price between 2005 

and 2006. 

TABLE 12.—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 ................................ 5.6 

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

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

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

Iron-dextran ................................ 0.0 

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

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

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 utilization factor 

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

We observed no growth in per patient 

utilization of drugs between 2005 and 

2006. Therefore, we are projecting no 

growth in per patient utilization for all 

ESRD facilities in CY 2008. 

b. Applying the Proposed Growth 

Update to the Drug Add-on Adjustment 

In CY 2006, we applied the projected 

growth update percentage to the total 

amount of drug add-on dollars 

established for CY 2005 to come up with 

a dollar amount for the CY 2006 growth 

update. In addition, we projected the 

growth in dialysis treatments for CY 

2006 based on the projected growth in 

ESRD enrollment. We divided the 

projected total dialysis treatments for 

CY 2006 into the projected dollar 

amount of the CY 2006 growth to 

develop the per treatment growth 

update amount. This growth update 

amount, combined with the CY 2005 per 

treatment drug add-on amount, resulted 

in an average drug add-on amount per 

treatment of $18.88 (or a 14.5 percent 

adjustment to the composite rate) for CY 

2006. 

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 (71 FR 69684). 

For CY 2008, we are proposing to 

update the per treatment drug add-on 

amount of $19.64 established in CY 

2007 and convert the update to an 

adjustment factor as specified in section 

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

in the CY 2007 PFS proposed rule (71 

FR 49007) and adopted in the CY 2007 

PFS final rule with comment period (71 

FR 69683), we believe this approach is 

more accurate than using an estimate of 

growth in treatments to determine the 

per treatment add-on adjustment each 

year. 

c. Proposed Update to the Drug Add-on 

Adjustment 

As discussed previously in this 

section, we estimate no growth in per 

patient utilization of ESRD drugs for CY 

2008. Using the projected CY 2008 PPI 

for prescription drugs of 3.66 percent, 

we are projecting that the combined 

growth in per patient utilization and 

pricing for CY 2008 would result in an 

update equal to 3.66 percent (1.0 * 

1.0366 = 1.0366). This update factor 

would be applied to the CY 2007 

average 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 CY 2007 drug add-on 

percentage. Thus, the total proposed 

drug add-on adjustment to the 

composite rate for CY 2008, including 

the growth update, would be 15.5 

percent (1.149 * 1.005 = 1.155). 

We propose to continue to use this 

method to estimate the growth update to 

the drug add-on component of the casemix 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 CY 2010. We intend to 

reevaluate our methodology for 

estimating the growth update at that 

time. 

d. Proposed Update to the Geographic 

Adjustments to the Composite Rates 

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

amended by section 623(d) of the MMA, 

gave the Secretary the authority to 

revise the wage indexes previously 

applied to the ESRD composite rates. 

The wage indexes 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. 

(i) Updates to Core-Based Statistical 

Area (CBSA) Definitions 

In the CY 2006 PFS final rule with 

comment period (70 FR 70167), we 

announced our adoption of the OMB’s 

CBSA-based geographic area 

designations to develop revised urban/ 

rural definitions and corresponding 

wage index values for purposes of 

calculating ESRD composite rates. 

OMB’s CBSA-based geographic area 

designations were described in OMB 

Bulletin 03–04, originally issued June 6, 

2003, and available online at 

www.whitehouse.gov/omb/bulletins/ 

b03–04.html. In addition, OMB 

published subsequent bulletins 

regarding CBSA changes, including 

changes in CBSA numbers and titles. 

We wish to clarify 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. 

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(ii) Updated Wage Index Values 

In the CY 2007 PFS final rule with 

comment period (71 FR 69685), we 

stated that we intend to update the 

ESRD wage index values annually. 

Current ESRD 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. 

The methodology for calculating the 

CY 2006 ESRD wage index values was 

described in the CY 2006 PFS final rule 

with comment period (70 FR 70168). We 

propose to use the same methodology 

for CY 2008, with the exception that FY 

2004 hospital data will be used to 

develop the CY 2008 wage index values. 

For a detailed description of the 

development of the proposed CY 2008 

wage index values based on FY 2004 

hospital data, see the FY 2008 

‘‘Proposed Changes to the Hospital 

Inpatient Prospective Payment Systems 

(IPPS) and Fiscal Year 2008 Rates’’

proposed rule (72 FR 24680). Section III 

G. (Computation of the Proposed FY 

2008 Unadjusted Wage Index) of the 

preamble to that proposed 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 Proposed 

Rule Occupational Mix Adjusted and 

Unadjusted Average Hourly Wage and 

Pre-reclassified Wage Index by CBSA’’. 

(A) 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 wage 

adjusted payment rate for the transition 

year involved. 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 is shown in Table 13. In 

CY 2006, the first year of the transition, 

we implemented a 75/25 blend. In CY 

2007, the second year of the transition, 

we implemented a 50/50 blend. 

Consistent with the transition blends 

announced in the CY 2006 PFS final 

rule with comment period (70 FR 

70170), we are proposing a 25/75 blend 

between an ESRD facility’s MSA-based 

composite rate, and its CY 2008 CBSAbased rate reflecting its revised wage 

index values. 

In CY 2006, we also eliminated the 

wage index cap of 1.30, and stated that 

we would implement a gradual 

reduction in the wage index floor of 

0.90. Prior to January 1, 2006, the wage 

indexes were restricted to values no less 

than 0.90 and no greater than 1.30, 

meaning that payments to facilities in 

areas where labor costs fell below 90 

percent of the national average, or 

exceeded 130 percent of that average, 

were not adjusted beyond the 90 percent 

or 130 percent level. Although we stated 

that the ESRD wage index values should 

not be constrained by the application of 

floors and ceilings, we also expressed 

concern that the immediate elimination 

of the floor could adversely affect ESRD 

beneficiary access to care. Therefore, we 

reduced the floor to 0.85 in CY 2006, 

and to 0.80 in CY 2007. 

For CY 2008, we are proposing to 

reduce the wage index floor to 0.75. As 

we stated in the CY 2006 PFS final rule 

with comment period (70 FR 70169 

through 70170), we intended to reassess 

the continuing need for a wage index 

floor in CY 2008 and CY 2009. For the 

third year of the transition, we believe 

that a reduction to 0.75 is appropriate as 

we continue to reassess the need for a 

wage index floor for future years. We 

believe that a gradual reduction to the 

wage index floor is needed to ensure 

patient access to dialysis in areas that 

have low wage index values, especially 

Puerto Rico, where payments would 

decrease significantly if the floor was 

eliminated. 

The proposed wage index floors, caps, 

and blended shares of the composite 

rates applicable to all ESRD facilities 

during CY 2008 through CY 2009 are 

shown in Table 13. They are identical 

to the values shown in Table 4 of the CY 

2007 PFS final rule with comment 

period (71 FR 69686) for the applicable 

years. 

TABLE 13.—WAGE INDEX TRANSITION BLEND

CY payment Floor Ceiling Old MSA 

(percent) 

New CBSA 

(percent) 

2006 .............................. 0.85 None ............................................................................................................. 75 25 

2007 .............................. 0.80 None ............................................................................................................. 50 50 

2008 .............................. *0.75 None ............................................................................................................. 25 75 

2009 .............................. Reassess None ............................................................................................................. 0 100 

*Each wage index floor is multiplied by a BN adjustment factor. For CY 2008, the BN adjustment is 1.054955 resulting in an actual wage index 

floor of 0.7912. 

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 CBSA 

based 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 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. 

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(B) 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 on which to 

base the calculations of the CY 2006 

ESRD wage index values. Our CY 2006 

policy and CY 2007 proposals for each 

area are discussed separately below in 

this section. 

The first situation is rural 

Massachusetts. Because in CY 2006 we 

had not determined a reasonable proxy 

for rural data within Massachusetts, we 

used the prior year’s acute care hospital 

wage index value for rural 

Massachusetts. For CY 2007, we 

continued to use this value and 

requested public input on an alternative 

methodology as described below in this 

section. We described an alternative 

methodology whereby we would impute 

a rural wage index value by using a 

simple average CBSA-based rural wage 

index value at the Census Division 

level. 

The second situation involves Puerto 

Rico. Rural Puerto Rico is similar to 

rural Massachusetts in that there are no 

acute care hospitals, and therefore, no 

hospital data. However, for ESRD 

facilities in rural Puerto Rico, the CY 

2007 ESRD wage index floor value 

(0.8000) was applied to rural Puerto 

Rico ESRD facilities. All areas in Puerto 

Rico that have a wage index are eligible 

for the ESRD wage index floor because 

they have wage index values that are 

below 0.8000. Accordingly, for CY 2007, 

we applied the ESRD wage index floor 

value to rural Puerto Rico. 

The third situation involves an urban 

area in Hinesville, GA (CBSA 25980). As 

with the rural areas noted previously in 

this section, there are no available 

hospital wage index data as there are no 

urban hospitals within that CBSA. For 

CY 2007, we used a wage index value 

based on wage index values in all of the 

other urban areas within the same State 

to serve as a reasonable proxy for the 

urban areas without hospital wage index 

data. Specifically, for CY 2007, we used 

the average wage index value for all 

urban areas within the State of Georgia 

as the urban wage index for purposes of 

calculating the ESRD wage index value 

for Hinesville. 

In CY 2007, we received no comments 

on maintaining the policies used in CY 

2006 for establishing ESRD wage index 

values for rural and urban areas without 

hospitals, or an alternative approach for 

developing wage index values for rural 

areas without hospitals for CY 2007 and 

subsequent years. Therefore, for CY 

2007, we maintained the policies used 

in CY 2006 for establishing ESRD wage 

index values for rural and urban areas 

without hospital data. 

For CY 2007, the Home Health PPS 

(71 FR 65884 through 65905) adopted 

an alternative approach using the 

average wage index from all contiguous 

CBSAs to represent a reasonable proxy 

for the rural areas without hospital wage 

index data. Because we have used the 

same wage index value (from CY 2005) 

for rural Massachusetts for both, CY 

2006 and CY 2007, we believe it is now 

appropriate to consider another 

methodology as a proxy for rural areas 

lacking hospital wage index data. We 

believe that use of contiguous areas is a 

valid proxy as it meets our criteria for 

imputing a wage index. This approach 

uses pre-floor, pre-reclassified hospital 

wage data, is easy to evaluate, can be 

updated from year-to-year, and uses the 

most local data available. 

Therefore, in cases where there is a 

rural area without hospital wage data, 

we propose to use the average wage 

index from all contiguous CBSAs to 

represent a reasonable proxy for that 

rural area. As was the case in previous 

years, this proposed policy impacts 

rural Massachusetts. 

In determining an imputed rural wage 

index, we interpret the term 

‘‘contiguous’’ to mean sharing a border. 

For example, in the case of 

Massachusetts, the entire rural area 

consists of Dukes and Nantucket 

counties. We have determined that the 

borders of Dukes and Nantucket 

counties are ‘‘contiguous’’ with 

Barnstable and Bristol counties. Under 

the proposed methodology, the wage 

indexes 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 

an imputed rural wage index of 1.1665 

for rural Massachusetts for CY 2008. 

While we believe that this policy could 

be readily applied to other rural areas 

that lack hospital wage data (possibly 

due to hospitals converting to a different 

provider type, such as a CAH, that does 

not submit the appropriate wage data), 

should a similar situation arise in the 

future, we may reexamine this policy. 

As we stated previously in this 

section, rural Puerto Rico is similar to 

rural Massachusetts in that there are no 

acute care hospitals, and therefore, no 

hospital wage index data. However, for 

ESRD facilities in rural Puerto Rico we 

propose to use the proposed CY 2008 

ESRD wage index floor value (0.7500) as 

a proxy for the hospital wage index 

data. Accordingly, all areas in Puerto 

Rico that have a wage index are eligible 

for the ESRD wage index floor value 

because they have wage index values 

that are below 0.7500. We continue to 

believe that this approach is an 

appropriate proxy for rural Puerto Rico 

because it ensures a rural Puerto Rico 

wage index value consistent with all 

other areas in Puerto Rico. Thus, 

consistent with previous years, for CY 

2008, we propose to continue to apply 

the ESRD wage index floor value 

(0.7500) to rural Puerto Rico. 

We also propose the following 

approach with regard to an urban area 

lacking hospital wage index data, 

specifically, Hinesville, GA (CBSA 

25980). Again, under CBSA 

designations there are no urban 

hospitals within that CBSA. For CY 

2006 and CY 2007, we used all of the 

urban areas within the State to serve as 

a reasonable proxy for the urban area 

without specific hospital wage index 

data. Specifically, we used the average 

wage index value for all urban areas 

within the State of Georgia as the urban 

wage index for purposes of calculating 

the value for Hinesville for CY 2007. 

We propose to continue this approach 

for urban areas without specific hospital 

wage index data. Specifically, for CY 

2008, we are proposing to continue 

using this method for Hinesville, GA 

(CBSA 25980). Therefore, the wage 

index for urban CBSA (25980) 

Hinesville-Fort Stewart, GA is 

calculated as the average wage index of 

all urban areas in Georgia. 

We solicit comments on these 

approaches to calculating the wage 

index values for areas without hospital 

wage index data for FY 2008 and 

subsequent years. We will also 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 where hospital wage data are not 

available may be feasible. 

(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. As 

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we are not proposing any changes to the 

case-mix measures for CY 2008, the 

current case-mix BN adjustment will 

remain in effect for CY 2008. For CY 

2008, we again propose to apply a BN 

adjustment factor (1.054955) 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 factor 

based on that proportion (53.711 

percent). 

To compute the proposed CY 2008 

wage index BN adjustment factor 

(1.054955), we used the wage index 

values in Addenda G and H, 2006 

outpatient claims (paid and processed 

as of December 31, 2006), and 

geographic location information for each 

facility which may be found through 

Dialysis Facility Compare Web page on 

the CMS Web site at http:// 

www.cms.hhs.gov/ 

DialysisFacilityCompare/. 

Using 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 new 

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 wage 

index shown in Addenda G and H, will 

result in payments to each facility that 

will remain within the target amount of 

composite rate expenditures when 

totaled for all ESRD facilities. The 

proposed BN adjustment factor for the 

CY 2008 wage index is 1.054955. 

To ensure BN, we also must apply the 

BN adjustment factor to the proposed 

wage index floor of 0.7500 which results 

in a proposed adjusted wage index floor 

of 0.7912(0.7500 × 1.054955) for CY 

2008. 

(iv) ESRD Wage Index Tables 

The proposed 2008 wage index tables 

are located in Addenda G and H. 

I. Independent Diagnostic Testing 

Facility (IDTF) Issues 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘IDTF ISSUES’’ at the beginning 

of your comments.] 

In the CY 2007 PFS final rule with 

comment period, we established 14 

performance standards and several other 

provisions at § 410.33(g) associated with 

independent diagnostic testing facilities 

(IDTFs). In this proposed rule, we are 

clarifying our interpretation of several of 

the performance standards at § 410.33(g) 

to assist the public in understanding 

how we expect our designated 

contractors to implement these 

standards. In addition, we are proposing 

several new performance standards and 

other provisions associated with IDTFs. 

1. Proposed Revisions of Existing IDTF 

Performance Standards 

a. § 410.33(g)(6) 

The supplier standard at 

§ 410.33(g)(6) states, ‘‘Has a 

comprehensive liability insurance 

policy in the amount of at least 

$300,000 that covers both the supplier’s 

place of business and all customers and 

employees of the supplier. The policy 

must be carried by a nonrelative-owned 

company.’’ We are proposing to revise 

this standard to read, ‘‘Has a 

comprehensive liability insurance 

policy in the amount of at least 

$300,000 per incident 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. The IDTF 

must list the Medicare contractor as a 

Certificate Holder on the policy and 

promptly notify the Medicare contractor 

in writing of any policy changes or 

cancellations. 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.’’ This 

proposed rule clarifies how we will 

verify whether an IDTF meets this 

standard to include the provision that 

IDTF suppliers are responsible for 

providing the contact information of an 

individual employed with the 

underwriter, who can verify coverage. 

This proposed revision will not 

preclude the use of self insurance to 

demonstrate compliance with the 

comprehensive liability insurance 

policy as long as CMS or our designated 

contractor can verify the policy and its 

coverage provisions with an 

independent underwriter. 

We believe that we should be able 

verify the issuance of a comprehensive 

liability insurance policy with an 

underwriter, as well as an insurance 

agent. This approach will allow our 

designated contractors to verify that a 

comprehensive liability insurance 

policy has been issued and is in effect 

at the time of enrollment and 

throughout the enrollment period. 

Moreover, since 90 days may pass 

before the underwriter receives 

notification the policy has been issued 

by the insurance agent or broker, we 

encourage IDTFs to obtain 

comprehensive liability insurance at 

least 90 days prior to filing its Medicare 

enrollment application. This will 

prevent delays in the enrollment 

process and will allow our designated 

contractors to verify the issuance of an 

IDTF’s comprehensive liability 

insurance policy on the day an 

application is submitted for review. 

As a result, at § 410.33(g)(6), we are 

proposing to revise this performance 

standard to include the requirement that 

an IDTF must list our designated 

contractor as a Certificate Holder on the 

policy. By listing our designated 

contractor as a Certificate Holder on the 

policy, our contractor will be able to 

verify coverage with the underwriter at 

the time of enrollment and as the need 

arises throughout the year. 

Therefore, we are also proposing to 

revise § 410.33(g)(6) to state that it is the 

IDTF supplier’s responsibility to: (1) 

Ensure that the insurance policy must 

remain in force at all times and provide 

coverage of at least $300,000 per 

incident; and (2) promptly notify the 

CMS designated contractor in writing of 

any policy changes and cancellations. 

b. § 410.33(g)(2) 

Based on feedback that we received 

after the implementation of 

§ 410.33(g)(2), we believe that several 

changes are necessary to ensure timely 

reporting of certain events and less 

frequent reporting of reportable events. 

Accordingly, we are proposing to 

change § 410.33(g)(2) from, ‘‘Provides 

complete and accurate information on 

its enrollment application. Any change 

in enrollment information must be 

reported to the designated fee-forservice contractor on the Medicare 

enrollment application within 30 

calendar days of the change,’’ to 

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‘‘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 within 30 calendar 

days of the change. All other reportable 

changes must be reported within 90 

days.’’

c. § 410.33(g)(8) 

We are proposing to revise 

§ 410.33(g)(8) from ‘‘Answer 

beneficiaries’ questions and respond to 

their complaints,’’ to, ‘‘Answer, 

document, and maintain documentation 

of beneficiaries’ questions and 

responses to their complaints at the 

physical site of the IDTF.’’ This change 

corrects an oversight in drafting of the 

initial performance standards for IDTFs. 

In the CY 2007 PFS final rule with 

comment period, we did not include a 

requirement for the documentation of 

the complaint process. Thus, by making 

this proposed change, we are proposing 

to require an IDTF to document its 

complaint process. We believe that this 

change is consistent with the 

established practice for durable medical 

equipment, prosthetics orthotics and 

supplies (DMEPOS) suppliers found in 

§ 424.57(c)(19). To meet this revised 

standard, an IDTF would be responsible 

for maintaining the following 

information on all written and oral 

beneficiary complaints, including 

telephone complaints, it receives: 

• The name, address, telephone 

number, and health insurance claim 

number of the beneficiary. 

• A summary of the complaint; the 

date it 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 

making the decision and the reason for 

the decision. For mobile IDTFs, this 

documentation would be stored at their 

home office. 

d. § 410.33(b)(1) 

At § 410.33(b)(1), we are proposing to 

delete, ‘‘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 believe that our earlier 

rulemaking effort had the unintended 

consequence of appearing to shift the 

overall administrative responsibility 

from owners or administrative staff 

employed by an IDTF to the supervising 

physician. This was not our intent. 

Moreover, we believe that this 

requirement can be interpreted as being 

too restrictive as it is currently written 

and may convey responsibilities to a 

general supervising physician who may 

not have the administrative authority or 

knowledge to make these decisions. We 

are proposing to clarify and expand on 

our meaning of what constitutes three 

IDTF sites found at § 410.33(b)(1). We 

believe that limitation on sites applies 

to both fixed sites and mobile units. 

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. For 

example, we believe that a physician 

providing general supervision could 

oversee up to three individual IDTF 

mobile units or three individual fixed 

location IDTFs, or a combination of both 

that total up to three separate places 

which can concurrently run diagnostic 

tests. This does not change the 

requirements found at § 410.32(b)(3) for 

direct and personal supervision. 

2. Proposed New IDTF Standards 

At § 410.33(i), we are proposing to 

add a provision to state that Medicare 

will establish an initial enrollment date 

for IDTFs. Currently, IDTFs can 

retroactively bill Medicare for services 

that are rendered before they submitted 

a Medicare enrollment application or 

were approved to participate in the 

Medicare program. This means an IDTF 

is allowed to bill Medicare for services 

rendered on dates prior to the date the 

IDTF was enrolled in the Medicare 

program. For example, if an IDTF 

submits a Medicare enrollment 

application in November 2007 and is 

enrolled in the Medicare program in 

December 2007, then a physician or 

supplier could retrospectively bill for 

services furnished to Medicare 

beneficiaries as far back as October 1, 

2005; indeed, an IDTF may bill 

Medicare for services rendered up to 27 

months prior to their Medicare 

enrollment date. This means that an 

IDTF in the example that is enrolled as 

meeting our program requirements in 

December 2007 may not have met those 

same requirements prior to the date of 

enrollment, even though the IDTF could 

bill Medicare and receive payments for 

services rendered up to 27 months prior 

to their enrolling in the Medicare 

program. 

We are concerned that some IDTFs 

may bill Medicare for services when 

they do not meet all of the program 

requirements, including compliance 

with the performance standards at 

§ 410.33(g). Allowing an IDTF to bill 

Medicare for services furnished prior to 

being enrolled in the Medicare program, 

creates a significant risk for the 

Medicare program and its beneficiaries. 

Specifically, we believe that allowing an 

IDTF to bill for services furnished prior 

to enrolling in the Medicare program 

allows these facilities to potentially be 

reimbursed for services they are not 

qualified to perform or for which they 

otherwise may be precluded from 

billing to the Medicare program. 

Since Medicare FFS contractors verify 

enrollment information at the time an 

enrollment application is filed, not for 

prior periods, we do not believe that it 

is appropriate to continue the practice 

of allowing IDTFs to bill the Medicare 

program for services rendered in periods 

prior to their enrollment in the 

Medicare program. Therefore, we are 

proposing to add § 410.33(i) to state that 

Medicare 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 FFS 

contractor; or (2) the date an IDTF first 

started rendering services at its new 

practice location. We also propose to 

define 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 contractor rejects or 

denies and enrollment application, the 

new date of filing would be established 

when an IDTF submits a new 

enrollment application that the 

contractor is able to process for 

approval. Please note that we expect to 

implement a Web-based enrollment 

process known as the Provider 

Enrollment, Chain, and Ownership 

System (PECOS) process, to be known 

as PECOS Web, in most States during 

the 2007 calendar year. This internet 

enrollment process will permit IDTFs to 

complete and submit enrollment 

applications online. The date of filing 

for applications submitted through 

PECOS Web will be the date the 

Medicare FFS 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 FFS 

contractor processes to approval. 

Further, our proposed policy is 

consistent with current Medicare 

payment policy of precluding payment 

for services until the provider or 

supplier of service establishes that they 

meet enrollment and certification 

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requirements prior to being eligible to 

bill the Medicare program. 

While this change limits the 

retrospective payments that an IDTF 

may obtain from Medicare program, we 

believe that this approach is consistent 

with our existing requirements for those 

providers that require a State survey 

prior to being enrolled as specified in 

§ 489.13 and the requirements followed 

by DMEPOS suppliers as established in 

section 1834(j)(1) of the Act and 

§ 424.57(b)(2). Moreover, this change 

would ensure that we are 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. 

We are also proposing a new 

performance standard at § 410.33(g)(15), 

which states, ‘‘Does not share space, 

equipment, or staff or sublease its 

operations to another individual or 

organization.’’ We believe that it is 

inappropriate for a fixed-base (physical 

site) IDTF to commingle office space, 

staff, and equipment, and that 

commingling office space, staff and 

equipment or subleases its fixed-base 

(physical site) operation to another 

individual or organization constitutes a 

significant risk to the Medicare program 

because it prohibits CMS or our 

contractors from ensuring that each 

fixed-base (physical site) IDTF 

establishes and maintains Medicare 

billing privileges consistent with the 

provisions at § 424.500 and each IDTF 

meets and maintains all performance 

standards and other requirements under 

§ 410.33. While we believe that this new 

performance standard should only 

apply to fixed-base (physical site) IDTF 

locations, we are seeking public 

comments on establishing a similar 

requirement for mobile IDTFs. This 

proposed standard, in conjunction with 

the existing IDTF performance standard 

three (concerning appropriate sites for 

an IDTF), expands the interpretation of 

these standards to state that a motel, or 

hotel is not an appropriate site for an 

IDTF. While we initially believed that 

this new performance standard should 

apply to only fixed-based (physical site) 

locations, we also believe it should 

apply to mobile IDTFs, but we are 

seeking public comment on establishing 

this requirement. 

We believe that allowing fixed-base 

(physical site) IDTFs to commingle 

office space (including waiting rooms), 

staff (including supervising physicians, 

nonphysician personnel, or 

receptionists), or equipment through 

subleasing agreements may allow an 

IDTF to circumvent Medicare 

enrollment and billing requirements. 

These types of arrangements also raise 

concerns because they may implicate 

the physician self-referral prohibition 

and the anti-kickback prohibition. 

J. Expiration of MMA Section 413 

Provisions for Physician Scarcity Areas 

(PSAs) 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘PHYSICIAN SCARCITY 

AREAS’’ at the beginning of your 

comments.] 

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 January 1, 2008, 

we are providing notification that these 

5 percent incentive payments will no 

longer be made for services furnished on 

or after January 1, 2008. 

K. Comprehensive Outpatient 

Rehabilitation Facility (CORF) Issues 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘CORF ISSUES’’ at the 

beginning of your comments.] 

Section 4541(a) of the Balanced 

Budget Act of 1997 (Pub. L. 105–33) 

(BBA), related to prospective payment 

for outpatient rehabilitation services, 

established section 1832(a)(2)(E) of the 

Act for all comprehensive outpatient 

rehabilitation facility (CORF) services, 

not just rehabilitation services of 

outpatient physical therapy services 

(including outpatient speech-language 

pathology (SLP) services), and 

outpatient occupational therapy 

services. The BBA also amended 

sections 1833 and 1834 of the Act to 

provide that all CORF services (as 

defined under section 1861(cc)(1) of the 

Act) furnished on or after January 1, 

1999 would no longer be paid on a 

‘‘reasonable cost’’ basis but instead 

would be paid based on the applicable 

fee schedule amount (or if less, based on 

the actual charge for the services). 

Where there is no applicable fee 

schedule amount, payment would be 

based on a comparable service or, if less, 

the CORF’s actual charge for the service. 

Specifically, section 1834(k)(1)(B) of the 

Act states that the payment basis for 

outpatient physical therapy services 

(including outpatient SLP services), 

outpatient occupational therapy 

services, and all other CORF services 

provided on or after January 1, 1999 will 

be 80 percent of the lesser of: (i) The 

actual charge for the services; or (ii) 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.’’

In the CY 1999 PFS final rule (63 FR 

58860), we stated that we would base 

payment for a CORF service on the PFS 

amount for the service when the PFS 

established a payment amount for such 

service. We further explained that we 

would use the higher PFS amount 

applicable to services furnished in a 

nonfacility setting, rather than the 

facility payment amount, because no 

separate payment will be made for 

facility costs. The nonfacility payment 

rate includes, along with any physician 

work and MP RVUs, the PE RVUs 

representing nonfacility resources 

necessary for the physician to perform 

each service in the office setting, 

including both direct and indirect PE 

inputs, such as the costs of clinical 

labor, disposable supplies, personnel 

salaries, equipment, and overhead 

expenses. The facility payment rate is 

based primarily on the physician work 

and MP RVUs, although it contains 

RVUs for the indirect PE RVUs related 

to the primary providing specialties, but 

does not include the costs of the direct 

PE inputs (that is, clinical labor, 

disposable supplies, and equipment) 

that are utilized when the service is 

provided in the physician office or 

nonfacility setting. Payment at the 

higher nonfacility payment rate was 

already in place prior to CY 1999 for 

physical therapy, occupational therapy, 

and speech-language pathology (SLP) 

services provided in the physician’s 

office and for the services of physical 

therapists (PTs) and occupational 

therapists (OTs) in private practice. 

Effective with the CY 1999 PFS final 

rule, we used the PFS nonfacility 

amount to make payment for outpatient 

Part B physical therapy, occupational 

therapy, and SLP services furnished in 

provider settings, including outpatient 

hospitals, SNFs, providers of outpatient 

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physical therapy (OPT) and SLP 

services, also known as rehabilitation 

agencies, CORFs, and home health 

agencies (HHAs) (for non-homebound 

patients), as discussed in the CY 1999 

PFS final rule (63 FR 58860). Similarly, 

we used the PFS nonfacility amount for 

all other CORF services when the PFS 

established a payment amount for such 

service. 

In addition, in CY 1999, we 

established a fee schedule amount 

under the PFS for nursing services 

delivered within a CORF, and created a 

new HCPCS code (G0128) for such 

services. We defined this code as direct 

face-to-face skilled nursing services 

delivered to a CORF patient by a 

registered nurse (RN) as part of a 

rehabilitative therapy plan of treatment, 

billable in 10-minute intervals provided 

the initial interval is longer than 5 

minutes. We stated that the HCPCS code 

G0128 could be used for RN services 

that are not included in the work or PE 

of another therapy or physician service. 

The CORF conditions of participation at 

§ 485.58 provide that CORF services 

must be provided by personnel that 

meet the qualifications set forth in 

§ 485.70. Sections 485.70(b) and (h) 

require, respectively, that as a condition 

of coverage of service a licensed 

practical nurse (LPN) be licensed as a 

LPN or vocational nurse by the State of 

practice, and that an RN be a graduate 

of an approved school of nursing and 

licensed as an RN by the State of 

practice. In creating the HCPCS code 

G0128 for CORF nursing services, we 

determined that a condition of coverage 

for the service is that it be furnished by 

an individual who meets the personnel 

requirements for an RN because we 

believe only an RN possesses the 

necessary training to provide the 

clinical nursing services that are 

medically necessary and appropriate for 

CORF patients as they relate to the 

therapy plan of treatment. 

Finally, 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. 

Specifically, we stated that we would 

use the existing fee schedules for 

prosthetic and orthotic devices, DME 

and supplies, and drugs and biologicals 

for covered prosthetics and orthotics 

devices, durable medical equipment 

(DME) and supplies, and drugs and 

biologicals, respectively, provided by 

CORFs. 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 section II.K.7., 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 propose to 

remove drugs and biologicals from the 

scope of CORF services as defined at 

§ 410.100. 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 propose 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 if the lesser of a 

payment amount under an existing fee 

schedule or the CORF’s actual charge, 

we are proposing to add a new subpart 

M to 42 CFR Part 414 to reflect the 

change in CORF payment methodology. 

In addition, we propose to revise the 

following sections of the Medicare 

regulations to clarify the CORF benefit. 

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 

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 are not 

covered as CORF services. 

We propose 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 note 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. 

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 

propose 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 propose to 

revise our definitions of physician 

services to reflect the change in 

payment methodology for CORF 

services. We also propose to revise 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). In addition, we propose 

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revisions to the definition of supplies, 

equipment, and appliances to conform 

to the statutory provision at section 

1861(cc)(1)(G) of the Act. Finally, we 

propose 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 propose 

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 

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); and 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. We are 

proposing 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 propose 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. The physician bills 

the carrier in the same manner as if the 

services were provided in the physician 

office setting and notes the CORF as the 

place of service. 

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 are proposing 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 

propose 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. 

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 SLP services. Because respiratory 

therapists (RTs) are not recognized as 

independent practitioners in the Act or 

regulations, and respiratory therapy 

services do not have a statutory benefit 

category except as specified in the 

CORF services benefit at section 

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

payment is not made for services 

provided by RTs. Instead, RTs are most 

often employed in physician offices and 

in facility settings, such as hospitals and 

SNFs, where payment is made to the RT 

employer. 

The description of CORF respiratory 

therapy services currently includes 

some services that should be provided 

by a physician, and not an RT, and thus 

are inappropriate to include in a 

respiratory therapy plan of care. 

Therefore, we are proposing to remove 

these services from the description of 

CORF respiratory therapy services 

under § 410.100(e), and to limit these 

services to those provided by RTs under 

a respiratory therapy plan of treatment. 

Section 410.105(c) requires a physician, 

and not the RT, to provide the clinical 

diagnosis; establish and sign the 

respiratory therapy plan of treatment for 

each patient that includes the type, 

amount, frequency and duration of the 

services to be furnished; and indicate 

the diagnosis and the patient’s 

rehabilitation goals. The physician must 

also recertify this plan for medical 

necessity every 60 days or sooner if 

appropriate. However, the description of 

respiratory therapy services under 

§ 410.100(e) includes these services, as 

well as other services that under current 

clinical standards should not be 

provided by RTs, but rather should be 

entrusted to the physician. 

Therefore, we are proposing to revise 

§ 410.100(e) to limit respiratory therapy 

services to those services appropriately 

provided to CORF patients by RTs 

under a physician-established 

respiratory therapy plan of treatment in 

accordance with current medical and 

clinical standards. Specifically, we 

propose to remove from the definition of 

CORF respiratory therapy services the 

services of establishing the medical and 

therapy-related diagnosis and the 

provision of E/M services because these 

services are provided by the physician, 

as necessary, to establish the respiratory 

therapy plan of treatment. These 

services may be provided by either the 

CORF facility physician, as CORF 

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physician services or as non-CORF 

physician services, or by the patient’s 

referring physician, as appropriate. We 

also propose to remove diagnostic tests 

from the description of CORF 

respiratory therapy services since 

diagnostic tests 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 accordingly are separately 

billable by the physician under the PFS 

as previously discussed. 

In addition to RTs, we note 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. These 

G-codes were created to differentiate 

between the CORF services provided 

under a respiratory therapy plan of 

treatment from those services provided 

under physical and occupational 

therapy plans of treatment by PTs and 

OTs, respectively, under benefit 

sections 1861(p) and (g) of the Act in the 

97XXX CPT code series. Because 

physical and occupational therapy 

services are subject to the therapy caps, 

the services provided under a CORF 

respiratory therapy plan of treatment 

needed to be identified by procedure 

codes specific to these services so as not 

to be attributed to the therapy caps. 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. We are 

proposing to revise the description of 

respiratory therapy services to remove 

those services appropriately provided 

by the physician establishing the 

respiratory therapy plan of treatment. In 

addition, we have determined 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 

will 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. 

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. 

Currently, the 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 the 

current definitions of CORF social and 

psychological services are too broad. As 

discussed above in this section, we 

propose 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 

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 propose 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 regulations at § 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 are proposing 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, SLP, or 

respiratory therapy plan of treatment. In 

addition, we propose 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 are proposing to revise 

the description of social and 

psychological services in § 410.100(h), 

we are interested in receiving comments 

concerning the CORF personnel 

qualifications in the conditions of 

participation at § 485.70(l) and (g) for 

social workers and psychologists, 

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 these covered services 

to directly relate to the patient’s 

rehabilitation treatment plan, we are 

inviting 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. 

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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 rehabilitative 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, 

we are proposing 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. Consequently, in 

addition to the above proposal, we are 

also asking for comments on the 

appropriateness of the personnel 

qualification standards at § 485.79(b) 

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

respectively. 

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 section 

§ 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 treatment plan. 

In addition, we are concerned about 

duplicate payment for drugs and 

biologicals provided to CORF patients 

in the CORF setting. Drugs and 

biologicals provided to CORF patients 

by CORF physicians or RNs under the 

supervision of a physician are 

considered services and supplies 

furnished incident to a physician’s 

professional services under section 

1861(s)(2)(A) of the Act, and therefore, 

may be paid to the physician in 

accordance with section 1847(A) of the 

Act. Physicians bill the carrier for such 

incident to services. If such drugs and 

biologicals also considered CORF 

services, the CORF could submit a claim 

for the same drugs and biologicals to the 

fiscal intermediary for payment. If 

physicians and CORFs each were able to 

bill for drugs and biologicals that are 

provided in the CORF setting, we 

believe there is a risk of duplicative 

payments for the same drugs and 

biologicals—one payment to the CORF 

and one payment to the physician by 

the carrier. Such duplicative billing 

would be difficult for us to detect given 

that CORFs bill the fiscal intermediary 

for CORF services while physicians bill 

the carrier for physician services. 

While we recognize that drugs and 

biologicals are enumerated as CORF 

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

Act, we do not believe that drugs and 

biologicals are appropriately provided 

under rehabilitation therapy plans of 

treatment. Therefore, we propose to 

remove § 410.100(k). 

We invite comments on this proposal. 

We are especially interested in receiving 

comments on the appropriateness of 

including drugs and biologicals under a 

CORF patient’s rehabilitation plan of 

treatment. 

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), is a CORF covered 

service 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 are 

proposing 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. 

We also note that DME, as well as 

prosthetics, orthotics, and supplies, 

provided in the CORF setting requires 

the CORF’s participation in the 

competitive bidding, where applicable, 

in accordance with 42 CFR part 414 

subpart F. 

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. We note 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 SLP 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 propose to do so now. 

Therefore, we are proposing to clarify 

the regulations at new § 410.100(l) (that 

is, the current § 410.100(m) is 

redesignated as § 410.100(l)) and 

§ 410.105(b)(3) to reflect these 

requirements. 

In § 410.105(b)(3), we propose to 

clarify that physical therapy, 

occupational therapy and SLP 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 propose 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 speechlanguage pathologist, as appropriate, 

because we believe that the patient’s 

presence is necessary to fully evaluate 

the potential impact of the home 

situation on the patient’s rehabilitation 

goals. 

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 

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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 SLP services), 

outpatient occupational therapy 

services, and all other CORF services 

provided on or after January 1, 1999 be 

80 percent of the lesser of: (i) The actual 

charge for the services; or (ii) the 

applicable fee schedule amount. 

Therefore, we are proposing to remove 

§ 413.1(a)(2)(iv) to clarify that cost-based 

payment is not applicable to services 

provided in the CORF setting. We are 

also proposing 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 SLP services effective for 

CY 1999. 

11. Payment for Comprehensive 

Outpatient Rehabilitation Facility 

(CORF) Services 

We are proposing 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 § 414.1101 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: (i) The actual charge for the services; 

or (ii) 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 propose at 

new § 414.1101(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, SLP, 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, we propose at 

new § 414.1101(c) that we use the 

existing fee schedules for prosthetic and 

orthotic devices, DME and supplies for 

covered DMEPOS provided by CORFs. 

Specifically, we propose 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 propose at new 

§ 414.1101(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 sections II.K.7. and 

II.K.12., we propose to remove drugs 

and biologicals from the scope of CORF 

services as defined under § 410.100. 

Therefore, we propose not to include 

payment for drugs and biologicals under 

§ 414.1101. 

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 practice expenses 

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, SLP, and 

respiratory 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 propose at § 414.1001(b) not to 

separately pay CORFs for CORF 

physician services. 

To ensure that CORFs are not paid 

twice for CORF services, we propose at 

new § 414.1101 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. For example, 

under the PFS, disposable supplies 

generally are included in the PE RVUs 

representing the resources necessary to 

perform the service in the nonfacility 

setting, and thus are included in the 

payment amount for each service and 

cannot be billed separately. 

Accordingly, under proposed 

§ 414.1001(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 note 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. These splint and cast supplies are 

currently paid using the HCPCS code 

series Q4001 through Q4051 which 

were established to make separate 

payment under section 1861(s)(5) of the 

Act for surgical dressings, and splint 

and cast materials. In the CORF setting, 

the splint and cast supplies may be 

applicable for certain cast/strapping 

application procedures in the CPT code 

series 29000 through 29750. We would 

note 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 

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established under the PFS for the 

provided services. 

For CORF services based on the 

payment amount determined under the 

PFS, we propose at new § 414.1101(a)(2) 

to use the PFS amount applicable to 

services furnished in a nonfacility 

setting, with no separate payment made 

for facility costs. The nonfacility 

payment rate includes, along with any 

physician work and malpractice RVUs, 

the PE RVUs representing the resources 

necessary to perform each service in the 

nonfacility setting, such as overhead 

expenses and personnel salaries and the 

direct costs of clinical labor, disposable 

supplies, and equipment. In contrast, 

the facility payment rate is based 

primarily on the physician work and 

malpractice RVUs, as well as RVUs for 

indirect PE incurred by the physician, 

and does not include the cost of the 

direct PE associated with providing 

each service in the physician office or 

nonfacility setting. We propose to use 

the PFS nonfacility amount for CORF 

services in order to offset any costs of 

providing such services in the CORF 

setting. 

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, we note 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 propose 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). 

We are interested in receiving 

comments on this proposal. 

L. Compendia for Determination of 

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

an Anti-cancer Chemotherapeutic 

Regimen (§ 414.930) 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRUG COMPENDIA’’ at the 

beginning of your comments.] 

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 

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

2007.) 

Section 6001(f)(1) of the 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 have suggested that 

the Secretary consider elimination of 

certain listed compendia. However, 

there is no established regulatory 

process by which the agency can 

currently accept and act definitively on 

such requests. In addition, there is 

currently no transparency about the 

criteria upon which we could base a 

decision. Therefore, we are seeking 

public input on this topic. 

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 EPC’s 

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 

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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 throughput 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 this 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 believe 

that the notice and comment period of 

this proposed rule will provide the 

opportunity for the public to present its 

concerns regarding this process. We 

encourage all interested parties to 

submit their comments via the process 

mentioned in the SUPPLEMENTARY

INFORMATION section of this 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 propose to create a 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. Requests may be for addition 

or deletion of a compendium from the 

list. 

We will use the following process to 

receive and make determinations 

regarding requests for changes to the list 

of compendia: 

• For the purposes of this section, the 

notice may be accomplished by posting 

the information on the CMS Web site. 

This does not preclude us from using 

other reasonable means at our 

discretion. We believe this will facilitate 

a timely and efficient consideration of 

requests. 

• We will issue annually a notice for 

requests to revise the list of compendia. 

This notice will be published and will 

specify a 30-day time period within 

which we will accept any external 

requests that are complete, as defined in 

this section. To allow sufficient time for 

the public to be notified, we will begin 

the acceptance process for external 

requests no sooner than 45 days after 

publication of the notice. We believe 

that this will enhance the administrative 

efficiency of this process without 

placing a significant burden on the 

public. 

• We will publish a listing of the 

timely complete request(s) received and 

allow the public 30 days to submit 

comments on the request(s). The listing 

will identify the requestor and the 

requested addition or deletion to the list 

of compendia. 

• A complete request must include 

the following: 

+ The full name and contact 

information (including the mailing 

address, e-mail address, and telephone 

number) of the requestor. If the 

requestor is not an individual person, 

the information shall identify the officer 

or other representative who is 

authorized to act for the requestor on all 

matters related to the request. 

+ 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. 

+ A complete written copy of the 

compendium that is the subject of the 

request. If the complete compendium is 

available electronically, it may be 

submitted electronically in place of hard 

copy. If the compendium is available 

online, the requestor may provide us 

with electronic access by furnishing at 

no cost to the Federal government 

sufficient accounts for the purposes and 

duration of the review of the application 

in place of hard copy. 

+ The specific action that the 

requestor wishes CMS to take, for 

example to add or delete a specific 

compendium. 

+ Detailed, specific documentation 

that the compendium that is the subject 

of the request does or does not comply 

with the conditions of this rule. Broad, 

nonspecific claims without supporting 

documentation cannot be efficiently 

reviewed; therefore, they will not be 

accepted. 

+ A request may have only a single 

compendium as its subject. This will 

provide greater clarity on the scope of 

the agency’s review of a given request. 

A requestor may submit multiple 

requests, each requesting a different 

action. 

+ Requests must be in writing as 

opposed to verbal. 

• Requests may be submitted in two 

ways (no duplicates please). Electronic 

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submissions are encouraged to facilitate 

administrative efficiency. We will, in 

our solicitation of requests, 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 solicitation period. We 

may internally generate a request to 

change the list of compendia at any 

time. We believe that this preserves the 

agency’s ability to act quickly if we 

determine that urgent action is needed 

to protect the interests of the Medicare 

program and its beneficiaries. 

• We will consider a compendium’s 

attainment of the MedCACrecommended desirable characteristics 

of compendia, listed above in this 

section, in reviewing requests. 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 a change in 

ownership or affiliation, 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 publish our decision 

within 120 days after the close of the 

public comment period. 

• For each compendium that we 

determine should be included on the 

list, the publisher or its designee must 

notify CMS, within 45 days from the 

publication date of each new edition or 

revision of the compendium, that a new 

edition or version is available. This will 

ensure that we have the most current 

information for each compendium. This 

may be provided electronically or via 

online access. We believe that this is 

necessary to permit us to efficiently 

ensure that the listed compendia 

continue to meet the conditions set forth 

in this rule. 

• In addition to the annual process, 

we may generate a request for changes 

to the list of compendia at any time. 

M. Physician Self-Referral Provisions 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘PHYSICIAN SELF-REFERRAL 

PROVISIONS’’ at the beginning of your 

comments.] 

1. Changes to Reassignment and 

Physician Self-Referral Rules Relating to 

Diagnostic Tests (Anti-Markup 

Provision) 

Medicare rules currently prohibit the 

markup of the technical component 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 (the 

interpretation) of diagnostic tests (CMS 

Pub. 100–04, Chapter 1, 30.2.9.1). 

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 to 

certain situations where a reassignment 

has occurred under 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 rules, which 

permit physician group practices to bill 

for certain services 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 lead to patient and program abuse 

in the form of overutilization of services 

and result in higher costs to the 

Medicare program (71 FR 49054). 

In the CY 2007 PFS proposed rule (71 

FR 48982), we proposed to amend 

§ 424.80 to provide that if the TC of a 

diagnostic test (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) 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, less the applicable deductibles 

and coinsurance, may not exceed the 

lowest of the following amounts: 

• The physician or other supplier’s 

net charge to the billing physician or 

medical group. 

• The billing physician’s or medical 

group’s actual charge. 

• The fee schedule amount for the 

service that would be allowed if the 

physician or other supplier billed 

directly. 

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 a 

reassigned PC of a diagnostic test. We 

stated that we were considering the 

following conditions (which currently 

appear in manual provisions and are 

known as the purchased interpretation 

rules): 

• The test must be ordered by a 

physician who is financially 

independent of the person or entity 

performing the test and also of the 

physician or medical group performing 

the interpretation. 

• The physician or medical group 

performing the interpretation does not 

see the patient. 

• The physician or medical group 

billing for the interpretation must have 

performed the TC of the test. 

We stated that, although we 

welcomed comments on all aspects of 

our proposals, we were particularly 

interested in receiving comments on 

whether: diagnostic imaging tests 

should be excepted from any of our 

proposed provisions; the proposal in 

whole or in part should apply only to 

pathology services; any of the proposed 

provisions should apply to services 

performed on the premises of the billing 

entity and if so, how to define the 

premises appropriately. We also 

requested comments as to whether an 

anti-markup provision should apply to 

the reassignment of the PC of diagnostic 

tests performed under a contractual 

arrangement, and if so, how to 

determine the correct amount that 

should be billed to the Medicare 

program. 

For our physician self-referral rules, 

we proposed to modify the definition of 

‘‘centralized building’’ at § 411.351 to 

require a centralized building to consist 

of at least 350 square feet. We further 

proposed that the proposed minimum 

square footage requirement would not 

apply to space owned or rented in a 

building in which no more than three 

group practices own or lease space in 

the ‘‘same building,’’ as defined at 

§ 411.351 (that is, in a building with the 

same street address) and share the same 

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‘‘physician in the group practice’’ (as 

defined at § 411.351). We also proposed 

that a centralized building must contain, 

on a permanent basis, the necessary 

equipment to perform substantially all 

of the designated health services (DHS) 

that are performed in the space in order 

to meet the definition of a centralized 

building. We solicited comments as to 

whether a centralized building should 

have a minimum square foot 

requirement, and if so, whether the 

minimum should be 350 square feet or 

an amount more or less than that. In 

addition, we sought comments 

regarding whether there should be an 

exception to any minimum square foot 

requirement, and if so, the 

circumstances under which an 

exception should apply. 

For our proposal that the centralized 

building permanently contain the 

necessary equipment to perform 

substantially all of the DHS that is 

furnished in the centralized building, 

we sought comments on whether this 

test should be imposed, and whether at 

least 90 percent or some other minimum 

percentage or measurement would be 

appropriate. We stated that we were also 

considering whether to require that, for 

space to qualify as a centralized 

building, the group practice must 

employ, in that space, a nonphysician 

employee or independent contractor 

who will perform services exclusively 

for the group for at least 35 hours per 

week. Finally, we sought comments on 

whether a group practice should be 

allowed to maintain a centralized 

building in a State different from the 

State(s) in which it has an office that 

meets the criteria in § 411.355(b)(2)(i), 

and if so, whether space that is located 

in a different State must be within a 

certain number of miles from an office 

of the group practice that meets the 

criteria in § 411.355(b)(2)(i) in order to 

qualify as a centralized building. 

We received numerous comments on 

these proposals. As a result, we did not 

finalize our proposals in the CY 2007 

PFS final rule with comment period. 

Based on the comments received and 

other information that we considered, 

we are proposing to impose an antimarkup provision on the TC and PC of 

diagnostic tests. We would apply the 

anti-markup provision irrespective of 

whether the billing physician or 

medical group outright purchases the 

PC or the TC, or whether the physician 

or other supplier performing the TC or 

PC reassigns his or her right to bill to 

the billing physician or medical group 

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

performing physician or other supplier, 

we would define ‘‘net charge’’ as 

exclusive of any amount that takes into 

consideration such charges. For 

example, consider the following 

hypothetical: 

• The fee schedule amount for the PC 

of a particular diagnostic test is $100. 

• Performing Physician A rents office 

space and equipment from Group B for 

$50 per test interpretation performed. 

• Physician A charges Group B $100 

per test. In this example, pursuant to 

our proposal, Physician A’s charge of 

$100 would be deemed to take into 

account the $50 rental fee imposed by 

Group B (simply by virtue of the rental 

arrangement). Therefore, Group B would 

not be allowed to bill the full fee 

schedule amount of $100, but rather, 

would be limited to the lesser of 

Physician A’s net charge determined 

exclusive of the amount that is deemed 

to have taken into consideration the 

lease expense, that is $50, or Group B’s 

actual charge for the PC. We are also 

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, our proposal in the 

CY 2007 PFS proposed rule to impose 

an anti-markup provision would not 

have addressed 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 are proposing to apply an antimarkup provision to TCs that are 

performed in a centralized building, and 

are seeking comments on whether we 

should have such a provision and, if so, 

how we should effect such a provision 

(for example, through amending the 

definition of ‘‘centralized building’’ or 

through some other means. We would 

except the anti-markup provision for 

PCs ordered by independent 

laboratories because we do not believe 

that PCs ordered by independent 

laboratories pose a significant risk of 

program abuse because the independent 

lab is not ordering the TC. In States 

where the corporate practice of 

medicine doctrine is in effect, 

independent labs that are organized as 

corporations are prevented from hiring 

physicians as employees to perform PCs 

of diagnostic tests. 

In addition, we are proposing in 

§ 414.50 that—(1) The PC of a purchased 

test be subject to an anti-markup 

provision; (2) the anti-markup provision 

for the TC and PC apply to all 

arrangements not involving a 

reassignment from a full-time employee 

of the billing entity; (3) the performing 

physician’s or other supplier’s net 

charge be calculated exclusive of any 

charge that reflects the cost of space or 

equipment leased to the performing 

physician or other supplier by the 

billing entity; and (4) the anti-markup 

provision not apply to independent labs 

that have not ordered the TC. 

At this time, we are not proposing to 

make changes to the definition of 

‘‘centralized building’’ (with the one 

possible exception noted below in this 

section). We believe that changes to the 

definition may be unnecessary in light 

of our proposals for an anti-markup 

provision on the TC and PC of 

diagnostic tests (although if we decide 

to impose an anti-markup for TCs 

performed by technicians in a 

centralized building, we may 

accomplish that through amending the 

definition of ‘‘centralized building’’). If 

an anti-markup provision is finalized, 

we may evaluate at a later time whether 

to make any revisions to the definition 

of ‘‘centralized building.’’ We also are 

not proposing to adopt the purchased 

test interpretation rules in the context of 

reassignments because this provision 

may be unnecessary if we impose an 

anti-markup provision and because the 

purchased test interpretation rules may 

be problematic for multi-specialty group 

practices. Finally, in the CY 2007 PFS 

proposed rule, we proposed that, in 

order to bill for the TC of the diagnostic 

test, the billing physician or medical 

group must directly perform the PC. 

However, we believe this provision may 

be unnecessary if we impose an antimarkup provision and also would be 

problematic for independent labs that 

cannot employ physicians due to 

corporate practice of medicine 

restrictions. 

2. Burden of Proof 

We are proposing to add § 411.353(g) 

to clarify that, consistent with our 

policy with respect to claims denials, in 

any appeal of a denial of payment for a 

DHS that was made on the basis that the 

service was furnished pursuant to a 

prohibited referral, the burden is on the 

entity submitting the claim for payment 

to establish that the service was not 

furnished pursuant to a prohibited 

referral. That is, the burden of proof is 

not on CMS or our contractors to 

establish that the service was furnished 

pursuant to a prohibited referral. 

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3. In-Office Ancillary Services 

Exception 

One of the most important exceptions 

to the physician self-referral 

prohibition, applicable to services 

furnished by group practices and sole 

practitioners, is the in-office ancillary 

services exception. Section 1877(b)(2) of 

the Act sets forth an exception for 

certain services (other than durable 

medical equipment and parenteral and 

enteral nutrients) that are provided 

ancillary to medical services provided 

by a physician or group practice and 

that meet certain conditions. The inoffice ancillary services exception is 

codified in § 411.355(b). 

Among other things, the exception 

allows patients of a sole practitioner or 

physician in a group practice to receive 

ancillary services in the same building 

in which the referring physician or his 

or her group practice furnishes medical 

services, including some services 

unrelated to the furnishing of DHS. The 

exception provides additional flexibility 

for patients seen by a physician in a 

group practice by allowing these 

patients to receive a test or procedure in 

another building in space owned or 

leased on a full-time, exclusive basis by 

a group practice (that is, a ‘‘centralized 

building’’ as defined at § 411.351). 

The in-office ancillary services 

exception does not contain certain 

requirements that are found in other 

compensation exceptions. For example, 

the exception for personal service 

arrangements in § 411.357(d), like many 

of the compensation exceptions, 

requires that compensation be set in 

advance, consistent with fair market 

value, and not determined in a manner 

that takes into account the volume or 

value of referrals or other business 

generated by the referring physician. 

These requirements are not present in 

the in-office ancillary services 

exception. Also, under the ‘‘special rule 

for productivity bonuses and profit 

shares’’ in § 411.352(i), a physician in a 

group practice may receive a share of 

profits or a productivity bonus for 

referred ancillary services, provided that 

the payment is not directly related to 

the volume or value of referrals. 

We believe that the Congress included 

an exception for in-office ancillary 

services to allow for the provision of 

certain services necessary to the 

diagnosis or treatment of the medical 

condition that brought the patient to the 

physician’s office. At the time of 

enactment, a typical in-office ancillary 

services arrangement might have 

involved a clinical laboratory owned by 

physicians located on one floor of a 

small medical office building. Under 

such an arrangement, a staff member 

would take a urine or blood sample to 

the clinical laboratory, create a slide, 

perform the test, and obtain the results 

for the physician while the patient 

waited. 

However, services furnished today 

purportedly under the in-office ancillary 

services exception are often not as 

closely connected to the physician 

practice. For example, pathology 

services may be furnished in a building 

that is not physically close to any of the 

group practice’s other offices, and the 

professional component of the 

pathology services may be furnished by 

contractor pathologists who have 

virtually no relationship with the group 

practice (in some cases, the technical 

component of the pathology services is 

furnished by laboratory technologists 

who are employed by an entity 

unrelated to the group practice). In other 

words, the core members of the group 

practice and their staff are never 

physically present in the contractor 

pathologist’s office. Similarly, the 

contractor pathologists do not 

participate in any group practice 

activities; they attend no meetings 

(except for phone calls about individual 

patients), and do not obtain retirement 

or health benefits from the group 

practice. In sum, these types of 

arrangements appear to be nothing more 

than enterprises established for the selfreferral of DHS. 

Even in the case of ancillary services 

furnished in the same building, there 

may be very little interaction between 

the physicians who treat patients and 

the staff that provide the ancillary 

services. For example, an entity with its 

own staff located in a large medical 

office building next to a hospital may 

furnish an array of diagnostic services, 

including clinical laboratory services 

and radiology services, to patients of 

physicians who practice in the building 

and own either the equipment or the 

entity. 

Comments received on the Phase I 

and Phase II physician self-referral rules 

(66 FR 856 and 69 FR 16055, 

respectively) stated that the in-office 

ancillary services exception is 

susceptible to abuse. For example, in 

response to the 1998 physician selfreferral proposed rule (66 FR 892), a 

commenter asserted that the Congress 

did not intend for a group practice to 

have multiple centralized office 

locations, except for the provision of 

clinical laboratory services. This 

sentiment was reiterated in response to 

the Phase I final rule when several 

commenters objected to the decision to 

allow group practices to have more than 

one centralized facility (69 FR 16075). 

In response to Phase II, we received 

hundreds of letters from physical 

therapists and occupational therapists 

stating that the in-office ancillary 

services exception encourages 

physicians to create physical and 

occupational therapy practices. In 

addition, we have been informed by a 

number of physician specialists that the 

in-office ancillary services exception 

enables physicians to order and then 

subsequently perform ancillary services 

instead of making a referral to a 

specialist. 

In the CY 2007 PFS proposed rule (71 

FR 48982), we stated our intent to 

address certain types of potentially 

abusive arrangements in which group 

practice physicians make a referral for a 

DHS to a specialist who is an 

independent contractor of the group 

practice. The specialist then performs 

the service for the group practice in a 

‘‘centralized building’’ and reassigns his 

or her right to Medicare payment to the 

group (which then bills Medicare at a 

profit). 

Comments received on the CY 2007 

PFS proposed rule stated that, although 

our proposal addressed potential abuses 

arising from referrals to independent 

contractors who perform services in a 

centralized building, it failed to address 

abusive arrangements within the 

physician’s office. Our review of 

industry trade articles and discussions 

with trade associations has heightened 

our awareness of the proliferation of inoffice laboratories and the migration of 

sophisticated and expensive imaging or 

other equipment to physician offices. 

‘‘Turn-key’’ operations, such as the 

arrangements described in this section 

for in-office laboratories and other 

ventures, are being marketed to 

physicians over the internet. 

At this time, we decline to issue a 

specific proposal for amending the inoffice ancillary services exception. 

Rather, we are soliciting comments as to 

whether changes are necessary and, if 

so, what changes should be made. We 

are interested in receiving comments on: 

(1) Whether certain services should not 

qualify for the exception (for example, 

any therapy services that are not 

provided on an incident to basis, and 

services that are not needed at the time 

of the office visit in order to assist the 

physician in his or her diagnosis or plan 

of treatment, or complex laboratory 

services); (2) whether and, if so, how we 

should make changes to our definitions 

of same building and centralized 

building; (3) whether nonspecialist 

physicians should be able to use the 

exception to refer patients for 

specialized services involving the use of 

equipment owned by the nonspecialists; 

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and (4) any other restrictions on the 

ownership or investment in services 

that would curtail program or patient 

abuse. 

4. Obstetrical Malpractice Insurance 

Subsidies 

We are concerned that our exception 

for obstetrical malpractice insurance 

subsidies is unnecessarily restrictive; 

that is, that our exception does not 

allow for certain obstetrical malpractice 

insurance subsidies that may be 

provided without a risk of program or 

patient abuse. The exception in 

§ 411.357(r) incorporates by reference 

the conditions in the anti-kickback safe 

harbor in § 1001.952(o). We have 

received accounts, through advisory 

opinion requests and anecdotally, of 

patient difficulty obtaining obstetrical 

care in some communities in States in 

which obstetrical malpractice insurance 

premiums are relatively high. We have 

also been informed that obstetricians 

have left these States for other practice 

locations where obstetrical malpractice 

insurance premiums are less expensive, 

requiring patients to drive long 

distances to receive obstetrical care. We 

are seeking comments describing such 

problems and recommendations for how 

the exception should be changed 

without creating a risk of program or 

patient abuse. For example, the 

exception requires that the physician 

practice in a primary care HPSA and 

that 75 percent of the physician’s 

obstetrical patients treated under the 

coverage of the malpractice insurance 

will either reside in a HPSA or a 

medically-underserved area or be part of 

a medically-underserved population. 

We are interested in whether the 

exception would more effectively 

ensure beneficiary access to obstetrical 

care without risking program abuse if 

any of the requirements were changed. 

In addition, to the extent possible, we 

would like to establish bright-line 

requirements in the exception. 

We are proposing to revise the 

exception in § 411.357(r) to specifically 

list the conditions that we believe are 

appropriate to safeguard against 

program or patient abuse when 

remuneration is provided by a hospital 

to a physician in the form of an 

obstetrical malpractice insurance 

subsidy. As noted previously, the 

current exception incorporates the 

conditions in the anti-kickback safe 

harbor in § 1001.952(o). We are seeking 

comments with respect to requirements, 

such as the following, that would be 

appropriate to include in the exception 

for obstetrical malpractice insurance 

subsidies: 

• A requirement for a written 

agreement between the parties. 

• Physician certification (or, in 

subsequent years, actual data indicating) 

that a specified percent of the 

physician’s obstetrical patients treated 

under the coverage of the subsidized 

malpractice insurance will either reside 

in a HPSA or medically-underserved 

area or be part of a medicallyunderserved population. 

• Location of the entity making the 

malpractice insurance premium subsidy 

payment. 

• Location of the medical practice of 

the physician receiving the malpractice 

insurance subsidy payment. 

• A requirement that the payment not 

be conditioned on the physician making 

referrals to, or otherwise generating 

business for, the entity. 

• No restriction on the physician 

establishing staff privileges at, referring 

any service to, or otherwise generating 

any business for any other entity. 

• A requirement that the amount of 

the payment may not vary based on the 

volume or value of any previous or 

expected referrals to or business 

otherwise generated for the entity by the 

physician. 

• A requirement that the physician 

must treat obstetrical patients who 

receive medical benefits or assistance 

under any Federal health care program 

in a nondiscriminatory manner. 

• A requirement that the insurance is 

a bona fide malpractice insurance 

policy or program, and the premium, if 

any, is calculated based on a bona fide 

assessment of the liability risk covered 

under the insurance. 

In addition, we would include the 

requirement that the arrangement not 

violate the anti-kickback statute (section 

1128B(b) of the Act) or any Federal or 

State law or regulation governing billing 

or claims submission (which is a 

requirement of our other compensation 

exceptions issued under our authority 

under section 1877(b)(4) of the Act). 

5. Unit-of-Service (Per-Click) Payments 

in Space and Equipment Leases 

Section 1877(e)(1) of the Act provides 

an exception to the prohibition of 

physician referrals for space and 

equipment leases, provided that certain 

requirements are met. Among the 

requirements, which are incorporated in 

our regulations in § 411.357(a) and (b), 

are that the lease be commercially 

reasonable even if no referrals were 

made between the parties, and that the 

rental charges be set in advance, be 

consistent with market value, and not be 

determined in a manner that takes into 

account the volume or value of any 

referrals or other business generated 

between the parties. The statute also 

requires that the lease arrangement meet 

such other requirements as the Secretary 

may impose by regulation as needed to 

safeguard against program or patient 

abuse. We are concerned with lease 

arrangements that are structured so that 

a physician is rewarded for each referral 

he or she makes for DHS. Such 

arrangements could take the form of a 

physician leasing equipment that he or 

she owns to a hospital, and receiving a 

per-use (per-click) fee each time a 

patient is referred by the physicianowner to the hospital for the use of the 

equipment. We are also concerned about 

arrangements where the physician is the 

lessee and rents space or equipment 

from a hospital or other DHS entity on 

a per-click basis. For example, if a 

physician rents an MRI machine from a 

hospital only when the physician refers 

a patient for an MRI and then provides 

the facility portion of the MRI service 

under arrangements with the hospital, 

the physician benefits financially and 

the arrangement could provide an 

incentive for overutilization or other 

program abuse. 

In the 1998 proposed rule (63 FR 

1714), we noted that we had been asked 

about situations in which a physician 

rents equipment (such as a magnetic 

resonance imaging (MRI) machine) to an 

entity that furnishes a DHS, such as a 

hospital, with the physician receiving 

rental payments on a per-click basis 

(that is, total rental payments increase 

each time the machine is used). We 

stated that we believed that this 

arrangement would not prohibit the 

physician from otherwise referring to 

the entity, provided that these kinds of 

arrangements were typical and 

complied with the fair market value and 

other requirements included under the 

rental exception. However, we added 

that, because a physician’s 

compensation under this exception may 

not reflect the volume or value of the 

physician’s own referrals, the rental 

payments may not reflect per-click 

payments for patients who are referred 

for the service by the lessor physician. 

In the Phase I rulemaking, we stated 

that we were substantially revising the 

proposed rule with respect to ‘‘the 

volume or value standard.’’ We stated: 

Most importantly, we are permitting timebased or unit-of-service-based payments, 

even when the physician receiving the 

payment has generated the payment through 

a DHS referral. We have reviewed the 

legislative history with respect to the 

exception for space and equipment leases 

and concluded that the Congress intended 

that time-based or unit-of-service-based 

payments be protected, so long as the 

payment per unit is at fair market value at 

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inception and does not subsequently change 

during the lease term in any manner that 

takes into account DHS referrals. (66 FR 876) 

After reconsidering the issue, we are 

proposing that space and equipment 

leases may not include unit-of-servicebased payments to a physician lessor for 

services rendered by an entity lessee to 

patients who are referred by a physician 

lessor to the entity. We believe that such 

arrangements are inherently susceptible 

to abuse because the physician lessor 

has an incentive to profit from referring 

a higher volume of patients to the 

lessee, and we would disallow such perclick payments, using our authority 

under section 1877(e)(1) of the Act, even 

if the statute does not expressly forbid 

per-click payments to a lessor for 

patient referred to the lessee. 

Finally, we are soliciting comments 

on whether, using our authority under 

section 1877(e)(1) of the Act, we should 

prohibit time-based or unit-of-servicebased payments to an entity lessor by a 

physician lessee, to the extent that such 

payments reflect services rendered to 

patients sent to the physician lessee by 

the entity lessor. 

6. Period of Disallowance for 

Noncompliant Financial Relationships 

In response to the Phase II interim 

final rule with comment period (69 FR 

16054), we received several comments 

that questioned what the period would 

be for which the physician could not 

refer DHS to the entity and the entity 

could not bill Medicare for the situation 

in which a financial arrangement 

between a referring physician and an 

entity failed to satisfy the requirements 

of an exception to the general 

prohibition on self-referrals. 

At this time, we are not making 

proposals for prescribing the period of 

disallowance for various types of 

noncompliance, but rather are seeking 

comments on how we might, to the 

extent practicable, set forth the period of 

disallowance for arrangements that 

implicate, but fail to satisfy the 

requirements of, one or more of the 

various exceptions. As a general matter, 

we believe that the statute contemplates 

that the period of disallowance should 

begin with the date that a financial 

arrangement failed to comply with the 

statute and the regulations and end with 

the date that the arrangement came into 

compliance or ended. However, in some 

instances it may not be clear when a 

financial arrangement has ended. For 

example, where an entity leases space to 

a physician at a rental price that is 

substantially below fair market value, it 

may raise the inference that the below 

market rent was in exchange for future 

referrals, including referrals made 

beyond the expiration of the lease. We 

are seeking comment whether, with 

respect to types of noncompliance for 

which it is not clear when a financial 

relationship ended, we should always 

employ a case-by-case approach, or 

deem certain types of financial 

relationships to continue for a 

prescribed period of time. 

We are also soliciting comment as to 

whether we should allow the period of 

disallowance to terminate where the 

parties have returned, or paid back the 

value of, the consideration. For 

example, if we were to impose a period 

of disallowance for a prescribed period 

of time because it would not be clear 

when a noncompliant compensation 

arrangement ended, we might allow the 

parties to terminate the period of 

disqualification sooner than the 

prescribed period if the prohibited 

compensation were returned. We 

caution that we do not envision 

allowing such an option where the 

parties knew or, in our judgment, 

reasonably should have known that the 

arrangement did not satisfy the 

requirements of an exception. 

We are also seeking comment as to 

whether we should impose a period of 

disqualification from using an exception 

where an arrangement has failed to 

satisfy the requirements of that 

exception. For example, suppose nonmonetary compensation is given by an 

entity to a physician that greatly 

exceeds the permissible limit prescribed 

in § 411.357(k). In addition to whatever 

period of disallowance that would 

apply, we are considering whether the 

parties should be disqualified, for a 

period of time, from relying on this 

exception. For example, if an entity 

gives a piece of equipment to a 

physician that has a fair market value of 

$900, we may—

• Prohibit one or both of the parties 

from relying on this exception for a 

period of time; 

• Require the parties to ‘‘spend 

down’’ in order to use the exception 

again (for example, if the permissible 

year limit is $300 (not taking into 

account adjustment for inflation) and 

the parties exceeded this limit by $600, 

the parties would be precluded from 

using the exception during the next 2 

years (not taking into account 

adjustment for inflation); or 

• Require the physician to return or 

pay back the value of the excess 

compensation in order for one or both 

of the parties to use the exception again. 

7. Ownership or Investment Interest in 

Retirement Plans 

In the 1998 proposed rule (63 FR 

1708), we noted that we had received 

questions concerning whether stock 

options and other nonvested interests 

(such as an interest in retirement funds 

that vests after a certain number of years 

worked) in an entity constitutes 

ownership in that entity. We replied 

that it was our view that options and 

nonvested interests are inchoate or 

partial ownership interests that qualify 

as ‘‘ownership’’ for purposes of the 

physician self-referral law. In response 

to a comment to the 1998 proposed rule, 

however, we stated in the Phase I final 

rule with comment period that we were 

withdrawing the statement in the 1998 

proposed rule that an interest in a 

retirement plan might be treated as an 

ownership or investment interest for 

purposes of section 1877 of the Act and 

that, instead, we would consider 

contributions (including employer 

contributions) to retirement plans to be 

part of an employee’s overall 

compensation arrangement with his or 

her employer (66 FR 870). As part of the 

Phase I rule, we promulgated 

§ 411.354(b)(3)(i), which excludes ‘‘[a]n 

interest in a retirement plan’’ from the 

definition of ownership and investment 

interests. We made no changes to this 

provision in Phase II (69 FR 16054). 

We received a comment in response 

to the Phase II interim final rule (69 FR 

16054) concerning the exclusion from 

an ownership or investment interest for 

retirement plans as specified in 

§ 411.354(b)(3)(i). The commenter stated 

that, contrary to our intent, some 

physicians are using retirement plans to 

purchase DHS entities to which they 

refer patients for DHS. We agree with 

the commenter that it was not our intent 

to exclude from the definition of an 

ownership or investment interest an 

interest in a DHS entity that results from 

a physician’s (or family member’s) 

participation in a retirement plan that 

purchases an interest in that DHS entity. 

That is, where a physician has an 

interest in a retirement plan offered by 

Entity A, through the physician’s (or an 

immediate family member’s) 

employment with Entity A, we intended 

to except from the definition of 

ownership or investment interests any 

interest the physician would have in 

Entity A by virtue of his or her interest 

in the retirement plan; we did not 

intend to exclude from the definition of 

ownership or investment interests any 

interest the physician may have in 

Entity B through the retirement plan’s 

purchase of an interest in Entity B. 

Accordingly we are proposing to 

revise § 411.354(b)(3)(i) to provide that 

ownership and investment interests do 

not include an interest in a retirement 

plan offered by the entity to the 

physician or immediate family member 

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as a result of the physician’s or 

immediate family member’s 

employment with the entity. 

8. ‘‘Set in Advance’’ and PercentageBased Compensation Arrangements 

Several of the compensation 

exceptions in section 1877 of the Act 

require that the compensation be ‘‘set in 

advance’’ (or ‘‘fixed in advance’’). This 

requirement has been carried over in 

our regulations implementing those 

statutory exceptions, and we have also 

included a ‘‘set in advance’’

requirement in some of our regulatory 

exceptions (that is, exceptions 

promulgated pursuant to our authority 

in section 1877(b)(4) of the Act to create 

additional exceptions that pose no risk 

of program or patient abuse). In 

§ 411.354(d), Special Rules on 

Compensation, we state that 

compensation will be considered ‘‘set in 

advance’’ if the aggregate compensation, 

a time-based or per unit-of-service-based 

amount, or a specific formula for 

calculating the compensation, is set 

forth in an agreement between the 

parties before the furnishing of the items 

or services for which the compensation 

is to be paid. Under Phase I (66 FR 959), 

the last sentence of § 411.354(d)(1) read, 

Percentage compensation arrangements do 

not constitute compensation that is ‘set in 

advance’ in which the percentage 

compensation is based on fluctuating or 

indeterminate measures or in which the 

arrangement results in the seller receiving 

different payment amounts for the same 

service from the same purchaser. 

We had explained in that rule, in 

response to a public comment, that 

‘‘[p]ercentage compensation that is 

determined by calculating a percentage 

of a fluctuating or indeterminate 

amount, such as revenues, collections or 

expenses, is not fixed in advance’’ (66 

FR 878). Following publication of the 

Phase I rule, however, we received 

anecdotal accounts about contracts for 

physician services under which 

payment was calculated based on a 

percentage of the revenue raised by a 

physician’s own professional services. 

Therefore, we delayed the effective date 

of the final sentence of § 411.354(d)(1) 

through four Federal Register notices, to 

allow us to revise the provision ‘‘to 

avoid unnecessarily disrupting existing 

contractual arrangements for physician 

services’’ (68 FR 74491, December 24, 

2003; 68 FR 20347, April 25, 2003; 67 

FR 70322, November 22, 2002; 66 FR 

60154 and 60155, December 3, 2001). 

In the Phase II interim final rule with 

comment period, in the section on 

physician compensation, we explained 

that percentage compensation 

arrangements were of particular concern 

to academic medical centers and to 

hospitals ‘‘which argued that percentage 

compensation is commonplace in their 

physician compensation arrangements’’

(69 FR 16068). We were persuaded that 

our original position was overly 

restrictive, and accordingly, we deleted 

the last sentence in § 411.354(d)(1) and 

clarified that the specific formula must 

be set forth in sufficient detail before the 

furnishing of the items or services and 

the formula may not be modified within 

the time period in any manner that 

reflects the volume or value of referrals 

or any other business generated between 

the parties. 

Despite our intent that percentage 

compensation arrangements could be 

used only for compensating physicians 

for the physician services they perform, 

it has come to our attention that 

percentage compensation arrangements 

are being used for the provision of other 

services and items, such as equipment 

and office space that is leased on the 

basis of a percentage of the revenues 

raised by the equipment or in the 

medical office space. We are concerned 

that percentage compensation 

arrangements in the context of 

equipment and office space rentals are 

potentially abusive. We note that 

section 1877(e)(1)(A)(vi) of the Act, with 

respect to office space rentals, and 

section 1877(e)(1)(B)(vi) of the Act, with 

respect to equipment rentals, allow us to 

impose requirements on office space 

and equipment rental arrangements as 

needed to protect against program or 

patient abuse. Although we are 

concerned primarily with percentage 

compensation arrangements in the 

context of equipment and office space 

rentals, we believe there is the potential 

for percentage compensation to be 

utilized in other areas as well. 

Therefore, relying on our authority in 

sections 1877(e)(1)(A)(vi), 

1877(e)(1)(B)(vi), and 1877(b)(4) of the 

Act, we are proposing to clarify that 

percentage compensation arrangements: 

(1) May be used only for paying for 

personally performed physician 

services; and (2) must be based on the 

revenues directly resulting from the 

physician services rather than based on 

some other factor such as a percentage 

of the savings by a hospital department 

(which is not directly or indirectly 

related to the physician services 

provided). 

9. Stand in the Shoes 

Commenters to the Phase I final rule 

with comment period proposed that we 

permit physicians to stand in the shoes 

of their group practices, thereby 

requiring analysis of certain indirect 

compensation arrangements as direct 

compensation arrangements. In the 

Phase II interim final rule, we solicited 

comments on this issue, and we may be 

addressing this issue in an upcoming 

final rule. In this proposed rule, we are 

focusing on the DHS entity side of 

physician-DHS entity financial 

relationships. We propose to amend 

§ 411.354(c) to provide that, where a 

DHS entity owns or controls an entity to 

which a physician refers Medicare 

patients for DHS, the DHS entity would 

stand in the shoes of the entity that it 

owns or controls and would be deemed 

to have the same compensation 

arrangements with the same parties and 

on the same terms as does the entity that 

it owns or controls. For example, a 

hospital would stand in the shoes of a 

medical foundation that it owns or 

controls (such as where the hospital is 

the sole member of a non-profit 

corporation). Thus, if a hospital owns or 

controls a medical foundation that 

contracts with a physician to provide 

physician services at a clinic owned by 

the medical foundation, the hospital 

would stand in the shoes of the medical 

foundation, and would be deemed to 

have a direct compensation relationship 

with the contractor physician. 

We believe that it is necessary to 

collapse the type of relationship 

discussed above to safeguard against 

program abuse by parties who endeavor 

to avoid the application of the physician 

self-referral requirements by simply 

inserting an entity or contract into a 

chain of financial relationships linking 

a DHS entity and a referring physician. 

We are soliciting comments as to 

whether and how we would employ a 

stand in the shoes approach for the type 

of relationship discussed above, as well 

as for other types of financial 

relationships. In submitting comments, 

commenters should be mindful that we 

finalize (or may already have finalized) 

a provision that treats physicians as 

standing on the shoes of their group 

practices or other physician practices. 

10. Alternative Criteria for Satisfying 

Certain Exceptions 

We received several comments in 

response to the Phase II rulemaking that 

asserted that even innocent and trivial 

violations of the physician self-referral 

statute may result in huge penalties to 

an entity that submits claims to 

Medicare. For example, the failure of a 

hospital to obtain a signature on a lease 

or a personal services arrangement with 

a physician could result in the hospital 

being required to make repayment for 

all services for which it billed Medicare 

as a result of prohibited referrals from 

the physician. One commenter stated 

that we should exercise our discretion 

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in pursuing minor violations and the 

failure to meet the procedural 

requirements of an exception (such as 

obtaining all required signatures prior to 

commencement of the agreement for 

personal services) and technical 

violations. Another commenter stated 

that we should consider adding an 

exception that would permit physicians 

to refer for DHS, and entities to submit 

and receive payment for DHS, if, in our 

sole discretion, we determined that 

there was no abuse. The commenter 

suggested that such an exception be 

available only after (1) receipt by the 

entity of a favorable advisory opinion, 

or (2) a voluntary disclosure by the 

entity or upon audit or investigation by 

the government. 

Although we do not have discretion to 

waive violations of the physician selfreferral statute, we are considering 

whether to amend certain of the 

exceptions that appear in § 411.355 

through § 411.357 to provide an 

alternate method for satisfying the 

exception. We caution that our proposal 

is intended to address only inadvertent, 

violations in which an agreement fails 

to satisfy the procedural of ‘‘form’’

requirements of an exception of the 

statute or regulations. We do not intend 

to apply the alternative method for 

compliance to other requirements such 

as compensation that is fair market 

value, not related to volume or value of 

referrals, or set in advance. What we 

have in mind, for example, is a situation 

in which parties are missing a signature 

but every other requirement of the 

exception for personal service 

arrangements is satisfied. In such a case, 

provided that there is full disclosure, 

the missing signature is inadvertent, and 

other conditions for alternative 

compliance described here are satisfied, 

the alternative method for compliance 

would be met and the parties would 

comply with the exception. 

The alternative method for 

compliance with the physician selfreferral prohibition would provide that, 

if an arrangement does not meet all of 

the existing prescribed criteria of an 

exception, the arrangement nevertheless 

would meet the exception if: (1) The 

facts and circumstances of the 

arrangement are self-disclosed by the 

parties to us; (2) we determine that the 

arrangement satisfied all but the 

prescribed procedural or ‘‘form’’

requirements of the exception at the 

time of the referral for DHS at issue and 

at the time of the claim for such DHS; 

(3) the failure to meet all the prescribed 

criteria of the exception was 

inadvertent; (4) the referral for DHS and 

the claim for DHS were not made with 

knowledge that one or more of the 

prescribed criteria of the exception were 

not met (consistent with other 

exceptions, we would apply the same 

knowledge standard as that applicable 

under the False Claims Act; (5) the 

parties have brought (or will bring as 

soon as possible) the arrangement into 

complete compliance with the 

prescribed criteria of the exception or 

have terminated (or will terminate as 

soon as possible) the financial 

relationship between or among them; (6) 

the arrangement did not pose a risk of 

program or patient abuse; (7) no more 

than a set amount of time had passed 

since the time of the original 

noncompliance with the prescribed 

criteria; and (8) the arrangement at issue 

is not the subject of an ongoing Federal 

investigation or other proceeding 

(including, but not limited to, an 

enforcement matter). We would 

consider there to be an ‘‘inadvertent’’

failure to meet all of the prescribed 

criteria in an exception only where 

there was an innocent or unintentional 

mistake. We would rely on our authority 

under section 1877(b)(4) of the Act to 

implement an alternative compliance 

policy, and we would include 

requirements that are contained in all 

exceptions that we promulgate under 

that authority (including, but not 

limited to, the requirement that the 

arrangement not violate the antikickback statute). 

We believe that if we were to adopt 

an alternative compliance method 

policy for certain exceptions, with the 

criteria specified above, the 

determination of whether an 

arrangement meets the terms of an 

exception despite not meeting all of the 

prescribed criteria of an exception 

should be at our sole discretion and not 

subject to further administrative or 

judicial review. We caution that we 

would retain the discretion as to 

whether to make such a determination; 

parties would have no right to receive 

such a determination and no time 

period by which we would be required 

to issue a determination. We further 

caution that, because we would retain 

sole authority to determine that an 

arrangement that failed to satisfy all of 

the prescribed procedural or ‘‘form’’

criteria of an exception that meets the 

conditions for the alternative method of 

compliance, and because of the 

proposed requirements that: (1) The 

failure to meet all of the prescribed 

criteria of the exception was 

inadvertent; and (2) the referral for DHS 

and the claim for DHS were not made 

with knowledge that one or more of the 

prescribed criteria of the exception were 

not met, parties to an arrangement 

would not be able to refer or bill for 

DHS with the knowledge that the 

arrangement did not comply with all of 

the prescribed criteria of an exception 

and then later claim in response to an 

enforcement action that they believed 

that their conduct was proper because, 

in their view, the arrangement would 

have met the criteria for the alternative 

method for compliance with the 

prescribed criteria of an exception. In 

fact, if our proposal were to be adopted 

and a DHS entity were to submit a claim 

for Medicare payment with the 

knowledge that its financial relationship 

with the referring physician (or his or 

her immediate family member) did not 

meet the prescribed criteria of any 

exception, and did so in advance of any 

determination from us that the 

arrangement met the alternative method 

of compliance, it could be found liable 

under the False Claims Act. 

We are especially interested in 

comments regarding: whether we 

should adopt an alternative compliance 

method policy, and if so, the exceptions 

for which the policy should be 

applicable; the conditions that must be 

met in order to obtain a favorable 

determination that an arrangement that 

does not meet all of the prescribed 

criteria of an exception nevertheless 

satisfies the alternative method of 

compliance with the exception; the 

manner (for example, advisory opinion) 

for making such a determination; the 

length of time during which the 

alternative method option would be 

available (that is, the length of time that 

a party would have to discover that an 

arrangement was out of compliance 

with the prescribed criteria of an 

exception and seek protection under the 

alternative compliance method policy); 

and, whether, having received a 

favorable determination that an 

arrangement satisfied the alternative 

method of compliance (essentially, that 

the arrangement was deemed to have 

met the prescribed criteria of an 

exception), an entity should be 

precluded for a period of time from 

receiving another favorable 

determination with respect to an 

arrangement that (1) failed to meet the 

prescribed criteria of the same exception 

(or similar criteria of another exception) 

and (2) that was entered into after the 

date the arrangement that received the 

favorable determination was entered 

into by the entity. We are also interested 

in comments as to whether each eligible 

exception should specify which 

criterion or criteria an arrangement can 

fail to meet and nevertheless still 

qualify under the alternative method 

criteria as satisfying the exception (for 

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example, specifying in several 

exceptions that an arrangement that is 

missing a signature can nevertheless 

qualify for the alternative compliance 

method), or whether, in addition to or 

in lieu thereof, we should provide that 

an arrangement may qualify for the 

alternative compliance method if we 

make a determination that the 

arrangement substantially complied 

with the prescribed criteria and met all 

of the other alternative criteria. We are 

specifically seeking comment on what, 

if any, additional requirements or 

standards should be met where an 

arrangement fails to satisfy a procedural 

of ‘‘form’’ requirement of an exception. 

For example, we would like comments 

on whether we should require other 

documentary proof of the parties’ intent 

to contract (through memoranda, 

electronic mail, or otherwise) in the case 

where the parties failed to obtain a 

necessary signature to effect the 

contractual arrangement. 

We reiterate that we do not have the 

authority to waive violations of the 

physician self-referral statute or 

regulations. We do not mean to suggest 

that, for financial relationships that 

implicate the general prohibition, 

anything less than full compliance with 

one or more of the exceptions is 

sufficient; rather, we are proposing to 

provide additional and alternative 

criteria for some of the exceptions 

themselves so that some arrangements 

that otherwise would be noncompliant 

as a result of an inadvertent mistake 

might satisfy an exception. In effect, we 

are merely proposing to expand the 

scope of some exceptions to provide 

more flexibility. 

Finally, we note that our proposal for 

an alternative compliance method 

policy is intended to complement, and 

not replace, the provisions in 

§ 411.353(f) for certain arrangements 

involving temporary noncompliance. 

Among other requirements, in order to 

qualify for protection under § 411.353(f), 

the financial relationship between the 

entity and the referring physician must 

have been in compliance with an 

exception for at least 180 consecutive 

calendar days immediately preceding 

the date on which the financial 

relationship became noncompliant, and 

the financial relationship must have 

fallen out of compliance due to reasons 

beyond the control of the entity. In 

addition, claims are payable only for 

DHS rendered during a maximum of 90 

consecutive calendar days following the 

date on which the financial relationship 

became noncompliant; the exception 

may be used by an entity only once 

every 3 years for the same referring 

physician; and the exception may not be 

used for temporary noncompliance with 

the exception for nonmonetary 

compensation or medical staff 

incidental benefits. 

11. Services Furnished ‘‘Under 

Arrangements’’

Our physician self-referral rules 

prohibit a physician from making 

referrals for DHS to an entity with 

which the physician (or an immediate 

family member) has a financial 

relationship, and prohibits the entity 

from billing Medicare for the DHS, 

unless an exception applies. In the 1998 

proposed rule, we stated that we had 

received questions about which entities 

are the relevant ones for purposes of the 

prohibition on referrals, given that some 

entities only bill for services, whereas 

others actually directly ‘‘furnish’’ the 

services. We noted that, for example, in 

an ‘‘under arrangements’’ situation, a 

hospital, rural primary care hospital, 

SNF, HHA, or hospice program 

contracts with a separate provider to 

furnish services to the hospital’s, SNF’s, 

or other contracting entity’s patients, for 

which the hospital, SNF or other 

contracting entity ultimately bills. 

Sections 1832, 1835(b)(1), 1861(e), and 

1861(w)(1) of the Act and § 413.65(i) 

provide for Medicare payment to 

providers for services furnished ‘‘under 

arrangements.’’ The Internet-Only 

Manual (IOM) manual 100–01, Medicare 

General Information, Eligibility and 

Entitlement Manual, Pub. 100–01, at 

Chapter 5, section 10.3 requires that the 

provider must exercise professional 

responsibility over an arranged-for 

service, using the same quality controls 

as applied to services furnished by the 

provider’s salaried employees. Under 

§ 413.65(i), a provider-based hospital 

department may not provide all of its 

services under arrangements. Therefore, 

a hospital department may not contract 

out all of its patient care services. 

We stated in the 1998 proposed rule 

that, absent an exception, the referral 

prohibition applies to a physician’s DHS 

referrals to any entity that directly 

furnishes DHS to Medicare or Medicaid 

patients. We stated that a physician can 

have an incentive to overutilize services 

if he or she has a financial relationship 

with the entity that directly furnishes 

DHS, even if this is not the entity 

ultimately billing for the services. In 

these situations, the physician can 

potentially recognize a profit from each 

referral based on the fact that the DHS 

will, in essence, be sold to the entity 

that bills (63 FR 1707). Notwithstanding 

our statements in the 1998 proposed 

rule, we have interpreted the definition 

of ‘‘entity’’ at § 411.351 as including 

only the person or entity that bills 

Medicare for the DHS, and not the 

person or entity that performs the DHS 

(where the person or entity performing 

the DHS is not the person or entity 

billing for it). 

We continue to have concerns with 

services provided under arrangements 

to hospitals and other providers. We 

believe that the risk of overutilization 

that we identified in the 1998 proposed 

rule has continued, particularly with 

hospital outpatient services for which 

Medicare pays on a per-service basis. 

That is, we pay a hospital separately for 

each clinical laboratory test, for each 

therapy service, and for the vast 

majority of radiology and other imaging 

services. We have received anecdotal 

reports of hospital and physician joint 

ventures that provide hospital imaging 

services formerly provided by the 

hospital directly. There appears to be no 

legitimate reason for these arranged for 

services other than to allow referring 

physicians an opportunity to make 

money on referrals for separately 

payable services. Many of the services 

furnished by the joint venture were 

previously furnished directly by the 

hospitals, and in most cases, could 

continue to be furnished directly by 

hospitals. 

We are also concerned that the 

services furnished under arrangements 

to a hospital are furnished in a less 

medically-intensive setting than the 

hospital, but billed at higher outpatient 

hospital PPS rates, which not only costs 

the Medicare program more, but also 

costs Medicare beneficiaries more in the 

form of higher deductibles and 

coinsurance. Often, physician 

specialists who order services for their 

hospital patients set up joint ventures, 

frequently including as an owner a 

hospital to which the physicians refer 

patients. The joint venture often owns 

an entity that furnishes medically less 

intensive services than a hospital, such 

as an ASC, an IDTF, or a physician 

office. The entity may even be located 

in a hospital building in space leased by 

the hospital to the joint venture, 

whether owned by physicians alone or 

with the hospital. It appears that the use 

of these arrangements may be little more 

than a method to share hospital 

revenues with referring physicians in 

spite of unnecessary costs to the 

program and to beneficiaries. 

We believe that more and more 

procedures are being performed as 

arranged for hospital services. The 

provider community is well aware that, 

effective for services furnished on or 

after January 1, 2008, Medicare may pay 

more for all hospital outpatient surgical 

procedures than for the same 

procedures billed by ASCs under the 

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revised ASC payment system required 

by section 626(b) of the MMA. (In the 

CY 2007 OPPS/ASC proposed rule (71 

FR 49635), we proposed that payment 

for an ASC surgical procedure would be 

made at 62 percent of the payment for 

the same procedure under the OPPS (71 

FR 49656).) 

After the close of the Phase II 

comment period, the Medicare Payment 

Advisory Commission (MedPAC), in its 

March 2005 Report to Congress, 

recommended that the Secretary 

‘‘should expand the definition of 

physician ownership in the physician 

self-referral law to include interests in 

an entity that derives a substantial 

proportion of its revenue from a 

provider of designated health services.’’

Specifically, MedPAC wrote: 

Physician ownership of entities that 

provide services and equipment to imaging 

centers and other providers creates financial 

incentives for physicians to refer patients to 

these providers, which could lead to higher 

use of services. Prohibiting these 

arrangements should help ensure that 

referrals are based on clinical, rather than 

financial, considerations. It would also help 

ensure that competition among health care 

facilities is based on quality and cost, rather 

than financial arrangements with entities 

owned by physicians who refer patients to 

the facility. 

(See http://www.medpac.gov/ 

publications/congressional_reports/ 

Mar05_EntireReport.pdf, at page 170.) 

We agree with the concerns of MedPAC 

and a commenter to the Phase II interim 

final rule that arrangements structured 

so that referring physicians own leasing, 

staffing, and similar entities that furnish 

items and services to entities furnishing 

DHS but do not submit claims, raise 

significant concerns under the fraud and 

abuse laws. We believe such 

arrangements to be contrary to the plain 

intent of the physician self-referral law. 

Arrangements so structured are 

particularly problematic because 

referrals by physician-owners of leasing, 

staffing, and similar entities to a 

contracting DHS entity can significantly 

increase the physician-owned entity’s 

profits and investor returns, creating 

incentives for overutilization and 

corrupting medical decision-making. 

We are attempting to determine the 

best approach to prohibit certain 

arrangements under which physicians 

supply items and services to DHS 

entities. We note that some of the 

arrangements described by MedPAC are 

subject to the physician self-referral 

prohibition and more may become 

subject to the physician self-referral 

prohibition through provisions we may 

implement in the upcoming Phase III 

final rule. 

Although MedPAC recommended that 

the definition of physician ownership 

subject to the physician self-referral 

prohibition be expanded to include any 

entity that derives a substantial 

proportion of its revenue from a 

provider of DHS, we are proposing what 

we believe is a more straightforward 

approach to addressing the issue. That 

is, we propose to revise our definition 

of entity at § 411.351 so that a DHS 

entity includes both the person or entity 

that performs the DHS, as well as the 

person or entity that submits claims or 

causes claims to be submitted to 

Medicare for the DHS. Our proposal is 

not meant to exclude any persons or 

entities that presently are considered to 

be DHS entities. (In this regard, we note 

that we propose to reorganize and delete 

some of the material in the current 

definition and are seeking comment on 

our proposed changes to the regulatory 

text.) Although we believe our proposed 

approach is sufficient to address abusive 

arrangements, we solicit comments on 

whether we should implement the 

MedPAC approach, either in some 

combination with our proposed 

approach or instead of our proposed 

approach. We would be particularly 

interested in comments related to what 

should constitute a ‘‘substantial’’

proportion of revenue derived from 

providing DHS. 

N. Beneficiary Signature for Ambulance 

Transport Services 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘BENEFICIARY SIGNATURE’’

at the beginning of your comments.] 

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. For 

example, if a beneficiary is physically or 

mentally incapable of signing the claim, 

the claim may be signed on the 

beneficiary’s behalf by another 

individual listed in § 424.36(b). 

Ambulance suppliers and providers 

have stated that, in emergency 

situations, it is 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; and 

(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 willing 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. 

We are sympathetic to the concerns of 

ambulance providers and suppliers 

insofar as emergency transport services 

are involved. Therefore, at § 424.36, we 

are proposing 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 (5) was available or willing to 

sign a claim on behalf of the beneficiary, 

the ambulance provider or supplier may 

submit the claim without a beneficiary 

signature. 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 (5) 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 (5) 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 

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 (5) prior to 

submitting claims to Medicare. 

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1Section 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 

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

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

scrivener’s error. 

O. Update to Fee Schedules for Class III 

DME for CYs 2007 and 2008 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘DME UPDATE’’ at the 

beginning of your comments.] 

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. 

Devices are to be classified into class I 

if there is information showing that the 

general controls of the act are sufficient 

to assure safety and effectiveness. 

General controls apply to all medical 

devices and include provisions that 

relate to adulteration, misbranding, 

device registration and listing, 

notification, including repair, 

replacement, or refund, records and 

reports, and good manufacturing 

practices. Examples of class I devices 

are canes and crutches. 

Class II devices are those for which 

general controls, by themselves, are 

insufficient to provide reasonable 

assurance of safety and effectiveness, 

but there is sufficient information to 

establish special controls to provide 

such assurance. Special controls include 

performance standards, postmarket 

surveillance, patient registries, 

development and dissemination of 

guidelines, recommendations, and any 

other appropriate action the FDA deems 

necessary (section 513(a)(1)(B) of the 

act). Examples of class II devices are 

blood glucose test systems and infusion 

pumps. 

Class III devices are those for which 

there is insufficient information to 

support classifying a device into class I 

or class II and the device is a lifesustaining or life-supporting device or is 

for a use which is of substantial 

importance in preventing impairment of 

human health, or presents a potential 

unreasonable risk of illness or injury. 

Class III devices paid in accordance 

with the DME fee schedule payment 

methodology include osteogenesis or 

bone growth stimulators, implantable 

infusion pumps, and stair-climbing 

wheelchairs (standard power 

wheelchair function only). This is not 

an inclusive list of class III devices. The 

Medicare DMEPOS suppliers should 

specify on the Medicare claim form 

whether the device furnished to a 

beneficiary is a class III device as 

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

Federal Food, Drug, and Cosmetic Act 

(21 U.S.C. 360c(a)(1)(C)). 

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) cannot be included in 

the competitive acquisition programs. 

As part of the transition to competitive 

acquisition, the Congress mandated in 

sections 1847(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)).1 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 

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, 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 

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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. Proposed 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, we 

are proposing a zero percent update for 

class III devices. Also, in accordance 

with the MMA, we are proposing to use 

the percent change in the CPI–U to 

update the class III device 2007 fee 

schedule amounts for 2008. 

P. Discussion of Chiropractic Services 

Demonstration 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘CHIROPRACTIC SERVICES 

DEMONSTRATION’’ at the beginning of 

your comments.] 

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 

offset during the CY 2009 PFS 

rulemaking process. 

Q. Technical Corrections 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘TECHNICAL CORRECTIONS’’

at the beginning of your comments.] 

1. Particular Services Excluded From 

Coverage (§ 411.15(a)) 

Prior to January 1, 2005, Medicare did 

not pay for routine physical 

examinations or checkups. Section 

1862(a)(7) of the Act states that routine 

physical checkups are excluded 

services. This exclusion is described in 

§ 411.15(a), Particular services excluded 

from coverage. In addition, we had 

interpreted section 1862(a)(1)(A) of the 

Act to exclude coverage for 

cardiovascular disease screening tests 

and diabetes screening tests. This 

section provides that items or services 

must be reasonable and necessary for 

the diagnosis or treatment of illness or 

injury, or to improve the functioning of 

a malformed body member as stated in 

§ 411.15(k). Since preventive services 

are not provided for diagnosis or 

treatment of illness, injury, or 

malformation, we determined that these 

services are not reasonable and 

necessary within the meaning of the 

statute. 

Effective January 1, 2005, Part B 

coverage was expanded to include an 

initial preventative physical 

examination (IPPE) for certain 

individuals. Our regulations governing 

the IPPEs are primarily set forth in 

§ 410.16. Additional conforming 

changes were made at that time to 

§ 411.15 to reflect this expansion in 

coverage. 

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). Those rules are 

codified in § 410.17 and § 410.18, 

respectively. However, at the time we 

neglected to make additional 

conforming changes to § 411.15 to 

reflect this expansion in coverage. 

To conform the regulations to the 

MMA provisions, we are proposing 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. 

2. Medical Nutrition Therapy (MNT) 

(§ 410.132) 

In the CY 2006 PFS final rule with 

comment period (70 FR 70160), we 

added individual medical nutrition 

therapy, as represented by HCPCS codes 

G0270, 97802 and 97803, to the list of 

telehealth services. We are making 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 

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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.’’

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 are 

proposing to revise the section heading 

of § 413.184 to read as follows: 

‘‘Payment exception: Pediatric patient 

mix.’’

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 with 

respect to the services they can provide 

under Medicare, it had been 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). 

We revised § 410.22 to reflect the BBA 

change in the CY 2000 PFS final rule (64 

FR 59439). (Note: § 410.22 was 

redesignated as § 410.21 in the CY 2001 

PFS final rule.) However, we neglected 

to remove the chiropractic exception at 

§ 410.32 (a)(1). Because of the BBA 

change, which removed the requirement 

that subluxation must be demonstrated 

by an x-ray, the chiropractic exception 

is no longer warranted. We do not 

believe it would be 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 are proposing to 

revise § 410.32 by removing paragraph 

(a)(1) and by redesignating paragraphs 

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

respectively. 

R. The Percentage Change in the 

Medicare Economic Index (MEI) 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘MEI’’ at the beginning of your 

comments.] 

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. Table 14 presents a 

listing of the MEI cost categories with 

the associated weights. 

TABLE 14.—MEDICARE ECONOMIC

INDEX EXPENDITURE CATEGORIES

AND WEIGHTS

Expenditure category 

2000 

Expense 

weight 

Physician Compensation ............ 52.466 

Wages and Salaries ............ 42.730 

Benefits ................................ 9.735 

Practice Expense ........................ 47.534 

Nonphysician Compensation 18.653 

Nonphysician wages .... 13.808 

Prof/Tech Wages .. 5.887 

Manager Wages .... 3.333 

Clerical Wages ...... 3.892 

Services Wages .... 0.696 

Employee Benefits 4.845 

Other Practice Expense 18.129 

Office Expenses .... 12.209 

Prof. Liability Insurance ................... 3.865 

Medical equipment 2.055 

Drugs and Supplies ...... 4.319 

Medical material 

and supplies ...... 2.011 

Prescription Drugs 2.308 

Other Expenses ........... 6.433 

All Other ................ 6.433 

Beginning in April 2007, with their 

March 2007 publication, the Bureau of 

Labor Statistics (BLS) will discontinue 

production and publication of the white 

collar occupation employment cost 

index (ECI) series. 

The white collar benefit ECI for 

private workers has been used as the 

price proxy for nonphysician benefits in 

the MEI. There is no other comparable, 

published series that is a suitable 

replacement for the white collar benefit 

ECI. Consequently, 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. Global Insight Inc. is a 

nationally recognized economic and 

financial forecasting firm that contracts 

with CMS to forecast the components of 

the market baskets. 

Table 15 lists the four ECI series and 

corresponding weights used to construct 

the new composite benefit index. We 

are proposing to replace the ECI white 

collar benefit series with this composite 

benefit index effective for the CY 2008 

MEI update. 

TABLE 15.—CMS COMPOSITE PRICE

INDEX FOR NON-PHYSICIAN EMPLOYEE BENEFITS

ECI series Weight 

Benefits, Private, Professional, 

Scientific, Technical .................. 59.0 

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TABLE 15.—CMS COMPOSITE PRICE

INDEX FOR NON-PHYSICIAN EMPLOYEE BENEFITS

ECI series Weight 

Benefits, Private, Management, 

Business, Financial ................... 6.3 

Benefits, Private, Office & Administrative Support ........................ 32.6 

Benefits, Private, Service Occupations ........................................... 2.1 

We compared the historical 4-quarter 

moving average percent changes of the 

MEI using the ECI white collar benefit 

index and the proposed ECI composite 

benefit series and in the 5 most recent 

calendar years, the difference in the 

overall MEI update is no greater than 0.1 

percentage point. This analysis shows 

that the new composite benefit index 

would be expected to have little 

material impact on the aggregate MEI 

updates; and therefore, we believe the 

use of this composite benefit index is 

the most technically accurate index for 

capturing nonphysician benefits price 

pressures. 

Although we have not done so in the 

past, we believe it would be beneficial 

to publish a preliminary estimate of the 

expected MEI update. For CY 2008, the 

forecasted increase in the MEI is 1.9 

percent, which includes a forecasted 1.5 

percent productivity offset based on the 

10-year moving average of multifactor 

productivity. This forecast is based on 

GII’s 1st quarter 2007 forecast of the MEI 

market basket. The final update will be 

based on historical data through 2nd 

quarter 2007. 

S. Other Issues 

1. Recalls and Replacement Devices 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘RECALLS AND 

REPLACEMENT DEVICES’’ at the 

beginning of your comments.] 

Recently, there has been a recall of 

73,000 implantable cardioverterdefibrillators (ICDs) and cardiac 

resynchronization therapy defibrillators 

(CRT–Ds) because of a faulty capacitor 

that can cause the batteries to deplete 

sooner than expected. (See the FDA 

Web site at www.fda.gov/cdrh/news for 

Questions and Answers posted April 20, 

2007 on this recall). This follows upon 

the recall of thousands of ICDs and 

pacemakers in CY 2004 and CY 2005. 

These recalls 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. 

For outpatient hospital costs of the 

replacement devices, effective for 

services furnished on or after January 1, 

2007, we reduce the ambulatory 

payment classification (APC) payment 

we make to hospitals when the hospital 

receives a replacement device without 

cost or with full credit for the device. 

We also proposed a reduction to 

Medicare payment for inpatient hospital 

services in the FY 2008 IPPS proposed 

rule (72 FR 26479). This proposed rule 

would reduce payments for hospital 

inpatients when hospitals use a recalled 

or replacement device at no cost or with 

partial credit. 

While these regulations address 

hospital payment for the devices 

involved, there are also costs associated 

with physician monitoring of patients 

treated with recalled devices. 

Specifically, the manufacturer of the 

devices that have been most recently 

recalled recommends that patients with 

the recalled device consult with their 

physicians in each case and, in some 

cases, begin a routine of monthly 

evaluations. We would expect that not 

only could extra visits to physicians’

offices or hospital outpatient 

departments be necessary, but 

additional diagnostic tests may also be 

needed to care for the beneficiaries who 

have the recalled devices. Thus, even 

when immediate replacement of the 

device is not required, we are concerned 

that the potential greater costs to 

Medicare and to the beneficiary for 

these unforeseen extra services may be 

substantial and burdensome. 

We will be actively assessing ways to 

identify the additional health care costs 

and Medicare expenditures associated 

with device recall actions and exploring 

what actions would be appropriate in 

the case of these additional monitoring 

and related expenses as they relate to 

both the hospital outpatient and 

physician payment systems. We 

welcome public comments on this issue 

to inform our future review and 

analyses. 

2. Therapy Standards and Requirements 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘THERAPY STANDARDS AND 

REQUIREMENTS’’ at the beginning of 

your comments.] 

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 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 speech-language pathologists 

(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). 

We propose to update the personnel 

qualifications in § 484.4 for PTs, PTAs, 

OTs, and OTAs. We also propose to 

revise the qualifications for SLPs to 

remove a reference to audiologists in the 

definition for speech-language 

pathologists because a speech-language 

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. Otherwise, we are not 

proposing to update the qualifications 

for SLPs because we believe the 

qualifications in § 484.4 are currently 

appropriate and address the issues of 

continuing education and 

internationally trained SLPs. 

We are proposing these changes for 

the following several 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. In 

particular, the qualifications for PTAs 

vary widely among States. According to 

the Federation of State Boards of 

Physical Therapy Web site (accessed on 

March 29, 2007), the ‘‘Number of states 

that grandfathered PTAs prior to 

regulation = 41.’’ Under the title ‘‘What 

method does your state use to regulate 

PTAs?’’ the field contains the word 

‘‘Licensed,’’ or ‘‘Certified’’, or is blank. 

Therefore, we believe PTAs who have 

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been licensed and practicing for many 

years may not meet the current 

education requirements in § 484.4. We 

believe the same is true of occupational 

therapy assistants who obtained their 

training prior to application of the 

requirements of the certification 

examination for Certified Occupational 

Therapy Assistant (COTA) developed 

and administered by the National Board 

for Certification in Occupational 

Therapy, Inc. (NBCOT). Additionally, 

we believe some States permitted 

licensure or certification of PTs and OTs 

without successful completion of a 

curriculum in physical therapy or 

occupational therapy after 1977 (the 

date currently specified under the 

‘‘grandfather clause’’ in § 484.4 before 

which a practicing PT or OT need not 

have completed a curriculum in 

physical therapy or occupational 

therapy). We believe there may also be 

licensed or certified PTAs and OTAs 

who do not meet the educational 

requirements in § 484.4. 

Therefore, we believe it would be 

appropriate to broaden the current 

grandfathering clauses for practicing 

PTs, OTs, PTAs, and OTAs. We propose 

to revise our requirements to recognize 

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. Individuals who furnish physical 

or occupational therapy services but 

have not met State qualifications (or 

received State recognition as PTs, OTs, 

PTAs and OTAs) before January 1, 2008, 

would be required to meet the updated 

qualifications in § 484.4. 

We are not proposing to change the 

current grandfathering provisions 

relating to the qualifications for PTs, 

OTs, PTAs, and OTAs furnishing 

services under the Home Health PPS or 

the Hospice PPS because the current 

regulations in § 484.4 (that is, 

occupational therapist (paragraph (c)), 

OTA (paragraph (b)), physical therapist 

(paragraph (c) or (d)), or PTA (paragraph 

(2)) have applied to those settings 

consistently for almost 20 years. We do 

not expect that there are therapists 

furnishing services in a HHA or hospice 

that do not meet either the current or 

proposed revised qualifications. 

Therefore, we will retain the current 

grandfathering clauses for personnel 

providing services in those settings 

before 1977. We would not apply to 

Home Health and Hospice settings the 

proposed new grandfathering clause 

that would permit those qualified 

professionals who are licensed, 

certified, registered or otherwise 

regulated by a State and are furnishing 

services in other settings before January 

1, 2008 to continue providing services 

without updating their education to 

meet the new requirements. 

We are seeking comment on 

appropriate grandfathering provisions 

relating to qualifications of therapists 

and assistants to assure that skilled 

therapists and assistants with 

comparable and appropriate education 

and training treat Medicare beneficiaries 

in all settings. We propose these 

grandfathering provisions to § 409.16, 

§ 409.23, § 410.43, § 410.59, § 410.60, 

§ 482.56, § 485.70, § 485.705, § 491.9. 

The proposed revised personnel 

qualifications in § 484.4 for therapists 

and assistants must address minimum 

requirements for the provision of 

therapy services by qualified personnel 

who have attained the skills of 

therapists with education and training 

in the specific discipline in which they 

are practicing, but who are not licensed. 

Also, for therapists and assistants 

trained outside the United States or 

trained by the United States military, we 

want to consider developing standards 

comparable to those applied to 

therapists and assistants trained in the 

United States. By ‘‘comparable’’ we 

mean that we would refer to and base 

our standard on a process whereby it is 

determined (either by the State or by 

another credentialing authority such as 

the NBCOT) that the education, training, 

or testing standards obtained outside the 

United States or in the military are so 

similar as to be substantially 

indistinguishable from standards 

applied to those who meet the 

qualifications for therapists and 

assistants trained in the United States. 

However, we note that we intend to 

establish standards comparable to those 

we establish for PTs, OTs, PTAs, OTAs, 

and speech-language pathologists, and 

not to recognize as qualified therapists 

or therapy assistants individuals trained 

in other disciplines for purposes of 

furnishing PT, OT, or SLP services to 

Medicare beneficiaries. It is not our 

intention to modify the policy that 

requires physical therapy, occupational 

therapy, and SLP services furnished 

incident to a physicians service to meet 

all the standards and conditions (except 

licensure) that apply to therapists, as 

this policy is based on the section 

1862(a)(20) of the Act. Rather, it is our 

intention to assure that Medicare 

payment is made only for physical 

therapy, occupational therapy, and SLP 

services provided by personnel who 

meet qualifications, including 

consistent and appropriate education 

and training relevant to the discipline, 

so that they are adequately prepared to 

safely and effectively treat Medicare 

beneficiaries. 

In this proposal, we refer to persons 

who are licensed, certified, and 

otherwise regulated by a State. We 

interpret ‘‘otherwise regulated’’ to mean 

that, while a State may not regulate a 

profession by granting a license or 

certifying educational or training 

credentials, it may nevertheless regulate 

the practice of a profession by 

application of certain other 

requirements. For example the use of 

the title physical therapy assistant might 

be limited to those who have passed a 

course for PTAs in a State-approved 

college, even when the State does not 

grant graduates a license or certificate to 

practice. By ‘‘otherwise regulated,’’ we 

do not mean to refer to State regulations 

that are generally applicable to all 

health care or other professionals 

regarding, for example, business 

practices, employment or hygiene. 

Rather, we mean to refer to the specific 

qualifications one must have in order to 

practice within a particular discipline or 

use a particular title. 

We propose to require that OT’s 

beginning their practice after January 1, 

2008, 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 NBCOT. By 

‘‘successfully completed’’ we mean 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, the education requirements 

continue to apply. 

We propose that after January 1, 2008, 

OTAs must be licensed, certified, 

registered or otherwise regulated as an 

OTA and have graduated from an OTA 

curriculum accredited by the nationally 

recognized organization for 

accreditation of occupational therapists, 

the ACOTE of the AOTA, and 

successfully completed the certification 

examination for Certified Occupational 

Therapy Assistant (COTA) developed 

and administered by the NBCOT. 

We are proposing that OTs who are 

educated outside the United States or by 

the U.S. Military— (1) Be graduates of 

an occupational therapy curriculum 

accredited by the World Federation of 

Occupational Therapists (WFOT); (2) 

have successfully completed the 

NBCOT International Occupational 

Therapy Eligibility Determination 

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(IOTED) review; and (3) have 

successfully completed the certification 

examination for Registered 

Occupational Therapist. We propose to 

adopt similar standards for OTAs (but 

with an OTA curriculum) and seek 

comments on qualifications for 

internationally educated occupational 

therapy assistants. 

For PTs, we propose the therapist 

must be licensed as a physical therapist 

by the State in which practicing and 

accredited by the Commission on 

Accreditation in Physical Therapy 

Education (CAPTE) based on American 

Physical Therapy Association (APTA) 

guidelines. When the licensure 

requirement is not applicable (that is, 

for services furnished incident to the 

services of physicians and NPPs), we 

propose to require that PTs must have 

been accredited by the CAPTE. We seek 

comment on qualifications for PTs that 

include a curriculum and a national 

examination each approved by the 

APTA. 

We propose that licensure or 

certification, registration or other 

regulation by the State in which services 

are furnished would be required for 

PTAs under our regulations. We also 

propose that PTAs be accredited by the 

CAPTE. We seek comment on 

appropriate qualifications for PTAs. 

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. For example, personnel 

qualifications for therapists and 

assistants should apply equally to all 

settings in which Medicare pays for 

physical therapy, occupational therapy 

and SLP services. Therefore, we propose 

to revise our regulations to crossreference 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 welcome comments on 

whether the personnel qualifications at 

§ 484.4 should be made applicable in 

other settings. 

It is our intention that when Medicare 

policies describe physical therapists, 

physical therapist assistants, 

occupational therapists, occupational 

therapy assistants and speech-language 

pathologists, the qualifications for those 

professions would be the same in all 

settings, without exception. 

(2) Application of Consistent Therapy 

Standards 

In tandem with cross-referencing Part 

A and Part B therapy personnel 

requirements in the regulations, we 

believe it would be appropriate 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. 

In § 409.17, we propose to clarify that 

hospital services include physical 

therapy, occupational therapy and SLP. 

We propose to add regulations for 

inpatient hospital services to include a 

plan of treatment for therapy services 

consistent with the plan required for 

outpatient therapy services. We invite 

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. 

Since inpatient hospital services are 

always provided under the care of a 

physician, we believe that the 

physician’s review and certification of 

the therapy plan of treatment is implied 

by the physician’s review and approval 

of a facility plan that includes therapy 

services and, therefore, we are not 

proposing additional therapy 

certification requirements for the 

hospital setting. 

c. Outpatient Therapy Certification 

Requirements 

The signature of a physician or NPP 

in the medical record indicating 

approval of the plan of care for 

outpatient therapy services certifies the 

initial need for therapy services 

furnished under Part B. For other 

covered medical and health services 

furnished by providers and suppliers of 

outpatient services, certification is 

required only once, either at the 

beginning or at the end of a series of 

visits. Recertification is not required for 

most health services. 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. 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 correct 

amount of therapy for the patient’s 

needs. In some cases, it may impact 

utilization by encouraging reevaluations 

at intervals based on certification 

timing, rather than on necessity. Since 

the 30-day recertification requirement 

was initiated in 1988, many other means 

of ensuring appropriate utilization of 

therapy services have been developed. 

Medicare policies have been clarified to 

define skilled services, reasonable and 

necessary services, and appropriate 

documentation. Payments for therapy 

services are now limited by annual per 

beneficiary caps, and there are many 

local medical review policies and 

system edits to monitor extended 

treatment. Therapy services are now 

identified as such on claims, making it 

easier to analyze and review 

overutilization of services. Three studies 

on utilization of therapy services are 

published and available to medical 

reviewers and providers or suppliers of 

services to help identify typical 

episodes of care. Taken together, these 

changes may have improved appropriate 

utilization and limit errors in billing for 

therapy services, as evidenced in the 

Improper Medicare Fee-for-Service 

Payment Report of May 2007. 

In 2004 and again in 2006, we 

engaged a contractor to perform an 

extensive analysis of the utilization of 

therapy services. The analyses indicated 

that the 30-day recertification 

requirement has not had the anticipated 

impact on utilization of services and 

does not serve to limit therapy services 

payments. About 70 percent of episodes 

are completed before the first 30-day 

recertification interval. Although CORFs 

have a 60-day recertification period, and 

SNFs and ORFs have 30-day 

recertification periods, the average 

number of treatment days is similar in 

these settings. This suggests that the 

interval of the recertification 

requirement does not affect professional 

decisions regarding the duration of 

treatment. In fact, contrary to the pattern 

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expected if certification impacted 

duration of treatment, the number of 

physical therapy treatment days is 

higher in a SNF (30-day recertification 

interval) than in a CORF (60-day 

recertification interval). 

For these reasons, we do not believe 

there is a continued need for 

recertification at the 30-day interval. We 

propose that review of the plan of care 

continue to be required at certification 

and recertification. Since the plan of 

care may be established by a nurse 

practitioner, a clinical nurse specialist, 

or a physician assistant (nonphysician 

practitioners) as well as a physician, we 

propose to modify the language in 

§ 410.61 to include those professionals 

among those who shall review the plan. 

Since the certification and 

recertification of the plan requires a 

signature, we propose to remove the 

current redundant requirement at 

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

the same time as the plan is certified. 

We propose to change the plan of 

treatment recertification schedule in 

§ 424.24. Currently, the physician must 

initially certify a plan of treatment at the 

time the plan is established or as soon 

thereafter as possible. If the need for 

treatment continues beyond 30 days, the 

plan of treatment must be recertified 

every 30 days until discharge. We 

propose that the physician (or NPP, as 

appropriate) would continue to review 

and certify the initial plan of care as 

soon as possible, but that the 

certification would apply for an episode 

length based on the patient’s needs, not 

to exceed 90 days and would be 

recertified every 90 days thereafter. 

Payment would continue to be denied if 

services were provided without a 

certified plan of care. Overutilization of 

services would continue to be 

monitored, as it is now, by Medicare 

contractors based on data analysis 

assisted by system edits. 

We believe adjusting the first 

recertification interval from 30 to 90 

days would allow the physician to 

approve a plan of care that represents 

the clinically appropriate length of 

treatment, discourage routine 30-day 

plans, encourage professional 

determination of an appropriate length 

of treatment at the time of the initial 

certification, protect the patient’s access 

to needed treatment when the certifying 

physician or NPP is not available at the 

30-day interval, reduce the 

administrative burden on providers, 

suppliers, physicians, NPPs and 

Medicare contractors, and provide an 

appropriate timeline for monitoring the 

necessity of continuing therapy services. 

Therefore, we are proposing to amend 

§ 424.24 to require recertification every 

90 days after beginning treatment. 

We propose to revise § 424.24 to 

remove reference to a certification 

‘‘statement’’ and to require that the 

continuing need for therapy services be 

documented in the medical record, for 

example, the plan of treatment. Since 

each plan must include the duration of 

treatment, the current requirement for 

an estimate of how much longer the 

services will be needed is proposed to 

be omitted as redundant. 

We propose to continue to review the 

utilization of therapy services to assess 

any changes in practice that might be 

related to the proposed changes in our 

regulations regarding certification of a 

plan of care for an appropriate length of 

treatment. After 2 years, if we determine 

that there are changes in practice that 

suggest inappropriate utilization of 

therapy services based on the 

certification timing, we will consider 

whether to reinstate the 30-day 

recertification requirement. 

3. Proposed Elimination of 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 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘PROPOSED ELIMINATION OF 

EXEMPTION FOR COMPUTERGENERATED FACSIMILES’’ at the 

beginning of your comments.] 

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, Medicare Advantage (MA) 

organizations offering Medicare 

Advantage-Prescription Drug Plans 

(MA–PD), and other Part D sponsors 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 

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 

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. 

Section 1860D–4(e) of the Act 

required the Secretary to conduct a pilot 

project to test initial standards 

recognized under section 1860D–4(e)(A) 

of the Act, prior to issuing the final 

standards in accordance with section 

1860D–4(e)(D) of the Act. Initial 

standards were recognized by the 

Secretary in 2005 and then tested in a 

pilot project during CY 2006. The MMA 

created an exception to the requirement 

for pilot testing of standards where, after 

consultation with the National 

Committee on Vital and Health 

Statistics (NCVHS), the Secretary 

determined that there already was 

adequate industry experience with the 

standard(s). Such ‘‘foundation 

standards’’ were recognized and 

adopted through notice and comment 

rulemaking as final standards without 

pilot testing. 

Based upon the evaluation of the pilot 

project, and not later than April 1, 2008, 

the Secretary is required to issue final 

uniform standards. These final 

standards must be effective not later 

than 1 year after the date of their 

issuance. 

For a complete discussion of the 

statutory bases for the e-prescribing 

portions of this proposed rule and the 

statutory requirements at section 

1860D–4 of the Act, please refer to the 

‘‘Background’’ section of the EPrescribing and the Prescription Drug 

Program proposed rule published in the 

February 4, 2005 Federal Register (70 

FR 6256). 

b. Regulatory History 

i. Foundation Standards 

After consulting with the NCVHS, the 

Secretary found that there was adequate 

industry experience with several 

potential e-prescribing standards. Upon 

adoption through notice and comment 

rulemaking, these standards were called 

‘‘foundation’’ standards, because they 

would be the first set of final standards 

adopted for an electronic prescription 

drug program. Three standards were 

adopted in the E-Prescribing and the 

Prescription Drug Program final rule 

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published in the November 7, 2005 

Federal Register (70 FR 67568). 

The foundation standards are as 

follows: 

• For the exchange of eligibility 

information between prescribers and 

Part D sponsors: ASC X12N–270/271—

Health Care Eligibility Benefit Inquiry 

and Response, Version 4010, May 2000, 

Washington Publishing Company, 

004010X092 and Addenda to Health 

Care Eligibility Benefit Inquiry and 

Response, Version 4010, A1, October 

2002, Washington Publishing Company, 

004010X092A1 (hereafter referred to as 

the ASC X12N 270/271 transaction). 

• For the exchange of eligibility 

information between dispensers and 

Part D sponsors: The National Council 

for Prescription Drug Programs (NCPDP) 

Telecommunication Standard Guide, 

Version 5, Release 1 (Version 5.1), 

September 1999, and equivalent NCPDP 

Batch Standard Batch Implementation 

Guide, Version 1, Release 1 (Version 

1.1), January 2000 supporting 

Telecommunications Standard, 

September 1999, Implementation Guide 

Version 5, Release 1 (Version 5.1) for 

NCPDP Data Record in the Detail Data 

Record (hereafter referred to as the 

NCPDP Telecommunication Standard). 

• For the exchange of new 

prescriptions, changes, renewals, 

cancellations and certain other 

transactions between prescribers and 

dispensers: NCPDP SCRIPT Standard, 

Implementation Guide, Version 5, 

Release 0 (Version 5.0), May 12, 2004 

(hereafter referred to as NCPDP SCRIPT 

Standard). 

ii. Exemption to Foundation Standard 

Requirements for Computer-Generated 

Facsimiles 

The November 7, 2005 final rule 

included an exemption for entities that 

transmit prescriptions or prescriptionrelated information by means of 

computer-generated facsimile (faxes) 

from the requirement to use the adopted 

NCPDP SCRIPT standard. ‘‘Electronic 

media’’ was already defined by the 

HIPAA, so e-prescribing utilized the 

same definition. As a result, faxes that 

were generated by a prescriber’s/ 

dispenser’s computer and sent to a 

provider’s/dispenser’s fax machine 

which prints out a hard copy of the 

original computer-generated fax (that is, 

‘‘computer-generated’’ faxes) fell within 

the definition of ‘‘electronic media’’ for 

e-prescribing. Absent an exemption, 

entities transmitting computergenerated faxes would be required to 

comply with the adopted foundation 

standards. Comments received from the 

health care industry indicated that this 

would cause computer-generated faxers 

to revert to paper prescribing. As the 

Secretary believed that prescribers/ 

dispensers using computer fax 

capabilities would eventually migrate to 

fully functional e-prescribing, possibly 

at the same time as they implemented 

electronic health record (EHR) systems, 

the November 7, 2005 final rule 

exempted entities transmitting 

computer-generated faxes from having 

to comply with the NCPDP SCRIPT 

standard. 

c. Proposal of Elimination of Exemption 

We propose to revise § 423.160(a)(3)(i) 

to eliminate the computer-generated 

facsimiles (faxes) 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). In the 

November 7, 2005 final rule (70 FR 

67571), we explained that faxes 

generated by one computer and 

electronically transmitted to another 

computer or fax machine would be 

included under the e-prescribing 

definition of electronic media. This 

computer-generated fax technology is 

used in some e-prescribing software 

products and under the definition of 

electronic media, providers and 

dispensers who utilize these products 

would be required to comply with 

adopted e-prescribing standards. Our 

discussion of computer-generated faxing 

distinguished between cases where the 

prescriber’s/dispenser’s software has the 

ability to generate SCRIPT transactions, 

but the feature is not activated because 

the prescriber has not activated the 

feature on their software, and other 

cases where software (such as a word 

processing program) is used that creates 

and sends a fax that results in a paper 

prescription or response at the receiving 

end, but does not have true eprescribing (electronic data interchange 

using the SCRIPT standard) capabilities. 

We believed that requiring 

prescribers/dispensers who already use 

electronic media to e-prescribe to 

modify or change their software and 

hardware products to be compliant with 

the foundation standards would likely 

result in their simply reverting to paper 

prescribing and would be 

counterproductive to achieving 

standardized use of non-fax electronic 

data interchange for prescribing. Also, 

we believed that prescribers and 

dispensers would begin to migrate to 

true e-prescribing in time, and therefore, 

adopted an exemption that permitted 

prescribers and dispensers to continue 

to use computer-generated faxes for 

transmitting certain prescriptions and 

prescription-related information. 

However, at the same time we 

encouraged all prescribers and 

dispensers using fax technology to move 

as quickly as possible to computer-tocomputer data interchange via the 

NCPDP SCRIPT standard. 

Since January 2006, we have seen 

little reduction in the use of computergenerated fax technology. Based on data 

provided to CMS by SureScripts, which 

operates the Pharmacy Health 

Information Exchange, the largest 

network to link electronic 

communications between pharmacies 

and physicians, serving more than 95 

percent of all pharmacies and all major 

physician technology vendors in the 

United States, it estimates that of the 

150,000 prescribers now using software 

that is capable of generating SCRIPT 

transactions, only 15 percent are doing 

so. The remaining 85 percent are still 

generating paper faxes. The costs to 

convert to e-prescribing using NCPDP 

SCRIPT for these prescribers would in 

most cases be included in the annual 

maintenance fee they pay their software 

vendor. However, the cost of conversion 

for prescribers using e-prescribing 

software that cannot generate SCRIPT 

transactions would be higher, as these 

prescribers would have to purchase and 

install other software products. 

Therefore, we are specifically soliciting 

comments on the impact to providers 

and pharmacies. 

Pharmacy implementation of eprescribing is considerably more 

widespread. SureScripts reports that all 

chain drug stores and 20 percent of 

independent pharmacies are capable of 

sending and receiving SCRIPT 

transactions. Independent pharmacies 

are less likely to perceive a return on 

investment for e-prescribing due to low 

numbers of practices seeking to move to 

e-prescribing using the SCRIPT 

transaction. 

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 believe it is important to take steps 

to encourage prescribers and dispensers 

to move toward use of the SCRIPT 

standard. 

One concrete step we could take to 

increase the use of the SCRIPT 

transaction would be to eliminate the 

exemption for computer-generated 

faxing. This would move prescribers 

and dispensers using this technology to 

upgrade to software products or to new 

versions of the products they currently 

use, that would enable electronic 

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transmission of SCRIPT transactions. 

Because this requirement would fall on 

prescribers that already use eprescribing software, it would increase 

the number of SCRIPT transactions 

fairly significantly in a relatively short 

time period, and this could in turn 

create a ‘‘tipping point’’ that could 

create an economic incentive for 

independent pharmacies to adopt 

software to begin to exchange SCRIPT 

transactions with their prescriber 

partners. 

Therefore, we propose to eliminate 

the computer-generated fax exemption 

for all provider/dispenser transactions. 

We anticipate having this change 

effective 1 year after the effective date 

of the CY 2008 PFS final rule. This will 

provide notice to prescribers and 

dispensers seeking to implement or 

upgrade e-prescribing software to look 

for products and upgrades that are 

capable of generating and receiving 

NCPDP SCRIPT transactions. It also 

affords current e-prescribers time to 

work with their trading partners to 

eventually eliminate computer to fax 

machine transactions. 

We now believe that, with the 

additional phase-in period allotted to 

allow for this transition, with improved 

and more readily available standardsbased e-prescribing products, and the 

apparent ability of e-prescribing 

networks to now identify which 

prescribers and dispensers are capable 

of making SCRIPT enabled transactions 

and which use this information to 

facilitate successful SCRIPT enabled 

transactions, this elimination of the 

exemption for computer-generated 

faxing will encourage e-prescribers and 

dispensers to move as quickly as 

possible to use of the SCRIPT standard 

with what we perceive to be minimal 

impact. 

We are soliciting comments on the 

impact of the proposed elimination of 

this exemption, including the total 

number of affected practices and 

pharmacies and the time required for 

them to implement SCRIPT-enabled 

software. Specifically, we are soliciting 

information regarding the number of 

practices that currently use legacy 

versions of software that are not capable 

of generating SCRIPT transactions and 

the amount of lead time they would 

need to comply. We are also soliciting 

comments regarding the extent to which 

eliminating the exemption would cause 

entities using fax technology to revert to 

paper prescribing rather than update 

current software. 

T. 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 section II.B. 

(GPCIs), additional provisions of the 

MIEA–TRHCA are discussed in this 

section of the proposed rule. 

1. Section 101(b)—Physician Quality 

Reporting Initiative (PQRI) 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘TRHCA—SECTION 101(b): 

PQRI’’ at the beginning of your 

comments.] 

a. Background 

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. As 

specified in section 1848(k)(3)(B) of the 

Act, 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 for 

2007, including the 2007 bonus 

payment, 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 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 as may be changed 

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

PVRP quality measures consist of the 66 

measures that we had identified and 

posted on the CMS Web site on 

December 5, 2006 (see ‘‘Transition from 

2006 PVRP’’ below in this section). The 

statute also allowed for additional 

quality measures to be added to the 

original set as the result of a consensusbased process in January 2007. As 

allowed under the statute, and based on 

actions approved at the AQA Alliance 

(formerly the Ambulatory Care Quality 

Alliance) meeting on January 22, 2007, 

8 quality measures were added to the 66 

measures identified and originally 

posted to the CMS Web site on 

December 5, 2006. The final result is 74 

‘‘2007 PQRI Quality Measures.’’ A list 

and description of these 74 measures is 

available for download from the PQRI 

Measures/Codes page of the PQRI 

section of the CMS Web site at 

www.cms.hhs.gov/PQRI. 

Although 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, the statute does allow 

modifications or refinements (such as 

code additions, corrections, or 

revisions) to the detailed specifications 

for the 2007 PQRI quality measures 

until the beginning date of the reporting 

period (that is, July 1, 2007). After this 

date, no further revisions to the 

specifications for 2007 PQRI measures 

are allowed by section 1848(k) of the 

Act. The 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 materials containing 

information on the 2007 PQRI, 

including but not limited to the 

calculation of eligibility for and amount 

of bonus payment for satisfactory 

reporting, are also available on this 

section of the CMS Web site. 

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

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. 

b. MIEA–TRHCA Requirements for 

Measures Included in the 2008 PQRI 

(i) Overview of MIEA–TRHCA 

Requirements for 2008 PQRI Quality 

Measures 

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 

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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 EHRs 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 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 (as identified 

by the Secretary) 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 one physician or 

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)(ii 

through iii) 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 discuss in the following section 

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. We also discuss 

the policies used in proposing the initial 

set of quality measures for eligible 

professionals for use in 2008 and the 

policies we propose to apply in 

publishing the final set. 

(ii) Consensus Organizations and 

Consensus-Based Process for 

Developing Measures 

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 having been developed through the 

use of a consensus-based process. 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 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 

technical standards that are developed 

or adopted by voluntary consensus 

standards bodies and shall also 

participate with such bodies in the 

development of technical standards 

when such participation is in the public 

interest and compatible with the agency 

and departmental missions, authorities, 

priorities, and budget resources. 

OMB A–119 provides specific policy 

guidance to agencies on the appropriate 

interpretation of agency responsibilities 

under the NTTAA. Specifically, 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 

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 further provides that 

‘‘voluntary consensus standards’’ are 

standards developed or adopted by 

voluntary consensus standards bodies. 

OMB A–119 defines ‘‘voluntary 

consensus standards body’’ as 

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 

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 include the following: (1) 

Industry standards, company standards, 

non-consensus 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; (2) 

Government-unique standards which 

are developed by the government for its 

own uses; (3) Standards mandated by 

statute such as those contained in the 

United States Pharmacopeia and the 

National Formulary, as referenced in 21 

U.S.C. 351. 

The term ‘‘technical standards’’ under 

12(d)(4) of the NTTAA, means 

‘‘performance-based or design-specific 

technical specifications and related 

management systems practices’’. When 

healthcare quality measures are used in 

a regulatory framework such as 

contemplated for the 2008 PQRI quality 

measures under the MIEA–TRHCA, we 

believe that such measures constitute 

‘‘technical standards’’ as used in the 

NTTAA and that NTTAA applies to 

such measures. 

Two consensus organizations are 

referenced in MIEA–TRHCA: the 

National Quality Forum (NQF) and the 

AQA. 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 physicians and other 

providers, hospital organizations, 

purchasers, researchers, payers, and 

employers. In achieving its 

determination of 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 

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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, also referenced in section 

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

organization for the purpose of 

identifying measures that have 

successfully completed review by a 

consensus organization, utilizes certain 

essential practices of a voluntary 

consensus standards body under 

NTTAA and the OMB A–119 relating to 

openness, balance of interest, and 

consensus. Of particular note is the 

breadth of formal participation among 

stakeholders that have an interest in 

healthcare quality measures dealing 

with physician care. Participants at 

AQA may vote without limitation as to 

which stakeholder category into which 

they may fall. Voting participation, for 

example, includes physicians, other 

providers, purchasers, payers, 

consumers, accrediting organizations, 

and employers. However, the AQA does 

not have a defined organizational 

structure intended to meet the 

requirements of the NTTAA and the 

OMB A–119 and has no formal due 

process or appeals structure. Therefore, 

the AQA does not meet the 

requirements of the NTTAA for a 

‘‘voluntary consensus standards body’’. 

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. 

Inasmuch as we are unaware of any 

other organizations that engage in 

endorsement or adoption of healthcare 

quality measures for physician services 

that have the level of openness, balance 

of interest, and consensus based on 

voting participation, that is comparable 

to NQF or AQA, we propose to limit 

measures for inclusion as 2008 PQRI to 

measures that are endorsed or adopted 

by NQF or AQA. However, as elaborated 

in the policies we set forth below in this 

section, we invite comment as to other 

consensus organizations that may have 

a comparable level of consensus 

organization characteristics. 

Given the 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. Unlike 

NQF, AQA is not established to serve as 

a ‘‘voluntary consensus standards body’’

under NTTAA. Therefore, the AQA is 

not established as an alternative or 

substitute for NQF endorsement 

processes as an entity organized to 

comply with the NTTAA and OMB A–

119 requirements for a voluntary 

consensus standards body. 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 

facilitate incorporation of 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 propose to 

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 will outline 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 including physician 

organizations, health care providers, 

Federal agencies, accreditation 

organizations, disease-focused not-forprofit 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 in concept but 

without proposing that 2008 PQRI 

measures be limited to those meeting 

the definition of a voluntary consensus 

standard under NTTAA, 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 and AQA as of the date of 

enactment of MIEA–TRHCA and the 

date of publication of this proposed 

rule. 

Based on the considerations 

previously discussed, we propose to 

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 

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level of openness, balance of interest, 

and consensus based on voting 

participation. As discussed above and 

further clarified in points (3) and (5), we 

do not 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, as 

implemented by 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 a 

measure has been specifically 

considered by NQF for possible 

endorsement but NQF has declined to 

endorse it as of November 15, 2007, we 

propose not to include it in the final set 

of 2008 PQRI Quality Measures. 

(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, 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 is 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 propose are based 

on the preference as articulated in 

NTTAA and OMB A–119 for ‘‘voluntary 

consensus standards’’ to government 

standards, and a preference for quality 

measures that have achieved broad 

consensus among stakeholders in the 

health care system. 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 selecting measures for PQRI 

based upon a lesser degree of consensus 

when necessary to meet CMS’ program 

needs as determined by the Secretary. 

c. Proposed 2008 PQRI Quality 

Measures 

The identified measures we propose 

for 2008 would be made final as of the 

effective date of the 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. These detailed specifications will 

include instructions for reporting and 

identify the circumstances in which 

each measure is applicable. 

For 2008, we propose PQRI Quality 

measures selected from measures listed 

in Tables 16 through 22, which fall into 

7 broad categories as set forth below in 

this section. We welcome comments on 

the implications of including any given 

measure or measures proposed herein in 

the final 2008 PQRI quality measures. 

(i) Measures Selected From the 2007 

PQRI Quality Measures 

We propose to retain and include in 

the final 2008 PQRI measures the 

following 2007 PQRI measures in Table 

16 contingent on NQF endorsement of 

each such included measure by 

November 15, 2007. All 2007 PQRI 

measures have been considered or are 

under consideration for endorsement 

under NQF projects. Those 2007 PQRI 

measures that have been declined for 

endorsement are not included in the list 

of proposed measures for 2008. The 

measures in Table 16 include measures 

submitted by specialties, in compliance 

with section 1848(k)(2)(B) of the Act, for 

example, the measures for diabetic 

retinopathy (ophthalmology). 

TABLE 16.—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. 

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TABLE 16.—2007 PQRI MEASURES—Continued 

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. 

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. 

Dialysis Dose in End Stage Renal Disease (ESRD) Patients. 

Hematocrit Level in ESRD Patients. 

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 measures 

specifications for 2007 PQRI measures 

may be updated or modified during the 

NQF endorsement process or may 

otherwise be modified prior to 2008. 

The 2008 PQRI measure specifications 

for any given measure may, therefore, be 

different from 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. 

(ii) AMA–PCPI Measures 

We propose to include measures in 

the final 2008 PQRI selected from those 

listed in Table 17 that are currently 

under development via the AMA–

Physicians Consortium for Performance 

Improvement (PCPI) provided that they 

achieve NQF endorsement or AQA 

adoption by November 15, 2007. We 

propose to select from among these 

measures based upon 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 

practitioners to which PQRI measures 

apply, the degree to which they meet 

the needs of the Medicare program, and 

their functionality in terms of their 

ability to be collected and calculated in 

the PQRI program. 

TABLE 17.—AMA/PCPI MEASURES

Prevention of Ventilator-Associated Pneumonia—Head elevation. 

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TABLE 17.—AMA/PCPI MEASURES—Continued 

Stress Ulcer Disease (SUD) Prophylaxis in Ventilated patients. 

Prevention of Catheter-Related Bloodstream Infections in Ventilated patients—Catheter Insertion Protocol. 

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). 

Blood Pressure Measurement in patients with CKD. 

Plan of Care for patients with CKD and Elevated Blood Pressure. 

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

Calcium, Phosphorus and Intact Parathyroid Hormone Measurement in patients with CKD. 

Lipid Profile in patients with CKD. 

Hemoglobin Monitoring in patients with CKD. 

Erythropoietin Overuse in patients with CKD and normal Hemoglobin. 

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

Vascular Access for patients Undergoing Hemodialysis. 

Permanent Catheter Vascular Access for patients Receiving 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 receive Anti-Inflammatory or Analgesia Medication. 

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

Patients with Acute Otitis Externa (AOE) or Otitis Media with Effusion (OME) who receive Topical Therapy. 

Patients with AOE/OME who have a pain assessment. 

Patients with AOE/OME who are inappropriately prescribed antimicrobials. 

Patients with AOE/OME who have an assessment of tympanic membrane mobility. 

Patients with AOE/OME who undergo hearing testing. 

Patients with AOE/OME who inappropriately receive antihistamines/decongestants. 

Patients with AOE/OME who inappropriately receive systemic antimicrobials. 

Patients with AOE/OME who inappropriately receive systemic steroids. 

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. 

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). 

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 

(iii) Nonphysician Measures Currently 

Under Development 

We propose to include measures in 

the final 2008 PQRI quality measures 

selected from those listed in Table 18 

that are currently under development by 

Quality Insights of Pennsylvania (under 

the Medicare Quality Improvement 

Organization (QIO) contract for the State 

of Pennsylvania) and that achieve NQF 

endorsement or AQA adoption by 

November 15, 2007. We propose to 

select from among these measures based 

upon: 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. 

TABLE 18.—QUALITY INSIGHTS OF

PENNSYLVANIA NONPHYSICIAN

MEASURES

Universal Weight Screening (BMI). 

Universal Weight Screening Follow-up (BMI). 

Universal Hypertension Screening. 

Universal Hypertension Screening Follow-up. 

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TABLE 18.—QUALITY INSIGHTS OF

PENNSYLVANIA NONPHYSICIAN

MEASURES—Continued 

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. 

Patient Co-development of Plan of Care. 

Pain Assessment Prior to Initiation of Patient 

Treatment. 

(iv) Structural Measures Currently 

Under Development 

We propose to include measures in 

the final 2008 PQRI measures selected 

from the structural measures listed in 

Table 19 that are currently under 

development by Quality Insights of 

Pennsylvania (under the Medicare QIO 

contract for the State of Pennsylvania) 

and that achieve NQF endorsement or 

AQA adoption by November 15, 2007. 

These measures meet the requirement of 

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

the quality reporting system for 2008 

include structural measures. 

TABLE 19.—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 propose to include measures in 

the final 2008 PQRI measures selected 

from the AQA starter set that were not 

included in the 2007 PQRI quality 

measures but that are relevant to 

Medicare beneficiaries. Specifications 

necessary for PQRI reporting of these 

measures will be completed for such 

measures by November 15, 2007, and 

posted on the CMS Web site. Each of the 

AQA starter-set measures that is 

identified in Table 20 we propose to 

include in the 2008 PQRI quality 

measures provided it retains NQF 

endorsement and AQA adoption as of 

November 15, 2007. 

TABLE 20.—ADDITIONAL AQA 

STARTER-SET MEASURES

Dilated eye exam in diabetic patient. 

Beta-Blocker Therapy (persistent for 6 

months or more)—Post MI. 

Screening Mammography. 

Colorectal Cancer Screening. 

Inquiry regarding Tobacco Use. 

Advising Smokers to Quit. 

(vi) Other NQF-Endorsed Measures 

We propose to 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 are relevant to 

Medicare beneficiaries, address overuse/ 

misuse of pharmacologic therapy, and 

that expand the specialty applicability 

and patient population. Specifications 

necessary for PQRI reporting of these 

measures will be completed for such 

measures by November 15, 2007, and 

posted on the CMS Web site. We 

propose to include in the 2008 PQRI 

quality measures each of the NQFendorsed measures identified in Table 

21 provided it retains NQF endorsement 

as of November 15, 2007. 

TABLE 21.—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 (LSVD). 

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

Annual Therapeutic monitoring for patients on the following persistent medications: 

• Angiotensin Converting Enzyme Inhibitor (ACE)/Angiotensis Receptor Blocker (ARB); 

• Digoxin; 

• Diuretics; 

• Anticonvulsants; and 

• Statins. 

Influenza vaccination for patients ≥ 50 years old. 

Pneumonia vaccination for patients 65 years and older. 

(vii) Podiatric Measures 

We propose to include measures in 

the final 2008 PQRI quality measures 

selected from those listed in Table 22 

that are currently under development by 

the American Podiatric Medical 

Association and that achieve NQF 

endorsement or AQA adoption by 

November 15, 2007. We propose to 

select from among these measures based 

upon development completion of the 

measures in a sufficiently timely 

manner that implementation for 2008 

would be practical. 

TABLE 22.—PODIATRIC MEASURES

Diabetic Foot and Ankle Care, Peripheral 

Neuropathy: Neurological Evaluation. 

TABLE 22.—PODIATRIC MEASURES—

Continued 

Diabetic Foot and Ankle Care, Peripheral Arterial Disease: Ankle Brachial Index (ABI) 

Measurement. 

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 

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’’. 

A medical registry, which is also often 

referred to as a ‘‘clinical registry’’ or 

‘‘clinical data registry’’, henceforth 

‘‘registry’’, may be broadly defined as a 

file of documents containing uniform 

information about a defined population 

of individual persons or events, 

collected using an observational study 

design in a systematic way, in order to 

serve a predetermined scientific, 

clinical, or policy purpose. It is 

generally agreed that clinical data 

registries are one potential means to 

measure and report physician and other 

eligible professionals’ performance for 

purposes of quality improvement, 

public reporting, quality based payment, 

continuous certification, and 

credentialing. Other possible uses of 

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data collected by a registry include 

satisfying requirements for maintenance 

of professional or specialty board 

certification status, and ongoing 

improvement of professional 

performance. 

The MIEA–TRHCA lists the Society of 

Thoracic Surgeons (STS) National 

Database registry as an example of a 

registry. The STS registry collects 

outcomes and quality data on cardiac 

surgeries. The data output provides an 

analysis of the participant’s adult 

cardiac surgery outcomes, resulting in a 

benchmarking of each participant’s data 

against regional and national outcomes. 

The STS registry currently collects data 

on two PQRI quality measures that have 

been adapted from existing STS 

measures. These two measures are: Use 

of Internal Mammary Artery (IMA) in 

Coronary Artery Bypass Graft (CABG) 

Surgery; and Pre-operative Beta-blocker 

in Patient with Isolated Coronary Artery 

Bypass Graft (CABG) Surgery. 

To be eligible for the incentive 

payment under MIEA–TRHCA, cardiac 

and thoracic surgeons who report data 

to the STS registry will in 2007 and 

2008 still find it necessary under PQRI 

to report quality data with reference to 

those same measures through the claims 

process. To avoid duplication of data 

submission and to support the use of 

registries, generally, we believe that it 

would be desirable to establish a 

mechanism whereby the quality data 

relevant to PQRI measures could be 

reported from the registries, on behalf of 

eligible professionals. 

At this point, it is unclear which 

registries currently collect or plan to 

collect data for PRQI quality measures 

and which approach or approaches 

should be utilized to allow registries to 

report quality data to PQRI. For this 

reason, in 2008, we anticipate 

evaluating and testing the mechanisms 

to use registries for the reporting of 

PQRI quality data. We plan to use the 

results of this evaluation and testing to 

determine whether and how to 

implement the use of registries for the 

reporting of quality data in the future. 

In concept, we anticipate that upon 

implementation of registry-based quality 

data reporting, eligible professionals 

would be able to provide data on PQRI 

quality measures through an appropriate 

medical registry by authorizing or 

instructing the registry to submit data 

on their behalf. Thus, the registry would 

act as a data submission vendor for the 

eligible professional. A ‘‘data 

submission vendor’’ is defined as an 

entity that has permission from the 

eligible professional to provide medical 

registry data to the Quality Reporting 

System developed per the statute. The 

registry, acting as such a data 

submission vendor, would submit data 

to the CMS clinical data warehouse 

component of the Quality Reporting 

System, using a CMS-specified record 

layout based on the quality measures’

specifications as published by CMS. For 

purposes of this proposed rule, the term, 

‘‘CMS clinical data warehouse,’’ is 

defined as a clinical data warehouse 

designated by CMS. 

For 2008, we expect to explore at least 

the five different data submission 

options described below, and to test in 

CY 2008 one or more of these options. 

There are several data formats and 

analytical options that we see as 

potentially available to fulfill the 

objectives of registry inclusion in PQRI. 

These options vary with regard to 

whether individual beneficiary-level 

data is submitted by the registry, as well 

as to the number and type of data 

elements needed from the registry. 

Option 1: Registries provide the 

quality-data codes required for a 

particular PQRI measure plus 

beneficiary/service identifier 

information needed to link the registry 

data to Medicare Part B claims. The 

beneficiary/service identifiers would be 

used to pull in the denominator data by 

CMS. All non-registry analytics 

payment information and diagnosis 

would come from claims. Reporting/ 

performing rates would be calculated 

from the registry-submitted data. 

Examples of data elements needed 

from a registry are: 

• Beneficiary HIC Number 

• Beneficiary Date of Birth 

• Date of Service 

• NPI and Tax ID 

• CPT category II and G codes and 

modifiers 

• Clinical data elements required to 

compute the appropriate CPT category II 

codes, G codes and modifiers 

Option 2: Registries provide the 

quality codes and diagnosis codes. We 

would use claims to capture the 

payment information at the NPI/Tax ID 

level. The beneficiary-specific 

information is de-identified. All PQRI 

reporting and performance calculations 

would be performed using registry data. 

Payment information would be 

extracted from Medicare claims. The 

registries would be required to add data 

elements to the database to allow 

collection of appropriate codes. 

Examples of data elements needed 

from a registry: 

• Beneficiary/procedure level data 

(ICD–9 and CPT codes) 

• HCPCS codes (G-codes and CPT 

category II codes and modifiers) 

• NPI and Tax ID 

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 would be 

required to add data elements to the 

database to allow collection of 

appropriate quality-data codes or 

clinical data needed to compute the 

quality-data codes. Registries would be 

required to perform the necessary 

calculations to be able to submit 

completed numerator/denominators for 

both reporting and performance rates. 

Option 4: Registries provide all of the 

claims data elements as submitted using 

the Part B claims process. We perform 

all rate calculations. 

Examples of data elements needed 

from a registry include the following: 

• Line Item TIN 

• Line Item Individual NPI 

• Line Item Group NPI 

• Claim Beneficiary Claim Account 

Number (CAN) 

• Claim Beneficiary Identification 

Code (BIC) 

• Claim Date of Birth 

• Line Item First Expense Date 

• Line Item Last Expense Date 

• Line Item Diagnosis Code 

• Line Item HCPCS (HCPCS Level 1, 

CPT Category I, CPT Category II, HCPCS 

Level 2 G Codes) 

• Line Item Initial Modifier Code 

• Line Item Secondary Modifier Code 

• Claim CMS Claims Processing Date 

• Claim Overall Allowable Charges 

• Line Item Allowable Charges 

• Claim Gender 

• Claim Carrier Number 

• Claim Control Number 

• Claim Final Action Status 

• Claim Carrier Claim Receipt Date 

• Claim Payment Denial Code 

• Line Item Procedure Indicator Code 

• Line Item Carrier Locality Code 

• Line Item Provider State Code 

• Line Item Place of Service 

• Line Processing Indicator Code 

Option 5: Registry data dump for 

Medicare beneficiaries only; for all 

information in the registry for the 

service period of interest. There is an 

assumption that the registry is able to 

submit either: (1) the ICD–9, HCPCS, 

and CPT category II codes and 

exclusions as stated in the measures 

specifications; or (2) supply the clinical 

information needed for CMS to make 

those judgments (eligibility and quality 

of care). We would be required to use 

a series of linkage algorithms to attempt 

to connect the registry data with the 

matching claims. 

Examples for linkage of registry data 

to the corresponding Medicare Part B 

claims include some combination of: 

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• Beneficiary-level identifiers: HIC (or 

SSN), DOB, gender 

• Procedure-level identifiers: date of 

service (or procedure date) 

• Provider identifiers: NPI, Tax ID, or 

even UPIN 

For CMS to maintain compliance with 

applicable statutes, including but not 

limited to HIPAA, the registry must 

maintain compliance with HIPAA 

requirements for processing, storing, 

and transmitting data. 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 

Consolidated Health Informatics 

Initiative (CHI) standards adopted by 

the Federal government, and therefore, 

applicable to the HHS. A description of 

the CHI, including its purpose, Federal 

member agencies, and the specific 

standards adopted by the Federal 

government, 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. 

Upon determination of the preferred 

option and conclusion of the testing 

phase for registry-based reporting to 

PQRI, we anticipate that all necessary 

information and instructions will be 

made available on the PQRI section of 

the CMS Web site at http:// 

www.cms.hhs.gov/pqri. This 

information will include at a minimum: 

(a) The exact data elements needed and 

the CMS-specified record layout for 

transmitting the data to the CMS clinical 

data warehouse; and (b) a detailed 

description of the proposed CMS 

infrastructure for accepting registrybased submission of PQRI quality data, 

including, but not limited to, electronic 

data exchange specifications, and 

applicable processes for authenticating 

registry users for access to the 

warehouse submission interface. 

We anticipate requesting that 

registries interested in participating in 

the testing of the registry-based quality 

data submission mechanism will be 

invited to self-nominate via a simple 

process that will be published on the 

PQRI section of the CMS Web site, and 

via one or more additional CMS 

communication venues, in the fourth 

quarter of 2007. We propose and expect 

to begin testing with the registries in the 

first quarter of 2008. 

We plan to select for testing, from the 

self nominees, a group of registries that 

are HIPAA and CHI compliant and 

technically capable of interfacing with 

the CMS clinical warehouse electronic 

data exchange interface (EDI). The 

number of registries selected for testing 

may be all that are technically capable 

or may need to be limited to some or all 

of those that already contain key 

minimum data elements on at least a 

test basis, depending on the number of 

registries falling into these categories 

and on the actual level of complexity 

and effort required for the testing from 

the CMS data infrastructure. 

(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 EDI than others.) 

We invite comments on these plans 

for evaluation and testing mechanisms 

for registry-based quality-data reporting 

to PQRI with reference to the 5 data 

submission options described. We also 

invite comments on appropriate 

validation methodologies for reporting 

and performance rates. 

In addition to the testing of registrybased submission of quality data, CMS 

is considering for 2008 the feasibility 

and utility of accepting clinical quality 

data submitted from EHRs. For 2008, we 

plan to consider accepting EHRextracted clinical data for a limited 

number of ambulatory-care PQRI 

measures for which data may also be 

submitted under the current Doctors 

Office Quality–Information Technology 

(DOQ–IT) Project. The listing of and 

specifications for DOQ–IT ambulatorycare measures are available at http:// 

www.qualitynet.org, under the 

subsidiary headings Physician Offices, 

Doctors Office Quality Information 

Technology (DOQ–IT), Ambulatory-Care 

Measures. If implemented in 2008, the 

EHR-based submission of PQRI/DOQ–IT 

overlapping ambulatory-care measures 

would serve as an alternative method to 

claims-based reporting of submitting 

quality data for those measures, not a 

required method. 

2. Section 110—Reporting of Anemia 

Quality Indicators (§ 414.707(b)) 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘TRHCA—SECTION 110: 

ANEMIA QUALITY INDICATORS’’ at 

the beginning of your comments.] 

Medicare Part B provides payment for 

certain drugs used to treat anemia. 

Anemia is common in cancer patients 

and may be caused by 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 have received the 

greatest attention. Notably, recent 

research has raised concerns that these 

drugs may be associated with significant 

adverse effects including a higher risk of 

mortality in some populations, possibly 

related to the amount of drug 

administered. 

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 ESRD receiving dialysis 

treatments in facilities. For many years 

prior, we have required the reporting of 

these red blood cell indicators by ESRD 

facilities to ensure that the beneficiaries’

anemia was addressed. 

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 MIEA–

TRHCA 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 the 

anemia quality indicators in cancer 

patients undergoing treatment for 

anemia, 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. 

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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. 

While not required by this statute, we 

are requesting public comment on the 

potential of expanding this regulation to 

include all uses of ESAs. 

3. Section 104—Extension of Treatment 

of Certain Physician Pathology Services 

Under Medicare 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘TRHCA—SECTION 104: 

PHYSICIAN PATHOLOGY SERVICES’’

at the beginning of your comments.] 

The 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 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, 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, 

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, 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 are implemented in the 

following year. However, in this case, 

the change to § 415.130 was delayed one 

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 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 implementing the 

provisions of the CY 2000 PFS final rule 

whose implementation had been 

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. 

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 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. 

4. Section 201—Extension of Therapy 

Cap Exception Process 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘TRHCA—SECTION 201: 

THERAPY CAPS’’ at the beginning of 

your comments.] 

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 outpatient 

hospital services. The caps were 

implemented from January 1, 1999 

through December 31, 1999, from 

September 1, 2003 through December 7, 

2003, and beginning January 1, 2006 

(with an exception process). In CY 2000 

through CY 2002, and from December 8, 

2003 through December 31, 2005, the 

Congress placed moratoria on 

implementation of the caps. 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). 

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 

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 

beginning on January 1, 2008. The 

dollar amount of the therapy caps in CY 

2008 will be the CY 2007 rate ($1,780) 

increased by the percentage increase in 

the MEI. 

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, the 

therapy caps will remain inapplicable to 

expenses incurred for therapy services 

furnished in the outpatient hospital 

setting as provided in section 1833(g) of 

the Act. 

5. Section 101(d)—Physician Assistance 

and Quality Initiative (PAQI) Fund 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘TRHCA—SECTION 101(d): 

PAQI’’ at the beginning of your 

comments.] 

Section 1848(1) of the Act, as added 

by section 101(d) of the MIEA–TRHCA 

requires the Secretary to establish a 

Physician Assistance and Quality 

Initiative Fund (PAQI) which shall be 

available for physician payment and 

quality improvement initiatives, which 

may include application of an 

adjustment to the update of the PFS CF. 

The provision makes available $1.35 

billion to the Fund for services 

furnished during 2008. Specifically, the 

provision directs the Secretary to 

provide for expenditures from the Fund 

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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 conversion 

factor for a year, the conversion factor 

for a subsequent year shall be computed 

as if the adjustment to the conversion 

factor had never occurred. 

As the legislation indicates, this Fund 

can be used to either buy down the 

negative update to the fee schedule or 

for quality improvement initiatives. We 

believe it is essential that Medicare 

continue to encourage improvement in 

the efficiency and quality of health care 

delivered to Medicare beneficiaries. 

Therefore, we are proposing that the 

$1.35 billion be used to fund bonus 

payments to be made during 2009 for 

physician reporting of measures during 

2008. Specifically, we propose that the 

physician quality initiative for 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. 

If, as discussed in section II.T.1 of this 

proposed rule, we determine that a 

quality measure reporting mechanism 

based on EHRs can be effectively 

implemented in 2008, we would plan to 

also offer eligible professionals the 

option of reporting quality measures via 

such EHR-based mechanism based in 

lieu of claims-based reporting. If the 

EHR-based reporting mechanism is 

implemented for 2008, we would expect 

to apply to professionals opting to 

report via that mechanism the same 

standards for satisfactory reporting as 

are applicable to professionals reporting 

quality measures via claims. 

The differences between 2007 and 

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/ 

01_Overview.asp#TopOfPage. 

As with the 2007 PQRI, we are 

proposing 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 propose that physicians 

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 propose that the 

2008 measures that we finalize in the 

PFS final rule would apply for 2008. We 

also propose 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 2008 

reporting period. Given that we are 

proposing to use the PAQI Fund for the 

2008 PQRI program, we also propose 

that the bonus payments to individual 

physicians be subject to an aggregate 

cap of $1.35 billion. Because we are 

proposing to scale aggregate payments 

to physicians in a manner such that 

Medicare would pay $1.35 billion 

during 2009 for measures reported for 

services furnished during 2008, we are 

unable to provide an exact percentage 

for the bonus payment at this time. 

However, 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 will exceed 2 percent). 

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. This approach allows CMS 

to fully expend the $1.35 billion fund 

and further the goal of improving 

quality and efficiency by utilizing the 

infrastructure that both physicians and 

Medicare have invested in for the 2007 

PQRI. We believe implementing this 

Fund through an extension of the PQRI 

program is the best way to ensure 

physicians get the greatest benefit from 

the Fund’s resources while ensuring 

that the Fund is being used to increase 

quality and efficiency of care for 

Medicare beneficiaries. 

We recognize that there is an 

alternative approach to using this fund. 

That is, the $1.35 billion could be used 

in some manner to reduce the update to 

the PFS of ¥9.9 percent that is 

projected for 2008. However, there are 

fundamental legal and 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 two 

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 2008 negative update, it 

could still leave money in the Fund, and 

we would be faced with the same 

problem of how to spend such 

remaining funds in the future. 

Therefore, as previously stated, we 

believe the best use of the Fund is to 

apply it to extend PQRI into 2008. 

6. Section 108—Payment Process Under 

the Competitive Acquisition Program 

(CAP) 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘TRHCA—SECTION 108: CAP’’

at the beginning of your comments.] 

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 which requires that 

payment for drugs and biologicals shall 

be made upon receipt of a claim for a 

drug or biological supplied for 

administration to a beneficiary. 

Section 108(a)(2) of the MIEA–

TRHCA required 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, 

Construction, 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. 

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III. Fee Schedule for Payment of 

Ambulance Services Update for CY 

2007; Ambulance Inflation Factor 

Update for CY 2008; and Proposed 

Revisions to the Publication of the 

Ambulance Fee Schedule (§ 414.620) 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘AMBULANCE SERVICES’’ at 

the beginning of your comments.] 

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. At this time, the CPI-U for the 12- 

month period ending with June 2007 is 

not available. We will announce the AIF 

for CY 2008 in the final rule which will 

be published in the Federal Register 

later this year. In addition, as set forth 

in Section III.D., we propose to 

announce the AIF for CY 2009 and 

subsequent years via CMS instruction 

and on the CMS Web site. 

D. Proposed Revisions to the Publication 

of the Ambulance Fee Schedule 

(§ 414.620) 

Currently, section 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. 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. 

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, the AIF is not 

published by CMS until November 

because § 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 

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review by CMS, HHS, and OMB prior to 

publication. Therefore, even though we 

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 

so that they can effectuate the proper 

payment on Medicare ambulance claims 

timely. 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 

practices 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 are proposing 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. 

IV. 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. To fairly evaluate whether an 

information collection should be 

approved by OMB, section 3506(c)(2)(A) 

of the Paperwork Reduction Act of 1995 

requires that we solicit comment on the 

following issues: 

• The need for the information 

collection and its usefulness in carrying 

out the proper functions of our agency. 

• The accuracy of our estimate of the 

information collection burden. 

• The quality, utility, and clarity of 

the information to be collected. 

• Recommendations to minimize the 

information collection burden on the 

affected public, including automated 

collection techniques. 

We are soliciting public comment on 

each of these issues for the following 

sections of this document that contain 

information collection requirements. 

Section 410.33 Independent diagnostic 

testing facility 

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, location, 

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 that must have a 

comprehensive insurance policy or 

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 a 

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) is not subject to the 

PRA. 

Section 414.707 Basis of payment 

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. 

Section 414.914 Term of contract 

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) 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) though (vi). 

When obtaining verbal verification, the 

CAP vendor must document the 

elements listed in § 414.914(h)(2)(i) 

though (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) 

through (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 

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5 CFR 1320.3(c)(4) because it would 

affect less than 10 persons. 

Section 414.930 Compendia for 

Determination of Medically-Accepted 

Indications for Off-Label Uses of Drugs 

and Biologicals in an Anti-Cancer 

Chemotherapeutic Regimen 

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 solicit requests for 

changes to the list of compendia. As 

stated in § 414.930(c)(1), we 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. 

Section 414.930(d) states that for each 

compendium that is determined by CMS 

to be included on the list, the publisher 

or its designee must notify CMS, within 

45 days of any update or revision, that 

a new edition or version is available. 

The burden associated with the 

requirements contained in § 414.930(b) 

through (d) is the time and effort 

required to draft and submit to CMS a 

complete written request for changes to 

the list of compendia. In addition, there 

is additional time and effort for each 

compendium that is determined by CMS 

to be included on the list; the publisher 

or its designee must furnish to CMS, 

within 45 days of listing and within 45 

days of any update or revision, a written 

copy of the current edition or version of 

the compendia, including updates. 

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 currently 

only 6 compendia that could reasonably 

be expected to be the subject of a 

request, so 6 requests is a likely 

maximum. 

Section 424.36 Signature 

Requirements 

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 persons specified 

in § 424.36(b)(1) through (5). Proposed 

§ 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 persons 

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 approximately 9,000 ambulance 

providers or suppliers will comply with 

these requirements. We estimate that it 

will take no more than 5 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 5 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 BLS-emergency 

ambulance claims processed by Part B 

carriers, incurred in 2006 and processed 

through April 2007, and thus, does not 

include the number of emergency 

ambulance transport services billed to 

fiscal intermediaries by ambulance 

providers (this 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 proposed rule imposes collection 

of information requirements as outlined 

in the regulation text and specified 

above. However, this proposed rule 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 of this 

proposed rule 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 

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control number 0938–0921, with an 

expiration date of May 31, 2009. 

Competitive Acquisition Program (CAP) 

In section II.F.2.c. 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.e. of the preamble 

discusses details of the CAP. 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.e. 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 30 days of its 

participation if it can prove that staying 

in the program would impose a 

significant burden. 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-case basis. 

Once the CAP-designated carrier 

receives a removal request, they are 

required to refer the physician to their 

approved CAP vendor. As part of the 

grievance process, the CAP vendor will 

try to work with the physician to 

address their concerns for participation 

in the program. Then, the CAP vendor 

has 2 business days to address the 

physician’s concerns. If the CAP vendor 

and the physician cannot resolve the 

outstanding issues within 2 business 

days, the CAP vendor may submit a 

request to CMS for an extension to allow 

for an additional 2 business days to 

resolve the physician’s issues. 

The burden associated with this 

requirement is the time and effort 

necessary to submit an extension 

request to CMS. While this burden is 

subject to the PRA, we currently have 

no way to quantify how many requests 

of this type we will receive. Requests 

from physicians will be reviewed by 

CAP vendors on an individual case-bycase basis. Similarly, requests for 

extensions from the CAP vendors will 

be reviewed individually, on a case-bycase 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.T.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.T.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.T.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 applicable to 

covered professional services they 

furnish to Medicare beneficiaries, 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 at least 1, 2, or 3 measures 

selected from the 74 PQRI 2007 quality 

measures. The minimum number of 

measures each professional must report 

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, three or more 

available measures will be applicable to 

their practice, and thus, the MIEA–

TRHCA requires that they report on at 

least three measures at a rate of at least 

80 percent for each of those three 

measures to meet statutory criteria for 

satisfactory reporting and qualify for the 

bonus payment. 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 available. 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 CMS 

Form 1500. There will be no new forms 

and no modifications to the existing 

transaction or form in support of 2007 

PQRI. We also do 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 2007. 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. 

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TABLE 23.—ESTIMATED ANNUAL REPORTING AND RECORDKEEPING BURDEN

Regulation section(s) OMB control 

number 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 

0938–0987 10,000 10,000 20,000 

§ 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–P, Room C4–

26–05, 7500 Security Boulevard, 

Baltimore, MD 21244–1850; and Office 

of Information and Regulatory Affairs, 

Office of Management and Budget, 

Room 10235, New Executive Office 

Building, Washington, DC 20503, Attn: 

Carolyn Lovett, CMS Desk Officer, 

[CMS–1385–P], 

carolyn_lovett@omb.eop.gov. Fax (202) 

395–6974. 

V. 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. 

VI. Regulatory Impact Analysis 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘IMPACT’’ at the beginning of 

your comments.] 

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 

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 proposed rules 

with economically significant effects 

(that is, a proposed 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 proposed 

rule will redistribute more than $100 

million in 1 year. We are considering 

this proposed 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 proposed 

rule 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 provide 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 proposed CAP 

provisions in this proposed rule 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 proposed 

rule is estimated to impact more than 5 

percent of the total number of small 

entities. Based on our analysis of the 

930 nonprofit ESRD facilities 

considered small entities in accordance 

with the above definitions, we estimate 

that the combined impact of the 

proposed changes to payment for renal 

dialysis services included in this 

proposed rule would have a 0.8 percent 

increase in overall payments relative to 

current overall payments. The analysis 

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and discussion provided in this section, 

as well as elsewhere in this proposed 

rule, 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 proposed rule 

constitutes our initial regulatory 

flexibility analysis for the remaining 

provisions. Therefore, we are soliciting 

comments on our estimates and analysis 

of the impact of this proposed rule on 

those small entities. 

Section 1102(b) of the Act requires us 

to prepare a regulatory impact analysis 

for any proposed rule that may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 603 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 proposed rule 

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 $120 million. This 

proposed rule 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 proposed rule 

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 

proposed rule; details the costs and 

benefits of the rule; analyzes 

alternatives; and presents the measures 

we propose to use to minimize the 

burden on small entities. As indicated 

elsewhere in this proposed rule, we 

propose 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 proposed rule. 

We are unaware of any relevant Federal 

rules that duplicate, overlap or conflict 

with this proposed rule. The relevant 

sections of this proposed rule contain a 

description of significant alternatives if 

applicable. 

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. See Table 

10 in Section II.E. for a listing of the 

RUC recommendations and CMS 

decisions on these additional codes 

reviewed for the 5-Year Review. 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 proposed 

revised work adjustor for 2008, based 

upon the proposed work RVUs for these 

additional CPT codes and proposed 

increases in the work of anesthesia 

services, is approximately 0.8816. Table 

24 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 

proposed payment rates for CY 2008 

using CY 2006 Medicare utilization for 

all years. We are using CY 2006 

Medicare claims processed and paid 

through March 30, 2007, that we 

estimate are 98 percent complete. 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 24. 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 24 shows only the payment 

impact on PFS services. The following 

is an explanation of the information 

represented in Table 24. Note that Table 

24 does not include the impact of the 

estimated CY 2008 update. 

• Specialty: The physician specialty 

or type of practitioner/supplier. 

• Allowed Charges: Allowed charges 

are the Medicare Fee Schedule amounts 

for covered services and include 

coinsurance and deductibles (which are 

the financial responsibility of the 

beneficiary.) These amounts have been 

summed across all services provided by 

physicians, practitioners, or suppliers 

with a specialty to arrive at the total 

allowed charges for the specialty. 

• Impact of Work RVU Changes for 

additional proposed 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 proposed 

work RVUs and PE RVUs for both 2008 

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Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38213 

and the fully implemented 2010 PE 

RVUs. 

TABLE 24.—PROPOSED COMBINED TOTAL ALLOWED CHARGE IMPACT FOR WORK AND PRACTICE EXPENSE RVU 

CHANGES

Specialty 

Impact of work 

RVU changes 

2008 

(percent) 

Impact of PE RVU changes 

(percent) 

Combined impact of PE and 

work changes* 

(percent) 

2008 

(PE trans. 

year 2) 

2010 

(PE full 

implement.) 

2008 

(PE trans. 

year 2) 

2010 

(PE full 

implement.) 

TOTAL .................................................................................. 0 0 0 0 0 

ALLERGY/IMMUNOLOGY ................................................... 0 1 2 1 3 

ANESTHESIOLOGY ............................................................ 15 ¥1 ¥3 14 13 

CARDIAC SURGERY .......................................................... ¥1 ¥1 ¥2 ¥2 ¥3 

CARDIOLOGY ..................................................................... ¥1 0 0 ¥1 ¥1 

COLON AND RECTAL SURGERY ..................................... ¥1 1 2 0 1 

CRITICAL CARE .................................................................. ¥1 0 ¥1 ¥1 ¥2 

DERMATOLOGY ................................................................. ¥1 2 7 2 6 

EMERGENCY MEDICINE ................................................... ¥1 0 ¥1 ¥2 ¥2 

ENDOCRINOLOGY ............................................................. ¥1 0 0 ¥1 ¥2 

FAMILY PRACTICE ............................................................. 0 0 0 0 0 

GASTROENTEROLOGY ..................................................... ¥1 1 4 0 3 

GENERAL PRACTICE ......................................................... 0 0 ¥1 0 ¥1 

GENERAL SURGERY ......................................................... ¥1 0 0 ¥1 ¥1 

GERIATRICS ....................................................................... 2 0 0 2 3 

HAND SURGERY ................................................................ ¥1 ¥1 ¥3 ¥2 ¥4 

HEMATOLOGY/ONCOLOGY .............................................. ¥1 0 ¥1 ¥1 ¥2 

INFECTIOUS DISEASE ....................................................... ¥1 0 1 ¥1 0 

INTERNAL MEDICINE ......................................................... 0 0 0 0 ¥1 

INTERVENTIONAL RADIOLOGY ....................................... ¥1 ¥1 ¥4 ¥2 ¥4 

NEPHROLOGY .................................................................... ¥1 ¥1 ¥4 ¥2 ¥5 

NEUROLOGY ...................................................................... ¥1 0 ¥1 ¥1 ¥2 

NEUROSURGERY .............................................................. ¥1 ¥1 ¥2 ¥2 ¥3 

NUCLEAR MEDICINE ......................................................... ¥1 4 13 4 12 

OBSTETRICS/GYNECOLOGY ............................................ ¥1 0 ¥1 ¥1 ¥2 

OPHTHALMOLOGY ............................................................ 2 ¥1 ¥3 1 ¥1 

ORTHOPEDIC SURGERY .................................................. ¥1 ¥1 ¥2 ¥1 ¥2 

OTOLARNGOLOGY ............................................................ 2 ¥1 ¥4 1 ¥2 

PATHOLOGY ....................................................................... ¥1 ¥1 ¥3 ¥2 ¥4 

PEDIATRICS ........................................................................ 0 0 0 0 ¥1 

PHYSICAL MEDICINE ......................................................... 0 ¥1 ¥2 ¥1 ¥2 

PLASTIC SURGERY ........................................................... ¥1 0 1 ¥1 0 

PSYCHIATRY ...................................................................... ¥1 0 1 0 1 

PULMONARY DISEASE ...................................................... ¥1 0 1 ¥1 0 

RADIATION ONCOLOGY .................................................... ¥1 0 1 0 1 

RADIOLOGY ........................................................................ ¥1 1 2 0 1 

RHEUMATOLOGY ............................................................... ¥1 ¥1 ¥2 ¥2 ¥3 

THORACIC SURGERY ....................................................... ¥1 ¥1 ¥2 ¥2 ¥3 

UROLOGY ........................................................................... ¥1 0 0 ¥1 ¥1 

VASCULAR SURGERY ....................................................... ¥1 0 ¥1 ¥1 ¥1 

AUDIOLOGIST ..................................................................... 26 ¥14 ¥43 12 ¥17 

CHIROPRACTOR ................................................................ ¥1 ¥1 ¥2 ¥2 ¥3 

CLINICAL PSYCHOLOGIST ............................................... ¥1 ¥2 ¥6 ¥3 ¥7 

CLINICAL SOCIAL WORKER ............................................. ¥1 ¥2 ¥5 ¥3 ¥6 

NURSE ANESTHETIST ....................................................... 22 0 0 22 22 

NURSE PRACTITIONER ..................................................... 1 0 1 2 2 

OPTOMETRY ...................................................................... 4 0 ¥1 4 3 

ORAL/MAXILLOFACIAL SURGERY ................................... ¥1 1 3 0 3 

PHYSICAL/OCCUPATIONAL THERAPY ............................ ¥1 1 4 1 4 

PHYSICIAN ASSISTANT ..................................................... ¥1 0 0 0 0 

PODIATRY ........................................................................... ¥1 1 4 1 3 

DIAGNOSTIC TESTING FACILITY ..................................... 0 0 0 0 0 

INDEPENDENT LABORATORY .......................................... 0 3 9 3 9 

PORTABLE X-RAY SUPPLIER ........................................... 0 2 6 2 6 

*Components may not sum to total due to rounding. 

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38214 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

2. Adjustments for Payments for 

Imaging Services 

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 section 

5102 of the DRA, the proposed addition 

of 6 codes to the list of services subject 

to the DRA OPPS cap (discussed in 

section II.E.1.), and the proposed 

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 25 shows the specialty-level 

impact of the proposed 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 proposed 

revision to OPPS payment amounts), 

and our most recent estimate (¥9.9 

percent) of the CY 2008 Medicare PFS 

update. Additionally, the impacts in 

this proposed rule reflect the use of 

updated physician time data from the 

AMA–RUC. 

As indicated in Table 25, our 

estimates of changes in Medicare 

revenues for PFS services compare 

payment rates for CY 2007 with 

proposed payment rates for CY 2008 

using CY 2006 Medicare utilization 

crosswalked to 2007 services. 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 25. 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. 

Table 25 shows only the payment 

impact on PFS services. The following 

is an explanation of the information 

represented in Table 25. 

• 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 provided by 

physicians, practitioners, or suppliers 

with a specialty to arrive at the total 

allowed charges for the specialty. 

• Impact of the 2008 Work and PE 

RVU proposed changes using the 

methodology finalized in the CY 2007 

PFS final rule with comment period and 

the revised data sources discussed in 

this proposed rule. 

• Impact of section 5102 of the DRA: 

The CY 2008 percentage decrease in 

allowed charges attributed to section 

5102 of the DRA with the proposed 

addition of six codes to the OPPS cap 

list. 

• Combined impact of the proposed 

work and PE RVUs, section 5102 of the 

DRA and the proposed addition of six 

codes to the OPPS cap list, and the 

proposed revisions to OPPS payment 

amounts. 

• CY 2008 Update: The percentage 

decrease in allowed charges attributed 

to the estimated CY 2008 PFS 

conversion factor update (¥9.9 

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 proposed additions to OPPS cap 

list), and the proposed revisions to 

OPPS payment amounts, and the CY 

2008 update. 

TABLE 25.—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 .............................................................................. $75,819 0 0 0 ¥10 ¥10 

ALLERGY/IMMUNOLOGY ............................................... 172 1 0 1 ¥10 ¥9 

ANESTHESIOLOGY ........................................................ 1,600 14 0 14 ¥10 4 

CARDIAC SURGERY ...................................................... 393 ¥2 0 ¥2 ¥10 ¥12 

CARDIOLOGY ................................................................. 7,447 ¥1 0 ¥1 ¥10 ¥11 

COLON AND RECTAL SURGERY ................................. 121 0 0 0 ¥10 ¥10 

CRITICAL CARE .............................................................. 197 ¥1 0 ¥1 ¥10 ¥11 

DERMATOLOGY ............................................................. 2,237 2 0 2 ¥10 ¥8 

EMERGENCY MEDICINE ............................................... 2,170 ¥2 0 ¥2 ¥10 ¥12 

ENDOCRINOLOGY ......................................................... 347 ¥1 0 ¥1 ¥10 ¥11 

FAMILY PRACTICE ......................................................... 5,011 0 0 0 ¥10 ¥10 

GASTROENTEROLOGY ................................................. 1,737 0 0 0 ¥10 ¥10 

GENERAL PRACTICE ..................................................... 964 0 0 0 ¥10 ¥10 

GENERAL SURGERY ..................................................... 2,282 ¥1 0 ¥1 ¥10 ¥11 

GERIATRICS ................................................................... 145 2 0 2 ¥10 ¥8 

HAND SURGERY ............................................................ 79 ¥2 0 ¥2 ¥10 ¥12 

HEMATOLOGY/ONCOLOGY .......................................... 1,905 ¥1 0 ¥1 ¥10 ¥11 

INFECTIOUS DISEASE ................................................... 499 ¥1 0 ¥1 ¥10 ¥11 

INTERNAL MEDICINE ..................................................... 9,867 0 0 ¥1 ¥10 ¥11 

INTERVENTIONAL RADIOLOGY ................................... 241 ¥2 0 ¥2 ¥10 ¥12 

NEPHROLOGY ................................................................ 1,649 ¥2 0 ¥2 ¥10 ¥12 

NEUROLOGY .................................................................. 1,385 ¥1 0 ¥1 ¥10 ¥11 

NEUROSURGERY .......................................................... 568 ¥2 0 ¥2 ¥10 ¥12 

NUCLEAR MEDICINE ..................................................... 77 4 0 4 ¥10 ¥6 

OBSTETRICS/GYNECOLOGY ........................................ 621 ¥1 0 ¥1 ¥10 ¥11 

OPHTHALMOLOGY ........................................................ 4,642 1 0 1 ¥10 ¥9 

ORTHOPEDIC SURGERY .............................................. 3,221 ¥1 0 ¥1 ¥10 ¥11 

OTOLARNGOLOGY ........................................................ 906 1 0 0 ¥10 ¥10 

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Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38215 

TABLE 25.—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—Continued 

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) 

PATHOLOGY ................................................................... 939 ¥2 0 ¥2 ¥10 ¥12 

PEDIATRICS .................................................................... 72 0 0 ¥1 ¥10 ¥11 

PHYSICAL MEDICINE ..................................................... 775 ¥1 0 ¥1 ¥10 ¥11 

PLASTIC SURGERY ....................................................... 268 ¥1 0 ¥1 ¥10 ¥11 

PSYCHIATRY .................................................................. 1,076 0 0 0 ¥10 ¥10 

PULMONARY DISEASE .................................................. 1,679 ¥1 0 ¥1 ¥10 ¥11 

RADIATION ONCOLOGY ................................................ 1,599 0 0 0 ¥10 ¥10 

RADIOLOGY .................................................................... 5,197 0 0 0 ¥10 ¥10 

RHEUMATOLOGY ........................................................... 491 ¥2 0 ¥2 ¥10 ¥12 

THORACIC SURGERY ................................................... 432 ¥2 0 ¥2 ¥10 ¥12 

UROLOGY ....................................................................... 2,021 ¥1 0 0 ¥10 ¥10 

VASCULAR SURGERY ................................................... 634 ¥1 ¥1 ¥2 ¥10 ¥12 

AUDIOLOGIST ................................................................. 31 12 0 12 ¥10 2 

CHIROPRACTOR ............................................................ 717 ¥2 0 ¥2 ¥10 ¥12 

CLINICAL PSYCHOLOGIST ........................................... 521 ¥3 0 ¥3 ¥10 ¥13 

CLINICAL SOCIAL WORKER ......................................... 347 ¥3 0 ¥3 ¥10 ¥13 

NURSE ANESTHETIST ................................................... 605 22 0 22 ¥10 12 

NURSE PRACTITIONER ................................................. 783 2 0 2 ¥10 ¥8 

OPTOMETRY .................................................................. 782 4 0 4 ¥10 ¥6 

ORAL/MAXILLOFACIAL SURGERY ............................... 36 0 0 0 ¥10 ¥10 

PHYSICAL/OCCUPATIONAL THERAPY ........................ 1,371 1 0 1 ¥10 ¥9 

PHYSICIAN ASSISTANT ................................................. 591 0 0 0 ¥10 ¥10 

PODIATRY ....................................................................... 1,554 1 0 1 ¥10 ¥9 

DIAGNOSTIC TESTING FACILITY ................................. 1,162 0 0 0 ¥10 ¥10 

INDEPENDENT LABORATORY ...................................... 1,081 3 0 3 ¥10 ¥7 

PORTABLE X-RAY SUPPLIER ....................................... 80 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. 

Table 26 shows the estimated impact 

on total payments for selected highvolume procedures of all of the changes 

discussed previously. We selected these 

procedures because they are the most 

commonly provided by a broad 

spectrum of physician specialties. There 

are separate columns that show the 

change in the facility rates and the 

nonfacility rates. For an explanation of 

facility and nonfacility PE refer to 

Addendum A of this proposed rule. 

TABLE 26.—IMPACT OF PROPOSED RULE AND ESTIMATED PHYSICIAN UPDATE ON PROPOSED 2008 PAYMENT FOR

SELECTED PROCEDURES

CPT/ 

HCPCS MOD Description 

Facility Nonfacility 

2007 Proposed 

2008 

Percent 

change 2007 Proposed 2008 

Percent 

change 

11721 ....... .......... Debride nail, 6 or more ............................ $28.80 $24.92 ¥13 $39.03 $35.50 ¥9 

17000 ....... .......... Destruct premalg lesion ........................... 44.72 41.64 ¥7 63.29 60.42 ¥5 

27130 ....... .......... Total hip arthroplasty ............................... 1,360.52 1,199.16 ¥12 NA NA NA 

27244 ....... .......... Treat thigh fracture .................................. 1,100.92 967.04 ¥12 NA NA NA 

27447 ....... .......... Total knee arthroplasty ............................ 1,464.74 1,288.25 ¥12 NA NA NA 

33533 ....... .......... CABG, arterial, single .............................. 1,908.52 1,664.76 ¥13 NA NA NA 

35301 ....... .......... Rechanneling of artery ............................ 1,071.74 938.37 ¥12 NA NA NA 

43239 ....... .......... Upper GI endoscopy, biopsy ................... 155.00 140.98 ¥9 325.16 293.90 ¥10 

66821 ....... .......... After cataract laser surgery ..................... 253.53 224.61 ¥11 270.97 239.63 ¥12 

66984 ....... .......... Cataract surg w/iol, 1 stage ..................... 641.98 563.91 ¥12 NA NA NA 

67210 ....... .......... Treatment of retinal lesion ....................... 556.34 491.54 ¥12 580.59 511.68 ¥12 

71010 ....... .......... Chest x-ray .............................................. NA NA NA 26.15 22.87 ¥13 

71010 ....... 26 Chest x-ray .............................................. 8.72 7.85 ¥10 8.72 7.85 ¥10 

77056 ....... .......... Mammogram, both breasts ...................... NA NA NA 97.40 90.46 ¥7 

77056 ....... 26 Mammogram, both breasts ...................... 41.31 37.55 ¥9 41.31 37.55 ¥9 

77057 ....... .......... Mammogram, screening .......................... NA NA NA 81.86 74.07 ¥10 

77057 ....... 26 Mammogram, screening .......................... 33.35 30.38 ¥9 33.35 30.38 ¥9 

77427 ....... .......... Radiation tx management, x5 .................. 176.22 159.07 ¥10 176.22 159.07 ¥10 

78465 ....... 26 Heart image (3d), multiple ....................... 73.14 66.56 ¥9 73.14 66.56 ¥9 

88305 ....... 26 Tissue exam by pathologist ..................... 37.90 32.77 ¥14 37.90 32.77 ¥14 

90801 ....... .......... Psy dx interview ....................................... 129.99 112.65 ¥13 145.15 131.76 ¥9 

90862 ....... .......... Medication management ......................... 44.72 39.60 ¥11 50.40 46.76 ¥7 

90935 ....... .......... Hemodialysis, one evaluation .................. 67.46 59.05 ¥12 NA NA NA 

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38216 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

TABLE 26.—IMPACT OF PROPOSED RULE AND ESTIMATED PHYSICIAN UPDATE ON PROPOSED 2008 PAYMENT FOR

SELECTED PROCEDURES—Continued 

CPT/ 

HCPCS MOD Description 

Facility Nonfacility 

2007 Proposed 

2008 

Percent 

change 2007 Proposed 2008 

Percent 

change 

92012 ....... .......... Eye exam established pat ....................... 34.11 38.23 12 61.77 62.47 1 

92014 ....... .......... Eye exam & treatment ............................. 55.71 59.39 7 91.33 91.14 0 

92980 ....... .......... Insert intracoronary stent ......................... 795.85 721.61 ¥9 NA NA NA 

93000 ....... .......... Electrocardiogram, complete ................... 24.63 20.48 ¥17 24.63 20.48 ¥17 

93010 ....... .......... Electrocardiogram report ......................... 8.34 7.51 ¥10 8.34 7.51 ¥10 

93015 ....... .......... Cardiovascular stress test ....................... 104.22 92.51 ¥11 104.22 92.51 ¥11 

93307 ....... 26 Echo exam of heart ................................. 46.99 42.33 ¥10 46.99 42.33 ¥10 

93510 ....... 26 Left heart catheterization ......................... 242.92 215.73 ¥11 242.92 215.73 ¥11 

98941 ....... .......... Chiropractic manipulation ........................ 28.80 25.60 ¥11 33.35 29.36 ¥12 

99203 ....... .......... Office/outpatient visit, new ....................... 67.08 59.05 ¥12 91.71 81.58 ¥11 

99213 ....... .......... Office/outpatient visit, est ........................ 42.07 37.55 ¥11 59.50 53.59 ¥10 

99214 ....... .......... Office/outpatient visit, est ........................ 66.32 59.05 ¥11 90.20 80.56 ¥11 

99222 ....... .......... Initial hospital care ................................... 119.00 105.48 ¥11 NA NA NA 

99223 ....... .......... Initial hospital care ................................... 173.57 154.29 ¥11 NA NA NA 

99231 ....... .......... Subsequent hospital care ........................ 35.62 31.75 ¥11 NA NA NA 

99232 ....... .......... Subsequent hospital care ........................ 63.67 57.01 ¥10 NA NA NA 

99233 ....... .......... Subsequent hospital care ........................ 90.95 81.24 ¥11 NA NA NA 

99236 ....... .......... Observ/hosp same date .......................... 205.40 180.57 ¥12 NA NA NA 

99239 ....... .......... Hospital discharge day ............................ 94.74 83.63 ¥12 NA NA NA 

99243 ....... .......... Office consultation ................................... 93.23 83.29 ¥11 122.41 109.57 ¥10 

99244 ....... .......... Office consultation ................................... 145.91 130.74 ¥10 179.26 160.43 ¥10 

99253 ....... .......... Inpatient consultation ............................... 108.77 97.63 ¥10 NA NA NA 

99254 ....... .......... Inpatient consultation ............................... 156.52 140.64 ¥10 NA NA NA 

99283 ....... .......... Emergency dept visit ............................... 60.64 52.91 ¥13 NA NA NA 

99284 ....... .......... Emergency dept visit ............................... 110.28 97.97 ¥11 NA NA NA 

99291 ....... .......... Critical care, first hour ............................. 208.82 183.65 ¥12 256.19 224.95 ¥12 

99292 ....... .......... Critical care, add’l 30 min ........................ 104.60 92.16 ¥12 114.45 100.70 ¥12 

99348 ....... .......... Home visit, est patient ............................. NA NA NA 66.32 58.03 ¥13 

99350 ....... .......... Home visit, est patient ............................. NA NA NA 150.83 131.42 ¥13 

G0008 ...... .......... Admin influenza virus vac ........................ NA NA NA 18.95 18.43 ¥3 

G0317 ...... .......... ESRD related svs 4+mo 20+yrs .............. 283.09 246.45 ¥13 283.09 246.45 ¥13 

B. Geographic Practice Cost Index 

Changes 

Section 1848(e)(1)(A) of the Act 

requires that payments under the 

Medicare PFS 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 PFS: 

Physician work; PEs (employee wages, 

rent, medical supplies, and equipment); 

and malpractice insurance. Section 

1848(e)(1)(C) of the Act requires that 

GPCIs be reviewed and, if necessary, 

revised at least every 3 years. The first 

GPCI revision was implemented in 

1993. The second revision was 

implemented in 1998, the next in 2001, 

and the last in 2005. In section II.C. of 

this proposed rule, we are proposing the 

next GPCI update. The proposed GPCI 

values are shown in Addendum E. 

These values reflect the expiration of 

the 1.000 floor on physician work as 

provided under section 102 of the 

MIEA–TRHCA. Section 1848(e)(1)(c) of 

the Act also requires that the GPCI 

revisions be phased-in equally over a 2- 

year period if more than 1 year has 

elapsed since the last adjustment. 

An estimate of the overall effects of 

proposed 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 proportions of work, PE, and 

malpractice expense RVUs for the 

service differ from those of the GAF. 

Addendum D shows the estimated 

effects of the revised GPCIs on area 

GAFs in descending order. The GAFs 

reflect the expiration of the 1.000 floor 

on physician work as provided under 

section 102 of the MIEA–TRHCA. 

The effects of the 2008 transition year 

will be only one-half of the total amount 

of the revisions associated with the 

updated GPCI values. As required by 

law, the GPCIs would be phased in over 

a 2 year period. The total impact of the 

GPCI revisions is shown in the 2009 

GPCI values of Addendum E. 

The most significant changes occur in 

11 payment localities where the GAF 

moves up by 1 or more percent or down 

by more than 2 percent. 

C. Telehealth 

In section II.D of this rule, we are 

proposing to add 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. 

mstockstill on PROD1PC66 with PROPOSALS2

Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38217 

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 proposed change will have a 

significant budgetary impact on the 

Medicare program. 

D. Payment for Covered Outpatient 

Drugs and Biologicals 

1. ASP Issues 

The proposed changes 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 changes will 

assist in clarifying existing policy with 

respect to ASP payment. 

2. CAP Issues 

This proposed 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 

contains proposals and seeks comment 

on certain approaches to refining the 

CAP seek to improve service by 

improving compliance, increasing 

flexibility, and increasing choices 

available to participating CAP 

physicians. The proposed CAP 

provisions 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. 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 

changes which are proposed or are 

being contemplated seek to improve 

service by improving compliance, and 

increasing the services that an approved 

CAP vendor may offer to participating 

CAP physicians. At this time we 

anticipate these changes will result in 

no significant additional cost savings or 

increases associated with the CAP, 

relative to the ASP payment system. 

E. Clinical Laboratory Fee Schedule 

issues 

As discussed in section II.G. of this 

preamble, we have proposed two 

additions to § 410.508 for determining 

payment for a new clinical diagnostic 

laboratory paid under the Medicare Part 

B clinical laboratory fee schedule. These 

proposals will not increase or decrease 

payment amounts for existing clinical 

diagnostic laboratory tests because the 

payment amounts are not subject to 

these regulatory changes. For new tests, 

the proposals would primarily permit 

additional comment opportunity for 

establishing a payment amount for a 

new test but not result in an increase or 

decrease in payment amounts. 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 of our proposal 

to establish a reconsideration process. 

By improving the comment 

opportunities and timeframes for 

establishing payment amount for new 

tests, we expect less than five tests per 

year to undergo a subsequent 

reconsideration process with the 

resulting adjustments in payment 

amounts to be very modest if any. 

F. Provisions Related to Payment for 

Renal Dialysis Services Furnished by 

End State Renal Disease (ESRD) 

Facilities 

The ESRD-related provisions in this 

proposed rule are discussed in section 

II.H. To understand the impact of the 

proposed 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 (CY 2008 

payments) as discussed in II.H. of this 

proposed rule. To estimate the impact 

among various classes of ESRD 

facilities, it is imperative that the 

estimates of current payments and 

proposed payments contain similar 

inputs. Therefore, we simulated 

payments only for those ESRD facilities 

that we are able to calculate both 

current 2006 payments and proposed 

2007 payments. 

ESRD providers were grouped into the 

categories based on characteristics 

provided in the Online Survey and 

Certification and Reporting (OSCAR) 

file and the most recent cost report data 

from the Healthcare Cost Report 

Information System (HCRIS). We also 

used the December 2006 update of CY 

2006 National Claims History file as a 

basis for Medicare dialysis treatments 

and separately billable drugs and 

biologicals. While the December 2006 

update of the 2006 claims is not 

complete, we wanted to use the most 

recent data available, and plan to use an 

updated version of the 2006 claims file 

for the final rule. Due to data 

limitations, we are unable to estimate 

current and proposed payments for 168 

of the 4,712 ESRD facilities that bill for 

ESRD dialysis treatments. 

Table 27 shows the impact of this 

year’s proposed changes to CY 2008 

payments to hospital-based and 

independent ESRD facilities. The first 

column of Table 27 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 proposed 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 proposed 

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 proposed 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 

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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 proposed 

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 

proposed floor. 

The sixth column shows the overall 

effect of the proposed changes in 

composite rate payments to ESRD 

providers. The overall effect is 

measured as the difference between the 

proposed CY 2008 payment with all 

changes as proposed in this rule and 

current 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 CY 2008 proposed 

payment is the transition year 3 wageadjusted 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 wageadjusted 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 proposed 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 27.—IMPACT OF CY 2008 PROPOSED CHANGES IN PAYMENTS TO HOSPITAL-BASED AND INDEPENDENT ESRD 

FACILITIES

[Percent change in composite rate payments to ESRD facilities (both program and beneficiaries)] 

ESRD provider 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: .................................................... 4,541 31.4 0.0 0.0 0.5 

Independent .............................................. 3,958 28.1 0.0 ¥0.1 0.5 

Hospital-Based .......................................... 583 3.3 0.0 0.5 1.0 

By Facility Size: 

Less than 5000 treatments ....................... 1,821 5.4 ¥0.1 ¥0.2 0.3 

5000 to 9999 treatments .......................... 1,805 13.0 0.0 0.0 0.6 

Greater than 9999 treatments .................. 915 13.0 0.0 0.1 0.6 

Type of Ownership: 

Profit .......................................................... 3,611 25.6 0.0 ¥0.1 0.4 

Nonprofit ................................................... 930 5.9 0.0 0.3 0.8 

By Geographic Location: 

Rural ......................................................... 1,227 6.5 ¥0.3 ¥0.5 0.0 

Urban ........................................................ 3,314 25.0 0.1 0.1 0.6 

By Region: 

New England ............................................ 154 1.1 0.1 1.6 2.2 

Middle Atlantic .......................................... 549 4.0 0.1 0.4 1.0 

East North Central .................................... 717 5.1 0.1 ¥0.7 ¥0.2 

West North Central ................................... 343 1.7 0.0 ¥0.3 0.3 

South Atlantic ............................................ 1,023 7.3 0.0 0.1 0.6 

East South Central ................................... 357 2.3 ¥0.3 ¥1.1 ¥0.6 

West South Central .................................. 622 4.4 ¥0.1 ¥0.6 ¥0.1 

Mountain ................................................... 248 1.4 0.1 0.5 1.0 

Pacific ....................................................... 498 3.9 0.1 1.3 1.8 

Puerto Rico ............................................... 30 0.4 ¥2.1 ¥3.1 ¥2.6 

1This column only shows the effect of the proposed wage index floor changes on ESRD providers for CY 2008. 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. 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 percent drug add-on times treatments. The CY 2007 payments to ESRD facilities includes the CY 2007 wage adjusted composite rate and the 14.9 percent drug add-on times treatments. 

G. IDTF Changes 

We believe that our proposals 

regarding IDTFs as discussed in section 

II.I. of this proposed rule 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 proposed IDTF 

provisions contained in this 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. 

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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 proposals 

related to the compendia discussed in 

section II.L. of this proposed rule will 

have a negligible cost to the Medicare 

program. The proposed 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 proposals in 

section II.M. of this proposed rule for 

the reassignment and anti-markup 

provisions, and the physician selfreferral provisions would result in 

savings to the program by reducing 

overutilization and anti-competitive 

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 proposal in 

section II.N. of this proposed rule 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 proposed rule, 

we discuss the proposed 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 proposed establishment of an 

update for 2007 of zero percent for class 

III devices, rather than 4.3 percent based 

on the CPI–U, this would result 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.S.2., we proposed to 

change the certification 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. Analysis of Medicare claims data 

shows negative or no impact for this 

change. In most cases, the appropriate 

length of treatment will be less than 30 

days. Certification of the appropriate 

length of treatment will discourage the 

practice of billing for re-evaluations 

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. 

In 2004 and again in 2006, we 

received an extensive analysis of the 

utilization of therapy services. The 

analysis indicates that the recertification 

has no impact on utilization of services 

and does not limit payment. About 70 

percent of episodes are completed 

before the first 30-day recertification 

interval. Although CORFs have a 60-day 

certification period, and SNFs and 

outpatient rehabilitation facilities 

(ORFs) have 30-day certification 

periods, the average number of 

treatment days is similar in these 

settings. Contrary to the pattern 

expected if certification impacted length 

of care, the number of physical therapy 

treatment days is higher in SNF than in 

CORF. 

We propose to 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 in section II.T.1. of this 

proposed rule, the proposed 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 a proposed 

set of measures that the Secretary 

determines would be appropriate for 

eligible professionals to use to submit 

data to the Secretary in 2008. We also 

expect to address registry-based data 

submission on a test basis in 2008. As 

discussed in section II.T.1. of this 

proposed rule, we will also explore and 

may offer an option in 2008 for 

reporting some of the 2008 PQRI 

measures via submission of clinical data 

extracted from EHRs. Although there 

may be some cost incurred for 

maintaining the measures and their 

associated code sets, and for expanding 

an existing clinical data warehouse to 

accommodate registry-based 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.T.5. of this 

proposed rule, 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 

physician’s services furnished during 

2008. 

P. TRHCA 110 Reporting of Anemia 

Quality Indicators 

As discussed in section II.T.2. of this 

proposed rule, there are no program cost 

savings or increased expenditure 

associated with this proposed change; 

however, we expect that the regulation 

will have a positive impact on patient 

care. 

Q. Proposed Elimination of Exemption 

From NCPDP SCRIPT Standard for 

Computer-Generated Facsimile 

Transmissions Under Medicare Part D 

The proposed elimination of the 

exemption for computer-generated fax 

transactions under Medicare Part D is 

discussed in section II.S.3. of this 

proposed rule. E-prescribing is 

voluntary for providers and pharmacies. 

This proposal would affect only 

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 e-prescribing 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 

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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 proposed elimination of this 

exemption will have indirect benefits in 

that it will help to encourage eprescribing using electronic data 

interchange, which will ultimately 

result in improved patient safety. 

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. However, we specifically 

solicit comments on the impact to 

providers and pharmacies. 

R. Revisions to Payment Policies Under 

the Ambulance Fee Schedule and the 

Ambulance Inflation Factor Update for 

CY 2008 

Ambulance providers and suppliers 

for purposes of the RFA are considered 

to be small entities. The proposal to 

remove the requirement that the AIF be 

published annually via Federal Register 

notice, as discussed in Section III. of 

this proposed rule 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. 

S. Alternatives Considered 

This proposed rule 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 proposed rule 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 

the quality and value of care provided 

to Medicare beneficiaries. 

We do not believe that beneficiaries 

will experience drug access issues as a 

result of the proposed 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 26, 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 proposed rule, the 2008 

national payment amount in the 

nonfacility setting for CPT code 99203, 

as shown in Table 26, is $81.58 which 

means that, in 2008, the beneficiary 

coinsurance for this service would be 

$16.32. 

Proposed policies discussed in this 

rule that do affect overall spending, 

such as the proposed 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.whitehouse.gov/omb/circulars/ 

a004/a-4.pdf), in Table 28, we have 

prepared an accounting statement 

showing the classification of the 

expenditures associated with this 

proposed rule. This estimate includes 

the incurred benefit impact associated 

with the estimated CY 2008 PFS update, 

shown in this proposed rule, based on 

the 2007 Trustees Report baseline. All 

estimated impacts are classified as 

transfers. 

TABLE 28.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES FROM CY 2007 TO CY 2008 

Category Transfers 

Annualized Monetized Transfers ........................ Estimated decrease in expenditures of $ 5.9 billion. 

From Whom To Whom? ..................................... 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 to Federal Government. 

In accordance with the provisions of 

Executive Order 12866, this proposed 

rule 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, 

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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. 

42 CFR Part 491 

Grant programs-health, Health 

facilities, Medicaid, Medicare, 

Reporting and recordkeeping 

requirements, Rural areas. 

For the reasons set forth in the 

preamble, the Centers for Medicare & 

Medicaid Services proposes to amend 

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. A new § 409.17 is added to read as 

follows: 

§ 409.17 Physical therapy, occupational 

therapy, and speech-language pathology 

services. 

(a) General rules. (1)(i) Except as 

specified in paragraph (a)(1)(ii) of this 

section, physical therapy, occupational 

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 in § 484.4 of 

this chapter. 

(ii) Physical therapy, occupational 

therapy or speech-language pathology 

services may be furnished by qualified 

physical therapists, physical therapist 

assistants, occupational therapists, or 

occupational therapy assistants who 

have been licensed, certified, registered 

or otherwise regulated as physical 

therapists, physical therapist assistants, 

occupational therapists, or occupational 

therapy assistants by the State in which 

practicing before January 1, 2008 and 

continue to furnish Medicare services at 

least part time without an interruption 

in furnishing services of more than 2 

years. 

(2) Physical therapy, occupational 

therapy or speech-language pathology 

services must be furnished under a plan 

of treatment that meets the requirements 

of paragraphs (b) through (e) of this 

section. 

(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 

must—

(1) Prescribe 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) Indicate the diagnosis and 

anticipated goals. 

(d) Changes in the plan. Any changes 

in the plan must be made in writing, 

incorporated immediately, and signed 

by one of the following: 

(1) A physician. 

(2) A nurse practitioner, clinical nurse 

specialist, or a physician assistant. 

(3) The physical therapist furnishing 

the physical therapy services. 

(4) The speech-language pathologist 

furnishing the speech-language 

pathology services. 

(5) The occupational therapist 

furnishing the occupational therapy 

services. 

(6) A registered professional nurse or 

a staff physician, in accordance with 

verbal orders from one the practitioners 

listed in paragraphs (1) through (5) of 

this section. 

(e) Review of the plan. The physician, 

nurse practitioner, clinical nurse special 

or physician assistant reviews the plan 

as often as the individual’s condition 

requires, but at least prior to 

certification. 

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)(i) By qualified physical therapists, 

physical therapist assistants, 

occupational therapists, occupational 

therapy assistants or speech-language 

pathologists as defined in § 484.4; or 

(ii) By qualified physical therapists, 

physical therapist assistants, 

occupational therapists, or occupational 

therapy assistants who have been 

licensed, certified, registered or 

otherwise recognized by the State in 

which practicing before January 1, 2008 

and continue to furnish Medicare 

physical therapy or occupational 

therapy services at least part time 

without an interruption in furnishing 

services of more than 2 years. 

(2) In accordance with a plan of 

treatment that meets the requirements of 

§ 409.16(b) through (e) 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. Removing the phrase, ‘‘and (h)’’ in 

the introductory text of paragraph (a)(2) 

and adding in its place, ‘‘and (i)’’. 

B. Revising paragraphs (b)(1), (g)(2), 

(g)(6), and (g)(8). 

C. Adding paragraphs (g)(15) and (i). 

The revisions and additions read as 

follows: 

§ 410.33 Independent diagnostic testing 

facility. 

* * * * * 

(b) * * * 

(1) Each supervising physician must 

be limited to providing supervision to 

no more than three IDTF sites. This 

applies to both fixed sites and mobile 

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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 designated 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. 

* * * * * 

(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; 

(ii) Notify the CMS designated 

contractor in writing of any policy 

changes or cancellations; and 

(iii) List the CMS designated 

contractor as a Certificate Holder on the 

policy. 

* * * * * 

(8) Answer, document, and maintain 

documentation of all beneficiaries’

questions and responses to their 

complaints at the physical site of the 

IDTF. This includes, but is not limited 

to, the following: 

(i) The name, address, telephone 

number, and health insurance claim 

number of the beneficiary. 

(ii) A summary of the complaint; the 

date it 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. For mobile IDTFs, this 

documentation would be stored at their 

home office. 

* * * * * 

(15) Does not share space, equipment, 

or staff or sublease its operations to 

another individual or organization. 

* * * * * 

(i) Effective date of billing privileges. 

The effective date of billing privileges 

for a newly enrolled IDTF is the later of 

the following: 

(1) The filing date of the Medicare 

enrollment application that was 

subsequently approved by a fee-forservice contractor; 

(2) The date the IDTF first furnished 

services at its new practice location; or 

(3) The filing date of the Medicare 

enrollment application or the date that 

the Medicare fee-for-service contractor 

receives a signed provider enrollment 

application that it is able to process for 

approval. 

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—

(A) As specified in § 484.4 of this 

chapter; or 

(B) Who has been licensed, certified, 

registered or otherwise recognized as an 

occupational therapist or occupational 

therapy assistant by the State in which 

practicing before January 1, 2008 and 

continues to furnish Medicare 

occupational therapy services at least 

part time without an interruption in 

furnishing services of more than 2 years. 

* * * * * 

8. Section 410.59 is amended by—

A. Removing the phrase ‘‘paragraph 

(a)(3)(iii)’’ in the introductory text to 

paragraph (a) and adding the phrase, 

‘‘paragraphs (a)(3)(iii) and (iv)’’ in its 

place. 

B. Adding a new paragraph (a)(3)(iv). 

The addition reads as follows: 

§ 410.59 Outpatient occupational therapy 

services: Conditions. 

(a) * * * 

(3) * * * 

(iv) By qualified occupational 

therapists or appropriately supervised 

occupational therapy assistants who 

meet the qualifications in § 484.4 of this 

chapter or who have been licensed, 

certified, registered or otherwise 

recognized by the State in which 

practicing before January 1, 2008 and 

continue to furnish Medicare 

occupational therapy services at least 

part time without an interruption in 

furnishing services of more than 2 years; 

* * * * * 

9. Section 410.60 is amended by—

A. Removing the phrase ‘‘paragraph 

(a)(3)(iii)’’ in the introductory text to 

paragraph (a) and adding the phrase, 

‘‘paragraphs (a)(3)(iii) and (iv)’’ in its 

place. 

B. Adding a new paragraph (a)(3)(iv). 

The addition reads as follows: 

§ 410.60 Outpatient physical therapy 

services: Conditions. 

(a) * * * 

(3) * * * 

(iv) By qualified physical therapists or 

appropriately supervised physical 

therapist assistants who meet the 

qualifications in § 484.4 of this chapter 

or who have been licensed, certified, 

registered or otherwise recognized by 

the State in which practicing before 

January 1, 2008 and continue to furnish 

Medicare physical therapy services at 

least part time without an interruption 

in furnishing services of more than 2 

years; 

* * * * * 

10. Section 410.61 is amended by 

revising paragraph (e)(1) to read as 

follows: 

§ 410.61 Plan of treatment requirements 

for outpatient rehabilitation services. 

* * * * * 

(e) * * * 

(1) The physician, nurse practitioner, 

clinical nurse specialist or physician’s 

assistant reviews the plan as often as the 

individual’s condition requires, but at 

least at every certification and 

recertification. 

* * * * * 

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). 

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B. Removing paragraphs (i) and (k). 

C. Redesignating paragraphs (j), (l), 

and (m) to (i), (j), and (k), respectively. 

D. Revising new paragraphs (i), (j), 

and (k). 

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 § 414.1101 of this chapter. 

(a) Physician’s services. CORF facility 

physician services are administrative in 

nature and include consultation with 

and medical supervision of 

nonphysician staff, participate 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 

of this chapter. 

* * * * * 

(e) Respiratory therapy services. (1) 

Respiratory therapy services are for the 

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) 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. 

(k) 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. 

13. Section 410.105 is amended by 

revising paragraphs (b)(3)(i) and (ii), 

(c)(1) introductory text, and (c)(1)(ii) 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 rehabilitation plan of 

treatment that—

(i) * * * 

(ii) Indicates the diagnosis and 

rehabilitation goals, and prescribes the 

type, amount, frequency, and duration 

of the services to be furnished that relate 

directly to such rehabilitation goals. 

* * * * * 

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. 

* * * * * 

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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—

(1) A physician’s sole practice or a 

practice of multiple physicians or any 

other person, sole proprietorship, public 

or private agency or trust, corporation, 

partnership, limited liability company, 

foundation, nonprofit corporation, or 

unincorporated association that 

furnishes DHS. An entity does not 

include the referring physician himself 

or herself, but does include his or her 

medical practice. A person or entity is 

considered to be furnishing DHS if it—

(i) Is the person or entity that has 

performed the DHS, or 

(ii) Presented a claim or caused a 

claim to be presented for Medicare 

benefits for the DHS. 

(2) For purposes of this subpart, 

‘‘entity’’ includes a health plan, 

managed care organization (MCO), 

provider sponsored organization (PSO), 

or independent practice association 

(IPA) that employs a supplier or 

operates a facility that could accept 

reassignment from a supplier pursuant 

to § 424.80 of this chapter, with respect 

to any designated health services 

provided by that supplier; ‘‘entity’’ does 

not include a health care delivery 

system that is a health plan (as defined 

in § 1001.952(l) of this title), or any 

MCO, PSO or IPA with which a health 

plan contracts for services provided to 

plan enrollees. 

(3) For purposes of this subpart, 

‘‘entity’’ does not include a physician’s 

practice when it bills Medicare for a 

diagnostic testing accordance with 

§ 414.50 of this chapter (Physician 

billing for purchased diagnostic tests) 

and section 30.2.9 of the Internet-Only 

Manual, Pub.100–04, Chapter 1, General 

Billing Requirements. 

* * * * * 

18. Section 411.353 is amended by 

adding paragraph (g) to read as follows: 

§ 411.353 Prohibition on certain referrals 

by physicians and limitations on billing. 

* * * * * 

(g) Denial of payment for services 

furnished under a prohibited referral. 

When payment for a designated health 

service is denied on the basis that the 

service was furnished pursuant to a 

prohibited referral, and such payment 

denial is appealed, the burden is on the 

entity submitting the claim for payment 

to establish that the service was not 

furnished pursuant to a prohibited 

referral (and not on CMS or its 

contractors to establish that the service 

was furnished pursuant to a prohibited 

referral). 

19. Section 411.354 is amended by 

revising paragraphs (b)(3)(i) and (d)(1) to 

read as follows: 

§ 411.354 Financial relationship, 

compensation, and ownership or 

investment interest. 

* * * * * 

(b) * * * 

(3) * * * 

(i) An interest in an entity that arises 

from a retirement plan offered by that 

entity to the physician or immediate 

family member through the physician’s 

or immediate family member’s 

employment with that entity; 

* * * * * 

(d) * * * 

(1) Compensation will be considered 

‘‘set in advance’’ if the aggregate 

compensation, a time-based or per unit 

of service based (whether per-use or perservice) amount, or a specific formula 

for calculating the compensation is set 

in an agreement between the parties 

before the furnishing of the items or 

services for which the compensation is 

to be paid. The formula for determining 

the compensation must be set forth in 

sufficient detail so that it can be 

objectively verified, and the formula 

may not be changed or modified during 

the course of the agreement in any 

manner that reflects the volume or value 

of referrals or other business generated 

by the referring physician. Percentagebased compensation, other than 

compensation based on revenues 

directly resulting from personally 

performed physician services (as 

defined in § 410.20(a)), is not 

considered set in advance. 

* * * * * 

20. Section 411.357 is amended by 

revising paragraphs (a)(5) and (b)(4) to 

read as follows: 

§ 411.357 Exceptions to the referral 

prohibition related to compensation 

arrangements. 

* * * * * 

(a) * * * 

(5) The rental charges over the term of 

the agreement are not determined in a 

manner that takes into account the 

volume or value of any referrals or other 

business generated between the parties. 

Per unit-of-service rental charges are not 

allowed to the extent that such charges 

reflect services provided to patients 

referred by the lessor to the lessee. 

* * * * * 

(b) * * * 

(4) The rental charges over the term of 

the agreement are set in advance, are 

consistent with fair market value, and 

are not determined in a manner that 

takes into account the volume or value 

of any referrals or other business 

generated between the parties. Per unitof-service rental charges are not allowed 

to the extent that such payments reflect 

services provided to patients referred by 

the lessor to the lessee. 

* * * * * 

PART 413—PRINCIPLES OF 

REASONABLE COST 

REIMBURSEMENT; PAYMENT FOR 

END-STAGE RENAL DISEASE 

SERVICES; PROSPECTIVELY 

DETERMINED PAYMENT RATES FOR 

SKILLED NURSING FACILITIES 

21. 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] 

22. 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 

23. 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 

24. The authority citation for part 414 

is revised 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 

25. Section 414.50 is revised to read 

as follows: 

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§ 414.50 Physician billing for purchased 

diagnostic tests. 

(a) General rule. (1) For 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 rules set forth in 

section 1833(h)(5)(A) of the Act), if a 

physician or medical group bills for the 

technical or professional component of 

a diagnostic test that was performed by 

an outside supplier, the payment to the 

physician or the medical group (less the 

applicable deductibles and coinsurance) 

for the technical or professional 

component of the test may not exceed 

the lowest of the following amounts: 

(i) The supplier’s net charge to the 

physician or medical group. 

(ii) The physician’s or medical 

group’s actual charge. 

(iii) The fee schedule amount for the 

test that would be allowed if the 

supplier billed directly. 

(2) This provision applies regardless 

of whether the test or its interpretation 

was purchased by the physician or 

medical group billing for the test or the 

interpretation, or whether the right to 

bill for the test or its interpretation was 

reassigned to the physician or medical 

group billing for the test or the 

interpretation. 

(3) For purposes of paragraph (a) of 

this section—

(i) The physician’s or other supplier’s 

net charge must be determined without 

regard to any charge that is intended to 

reflect the cost of equipment or space 

leased to the outside supplier by or 

through the billing physician or medical 

group. 

(ii) An outside supplier is someone 

other than a full-time employee of the 

billing physician or medical group. 

(b) Restriction on payment. (1) The 

physician or medical group must 

identify the supplier and indicate the 

supplier’s net charge for the test. If the 

physician or medical group fails to 

provide this information, CMS makes no 

payment to the physician or medical 

group and the physician or medical 

group may not bill the beneficiary. 

(2) Physicians and medical groups 

that accept Medicare assignment may 

bill beneficiaries for only the applicable 

deductibles and co-insurance. 

(3) Physicians and medical groups 

that do not accept Medicare assignment 

may not bill the beneficiary more than 

the payment amount described in 

paragraph (a) of this section. 

26. 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 

27. 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. 

* * * * * 

28. 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: 

* * * * * 

29. 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. 

30. 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 public 

comments 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 commenter 

recommends that the basis for payment 

should be changed from gapfilling to 

crosswalking, the commenter may also 

recommend the code or codes to which 

to crosswalk the new test. 

(2) At the meeting convened under 

§ 414.506(c), those commenters who 

submitted comments within the 60-day 

comment period may present their 

comments. 

(3) Considering 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 public comments in 

written format regarding whether CMS 

should reconsider its determination and 

the recommended code or codes to 

which to crosswalk the new test. 

(ii) At the meeting convened under 

§ 414.506(c), those commenters who 

submitted comments within the 60-day 

comment period may present their 

comments. 

(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 

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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 

whether CMS should reconsider the 

interim payment amounts and the 

appropriate national limitation amount 

for the new test. 

(iii) Considering comments 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. 

31. 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] 

32. 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 

33. 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 for Medicare part B 

cancer anti-anemia drugs. 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 in a manner specified 

by the Secretary. 

Subpart J—Submission of 

Manufacturer’s Average Sales Price 

Data 

34. Section 414.802 is amended by 

adding the definition of ‘‘bundled 

arrangement’’ in alphabetical order to 

read as follows: 

§ 414.802 Definitions. 

* * * * * 

Bundled arrangement means 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 bundled drugs or 

biologicals been purchased separately or 

outside of the bundled arrangement. 

* * * * * 

35. Section 414.804 is amended by 

adding paragraph (a)(2)(iii) to read as 

follows: 

§ 414.804 Basis of payment. 

(a) * * * 

(2) * * * 

(iii) For the purposes of paragraph 

(a)(2)(i) of this section, the total value of 

all price concessions on all drugs sold 

under a bundled arrangement must be 

allocated proportionately according to 

the dollar value of the units of each drug 

sold under the bundled arrangement. 

* * * * * 

Subpart K—Payment for Drugs and 

Biologicals Under Part B 

36. 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 calendar year 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. 

* * * * * 

37. Section 414.908 is amended by—

A. Revising paragraph (a)(2)(iv). 

B. Revising paragraph (a)(3)(xi). 

C. Removing paragraph (a)(5). 

The revision reads as follows: 

§ 414.908 Competitive acquisition 

program. 

(a) * * * 

(2) * * * 

(iv) For other exigent circumstances 

defined by CMS, including—

(A) If the approved CAP vendor 

refuses to ship to the participating CAP 

physician because the conditions of 

§ 414.914(h) have been met, the 

physician can withdraw from the CAP 

category for the remainder of the year 

immediately upon notice to CMS and 

the approved CAP vendor. 

(B) If, during the first 30 days of 

participation in the CAP, the 

participating physician can document 

significant burden to the practice and 

the physician has attempted resolution 

through the vendor’s grievance process, 

the CAP dispute resolution process, and 

the request has been approved by CMS. 

(3) * * * 

(xi) Agrees to submit documentation 

such as medical records or certification, 

as necessary, to support payment for a 

CAP drug; 

* * * * * 

38. 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). 

The addition and revision reads 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 is 

expected to document, in writing, the 

following information necessary to 

verify drug administration: 

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(i) Beneficiary’s name. 

(ii) Medicare health insurance number 

(HIC). 

(iii) Expected date of service. 

(iv) Actual date of service. 

(v) Name of the CAP physician. 

(vi) CAP prescription order number. 

(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 for the CAPdesignated carrier for CAP drugs that 

have not been administered must 

promptly refund payment for such 

drugs to the CAP-designated carrier and 

must refund any coinsurance and 

deductible collected from the 

beneficiary and his or her supplemental 

insurer. 

* * * * * 

39. Section 414.917 is amended by—

A. Revising the section heading. 

B. Adding paragraph (d). 

The revision and addition reads 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 

CAP participating physicians’

requesting to terminate their 

participation in the program under 

exigent circumstances provisions 

described in § 414.908(a)(2)(iv): 

(1) The designated carrier must—

(i) Determine whether a request to 

terminate CAP participation was related 

to approved CAP vendor service and 

whether to 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 and within 

2 business days of receipt, and may do 

any of the following: 

(A) Request a single, 2-business day 

extension. 

(B) Recommend to CMS that the 

requesting physician be permitted to 

terminate his or her participation in the 

CAP. 

(C) Recommend to CMS that the 

physician not be permitted to terminate 

his or her participation in the CAP and 

refer to the CAP designated carrier’s 

dispute resolution process. 

(2) As a result of the findings as 

specified in paragraph (d)(1) of the 

section, CMS will—: 

(i) Consider the designated carrier’s 

recommendation and approve or deny 

the request to terminate participation in 

the CAP within 2 business days of 

receipt of the recommendation. A denial 

of the participating CAP physician’s 

request to terminate participation in the 

CAP and will include notification of the 

right to request reconsideration under 

this section. 

(ii) Communicate the decision to the 

appropriate Medicare contractors and 

the participating CAP physician. 

(3) Upon termination of participation 

in the CAP a physician must agree to the 

following: 

(i) Continue to submit claims for 

drugs supplied and administered under 

the CAP prior to the effective date of the 

physician’s termination 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. 

(4) 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). 

40. 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 process states that 

CMS—

(i) Solicits requests annually for 

changes to the list of compendia. This 

solicitation specifies a 30-day time 

period within which CMS receives 

requests, to begin no earlier than 45 

days after publication of the solicitation. 

(ii) Publishes a listing of the timely 

complete requests received and solicit 

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 

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 

120 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 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. 

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(2) CMS may at its discretion combine 

and consider multiple requests that refer 

to the same compendium. 

(d) Other provisions. (1) For each 

compendium that is determined by CMS 

to be included on the list, the publisher 

or its designee must notify CMS, within 

45 days of any update or revision that 

a new edition or version is available. 

Failure to meet this requirement may 

result in removal of the compendium 

from the list. 

(2) For the purposes of this section, 

publication by CMS may be 

accomplished by posting on the CMS 

Web site. 

41. 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), and (d) 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, and prosthetic and 

orthotic devices. 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) 

and orthotic devices that are CORF 

services under § 410.100(g) 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 

paragraph (a) of this section; or 

(2) The amount determined under the 

DMEPOS fee schedule established 

under part 414 Subparts D and F for the 

item, provided that payment for such 

item is not included in the payment 

amount for other CORF services paid 

under paragraph (a) of this section. 

(d) 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) or (c) 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) or (c) 

of this section. 

PART 415—SERVICES FURNISHED BY 

PHYSICIANS IN PROVIDERS, 

SUPERVISING PHYSICIANS IN 

TEACHING SETTINGS, AND 

RESIDENTS IN CERTAIN SETTINGS 

42. 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 

43. 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 

44. 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 

45. 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 § 484.4 of 

this chapter. 

* * * * * 

PART 423—VOLUNTARY MEDICARE 

PRESCRIPTION DRUG BENEFIT 

46. 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 

§ 423.160 [Amended] 

47. Section 423.160 is amended by—

A. Removing paragraph (a)(3)(i). 

B. Redesignating paragraphs (a)(3)(ii) 

and (iii) to (a)(3)(i) and (ii), respectively. 

PART 424—CONDITIONS FOR 

MEDICARE PAYMENT 

48. 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). 

Subpart B—Certification and Plan of 

Treatment Requirements 

49. 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) * * * 

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(2) Timing. The certification must be 

obtained at the time the plan of 

treatment is established or as soon 

thereafter as possible. 

(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 of treatment must recertify the plan 

by signing the medical record. 

* * * * * 

Subpart C—Claims for Payment 

50. Section 424.36 is amended by 

adding paragraph (b)(6) to read as 

follows: 

§ 424.36 Signature requirements. 

* * * * * 

(b) * * * 

(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 

paragraphs (b)(1) through (b)(5) 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 4 

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 paragraphs (b)(1) through (5) of 

this section were available or willing to 

sign the claim on behalf of the 

beneficiary. 

(B) Documentation with the date and 

time the beneficiary was transported, 

and the name and location of the facility 

that received the beneficiary. 

(C) 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. 

* * * * * 

§ 424.37 [Amended] 

51. Section 424.37(a) is amended by 

removing the reference to ‘‘§ 424.36(b)’’

and adding in its place the reference 

‘‘§ 424.36(b)(1) through (5).’’

Subpart F—Limitations on Assignment 

and Reassignment of Claims 

52. 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 diagnostic 

test services. If a physician or medical 

group 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 and who was not a full-time 

employee of the billing physician or 

medical group at the time the service 

was performed, each of the following 

conditions must be met: 

(i) The payment to the billing 

physician, or medical group, less the 

applicable deductibles and coinsurance, 

may not exceed the lowest of the 

following amounts: 

(A) The physician’s or other 

supplier’s net charge to the billing 

physician or medical group. The 

physician’s or other supplier’s net 

charge must be determined without 

regard to any charge that is intended to 

cover or address the cost of equipment 

or space leased to the physician or the 

other supplier by or through the billing 

physician or medical group. 

(B) The billing physician’s or medical 

group’s actual charge. 

(C) The fee schedule amount for the 

service that would be allowed if the 

physician or other supplier billed 

directly. 

(ii) The physician or medical group 

billing for the test must identify the 

physician or other supplier that 

performed the test and indicate the 

supplier’s net charge for the test. If the 

physician or medical group billing for 

the test fails to provide this information, 

CMS will not make any payment to the 

physician or medical group billing for 

the test and the billing physician or 

medical group can not bill the 

beneficiary. 

(iii) To bill for the technical 

component of the service, the physician 

or medical group must directly perform 

the professional component of the 

service. 

PART 482—CONDITIONS OF 

PARTICIPATION FOR HOSPITALS 

53. 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). 

Subpart D—Optional Hospital Services 

54. 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) 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. 

(b) Standard: Delivery of services. (1) 

Except as specified in paragraph 

(c)(1)(ii) of this section, physical 

therapy, occupational therapy, or 

speech-language pathology services 

must be furnished—

(i) By qualified physical therapists, 

physical therapist assistants, 

occupational therapists, occupational 

therapist assistants, speech-language 

pathologists, or audiologists as defined 

in § 484.4 of this chapter; or 

(ii) By qualified physical therapists, 

physical therapist assistants, 

occupational therapists, or occupational 

therapy assistants who have been 

licensed, certified, registered, or 

otherwise recognized by the State in 

which practicing before January 1, 2008 

and continue to furnish Medicare 

services at least part time without an 

interruption in furnishing services of 

more than 2 years. 

(2) The physical therapy, 

occupational therapy, or speechlanguage pathology must be in 

accordance with a written plan of 

treatment that meets the requirements of 

paragraphs (b)(3)(i) through (b)(3)(iv) of 

this section. 

(3) Plan of treatment requirements—

(i) Establishment of the plan. The plan 

must be established by one of the 

following before treatment begins: 

(A) A physician. 

(B) A nurse practitioner, a clinical 

nurse specialist, or a physician 

assistant. 

(C) The physical therapist furnishing 

the physical therapy services. 

(D) The speech-language pathologist 

furnishing the speech-language 

pathology services. 

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(E) The occupational therapist 

furnishing the occupational therapy 

services. 

(ii) Content of the plan. The plan 

must—

(A) Prescribe the type, amount, 

frequency, and duration of the physical 

therapy, occupational therapy, or 

speech-language pathology services to 

be furnished to the individual; and 

(B) Indicate the diagnosis and 

anticipated goals. 

(iii) Changes in the plan. Any changes 

in the plan must be made in writing, 

incorporated immediately, and signed 

by one of the following: 

(A) A physician. 

(B) A nurse practitioner, clinical 

nurse specialist, or a physician 

assistant. 

(C) The physical therapist furnishing 

the physical therapy services. 

(D) The speech-language pathologist 

furnishing the speech-language 

pathology services. 

(E) The occupational therapist 

furnishing the occupational therapy 

services. 

(F) A registered professional nurse or 

a staff physician, in accordance with 

verbal orders from one the practitioners 

listed in paragraphs (b)(3)(iii)(A) 

through (iii)(E) of this section. 

(iv) Review of the plan. The 

physician, nurse practitioner, clinical 

nurse specialist, or physician assistant 

reviews the plan as often as the 

individual’s condition requires, but at 

least at the time of certification and at 

recertification, if applicable. 

PART 484—HOME HEALTH SERVICES 

55. 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 

56. 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 

meets one of the one of the following 

requirements: 

(1) Requirements for individuals 

beginning their practice on or after 

January 1, 2008. Meets all practice 

requirements set forth by the State in 

which occupational therapy services are 

furnished and meets one of the 

following educational/training 

requirements on or after January 1, 

2008: 

(i)(A) Graduated after successful 

completion of an occupational therapist 

curriculum accredited by the 

Accreditation Council for Occupational 

Therapy Education (ACOTE) of the 

American Occupational Therapy 

Association, Inc. (AOTA); and 

(B) Successfully completed the 

National Registration Examination for 

occupational therapists developed and 

administered by the National Board for 

Certification in Occupational Therapy, 

Inc. (NBCOT). 

(ii) If educated outside the United 

States, or trained by the United States 

military—

(A) Graduated after successful 

completion of an occupational therapist 

curriculum accredited by the World 

Federation of Occupational Therapists, 

(WFOT)); 

(B) Is deemed eligible to test as a 

result of completing the NBCOT 

International Occupational Therapy 

Eligibility Determination (IOTED) 

review; and 

(C) Successfully completed the 

National Registration Examination 

developed and administered by the 

National Board for Certification in 

Occupational Therapy, Inc. (NBCOT)). 

(2) Requirements for individuals 

beginning their practice after December 

31, 1977 and before January 1, 2008. 

Meets the one following requirements 

after December 31, 1977 and before 

January 1, 2008: 

(i) Is a graduate of an occupational 

therapy curriculum accredited jointly by 

the Committee on Allied Health 

Education and Accreditation of the 

American Medical Association and the 

American Occupational Therapy 

Association. 

(ii) Is eligible for the National 

Registration Examination of the 

American Occupational Therapy 

Association. 

(3) Requirements for individuals 

beginning their practice on or before 

December 31, 1977. (i) Has 2 years of 

appropriate experience as an 

occupational therapist; and 

(ii) Has achieved a satisfactory grade 

on a proficiency examination 

conducted, approved, or sponsored by 

the U.S. Public Health Service on or 

before December 31, 1977. 

Occupational therapy assistant. A 

person who meets one of the following 

requirements: 

(1) Requirements for individuals 

beginning their practice on or after 

January 1, 2008. Provides certain 

occupational therapy services under the 

supervision of a qualified occupational 

therapist, continues to meet all practice 

requirements set forth by the State in 

which occupational therapy services are 

furnished, and meets one of the 

educational/training requirements if his 

or her professional practice begins on or 

after January 1, 2008: 

(i)(A) Graduated after successful 

completion of coursework and clinical 

field work from an occupational therapy 

assistant curriculum accredited by the 

Accreditation Council for Occupational 

Therapy Education (ACOTE) of the 

American Occupational Therapy 

Association, Inc. (AOTA); and 

(B) Successfully completed the 

certification examination for Certified 

Occupational Therapy Assistant 

developed and administered by the 

National Board for Certification in 

Occupational Therapy, Inc. (NBCOT). 

(ii) If educated outside the United 

States or trained in the United States 

military, graduated after successful 

completion of an occupational therapy 

assistant curriculum that by credentials 

evaluation conducted or approved by 

the American Occupational Therapy 

Association is determined to be 

comparable, with respect to 

occupational therapy assistant entry 

level education in the United States. 

(2) Requirements for individuals 

beginning their practice after December 

31, 1977 and before January 1, 2008. 

Meets the requirements for certification 

as an occupational therapy assistant 

established by the American 

Occupational Therapy Association after 

December 31, 1977 and before January 

1, 2008. 

(3) Requirements for individuals 

beginning their practice on or before 

December 31, 1977. Has 2 years of 

appropriate experience as an 

occupational therapy assistant, and has 

achieved a satisfactory grade on a 

proficiency examination conducted, 

approved, or sponsored by the U.S. 

Public Health Service on or before 

December 31, 1977. 

Physical therapist. A person who is 

licensed by the State in which 

practicing and meets one of the 

following requirements: 

(1) Requirements for individuals 

beginning their practice on or after 

January 1, 2008. Meets all practice 

requirements set forth by the State in 

which the physical therapy services are 

furnished and meets one of the 

following educational/training 

requirements on or after January 1, 

2008: 

(i)(A) Graduated after successful 

completion of a college or university 

physical therapy curriculum approved 

by the Commission on Accreditation in 

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Physical Therapy Education (CAPTE); 

and 

(B) Passed the National Examination 

approved by the American Physical 

Therapy Association. 

(ii) If educated outside the United 

States or trained by the United States 

military—

(A) Graduated after successful 

completion of an education program 

that, by a credentials evaluation process 

approved by the American Physical 

Therapy Association, is determined to 

be comparable with respect to physical 

therapist entry level education in the 

United States; and 

(B) Passed the National Examination 

approved by the American Physical 

Therapy Association. 

(2) Requirements for individuals 

beginning their practice after December 

31, 1977 and before January 1, 2008. 

Has graduated from a physical therapy 

curriculum approved by one of the 

following after December 31, 1977 and 

before January 1, 2008: 

(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. 

(3) Requirements for individuals 

beginning their practice on or after 

January 1, 1966 and on or before 

December 31, 1977. Had 2 years of 

appropriate experience as a physical 

therapist, and has achieved a 

satisfactory grade on a proficiency 

examination conducted, approved, or 

sponsored by the U.S. Public Health 

Service on or before December 31, 1977. 

(4) Requirements for individuals 

beginning their practice before January 

1, 1966. Meets one of the following 

requirements before January 1, 1966: 

(i) Was admitted to membership by 

the American Physical Therapy 

Association. 

(ii) Was admitted to registration by 

the American Registry of Physical 

Therapists. 

(iii) Graduated from a physical 

therapy curriculum in a 4-year college 

or university approved by a State 

department of education. 

(iv) Was licensed or registered prior to 

January 1, 1966, and prior to January 1, 

1970, had 15 years of full-time 

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. 

(5) Requirements for individuals 

trained outside of the United States 

before January 1, 2008. If trained 

outside the United States before January 

1, 2008 meets the following 

requirements: 

(i) 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. 

(ii) Meets the requirements for 

membership in a member organization 

of the World Confederation for Physical 

Therapy. 

Physical therapist assistant. A person 

who meets one of the following 

requirements: 

(1) Requirements for individuals 

beginning their practice on or after 

January 1, 2008. A person who provides 

certain physical therapy services under 

the supervision of a qualified physical 

therapist and is licensed, registered, 

certified or otherwise recognized as a 

physical therapist assistant, if 

applicable, by the State in which 

practicing, continues to meet all 

practice requirements set forth by the 

State in which physical therapy services 

are furnished, and meets one of the 

following educational/training 

requirements: 

(i) Graduated after successful 

completion of a physical therapist 

assistant curriculum approved by the 

Commission on Accreditation in 

Physical Therapy Education of the 

American Physical Therapy 

Association. 

(ii) If educated outside the United 

States or trained in the United States 

military, graduated after successful 

completion of an education program 

that by a credentials evaluation process 

approved by the American Physical 

Therapy Association, is determined to 

be comparable with respect to physical 

therapist assistant entry level education 

in the United States. 

(2) Requirements for individuals 

beginning their practice before January 

1, 2008. Is licensed as a physical 

therapist assistant, if applicable, by the 

State in which practicing, meets either 

of the following requirements: 

(i) Has graduated from a 2-year 

college-level program approved by the 

American Physical Therapy 

Association. 

(ii) Has 2 years of appropriate 

experience 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, except that these 

determinations of proficiency do not 

apply with respect to persons initially 

licensed by a State or seeking initial 

qualification as a physical therapist 

assistant after December 31, 1977. 

* * * * * 

Speech-language pathologist. A 

person who meets either of the 

following requirements: 

(1) The education and experience 

requirements for a Certificate of Clinical 

Competence in speech-language 

pathology granted by the American 

Speech-Language Hearing Association. 

(2) 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 

57. 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 

58. 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. 

59. 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 one of the following qualifications: 

(1) As set forth in § 484.4 of this 

chapter. 

(2) Occupational therapists or 

occupational therapy assistants must 

have been licensed, certified, registered, 

or otherwise recognized as occupational 

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38232 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

therapists or occupational therapy 

assistants by the State in which 

practicing before January 1, 2008, and 

continue to furnish Medicare services at 

least part time without an interruption 

in furnishing services of more than 2 

years. 

* * * * * 

(e) A physical therapist and a physical 

therapist assistant must meet one of the 

following qualifications: 

(1) As set forth in § 484.4 of this 

chapter. 

(2) Qualified physical therapists or 

physical therapist assistants must have 

been licensed, certified, registered, or 

otherwise recognized as physical 

therapists or physical therapist 

assistants by the State in which 

practicing before January 1, 2008, and 

continue to furnish Medicare services at 

least part time without an interruption 

in furnishing services of more than 2 

years. 

* * * * * 

(m) A speech-language pathologist 

must meet the qualifications set forth in 

§ 484.4 of this chapter. 

Subpart H—Conditions of Participation 

for Clinics, Rehabilitation Agencies, 

and Public Health Agencies as 

Providers of Outpatient Physical 

Therapy and Speech-Language 

Pathology Services 

60. Section 485.705 is amended by 

revising paragraph (a) to read as follows: 

§ 485.705 Personnel qualifications. 

(a) General qualification 

requirements. Except as specified in 

paragraphs (b) and (c) of this section, all 

personnel who are involved in the 

furnishing of outpatient physical 

therapy, occupational therapy and 

speech-language pathology services 

directly by or under arrangements with 

an organization must—

(1) Be legally authorized (licensed or, 

if applicable, certified or registered) to 

practice by the State in which they 

perform the functions or actions. 

(2) Act only within the scope of their 

State license or State certification or 

registration. 

(3) Meet one of the following 

requirements: 

(i) Meet the qualifications specified in 

§ 484.4 of this chapter. 

(ii) Physical therapy, occupational 

therapy or speech-language pathology 

services may be furnished by qualified 

physical therapists, physical therapist 

assistants, occupational therapists, or 

occupational therapy assistants who 

have been licensed, certified, registered 

or otherwise recognized as physical 

therapists, physical therapist assistants, 

occupational therapists, or occupational 

therapy assistants by the State in which 

practicing before January 1, 2008 and 

continue to furnish Medicare services at 

least part time without an interruption 

in furnishing services of more than 2 

years. 

* * * * * 

PART 491—CERTIFICATION OF 

CERTAIN HEALTH FACILITIES 

61. The authority citation for part 491 

continues to read as follows: 

Authority: Sec. 1102 of the Social Security 

Act (42 U.S.C. 1302); and sec. 353 of the 

Public Health Service Act (42 U.S.C. 263a). 

Subpart A—Rural Health Clinics: 

Conditions for Certification; and 

FQHCs Conditions for Coverage 

62. Section 491.9 is amended by 

adding paragraph (c)(4) to read as 

follows: 

§ 491.9 Provision of services. 

* * * * * 

(c) * * * 

(4) Physical therapy, occupational 

therapy or speech-language pathology 

services, if provided, must be 

furnished—

(i) By clinicians who meet either of 

the following qualifications: 

(A) The qualifications specified in 

§ 484.4 of this subchapter. 

(B) Physical therapists, physical 

therapist assistants, occupational 

therapists, or occupational therapy 

assistants who have been licensed, 

certified, registered or otherwise 

recognized as physical therapists, 

physical therapist assistants, 

occupational therapists, or occupational 

therapy assistants by the State in which 

practicing before January 1, 2008 and 

continue to furnish Medicare services at 

least part time without an interruption 

in furnishing services of more than 2 

years. 

(ii) In accordance with a written plan 

of treatment as described in § 410.61 of 

this chapter. 

* * * * * 

Authority 

(Catalog of Federal Domestic Assistance 

Program No. 93.774, Medicare—

Supplementary Medical Insurance Program) 

Dated: May 24, 2007. 

Leslie V. Norwalk, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Approved: June 28, 2007. 

Michael O. Leavitt, 

Secretary. 

Note: These addenda will not appear in the 

Code of Federal Regulations. 

The addenda on the following pages 

provide various data pertaining to the 

Medicare fee schedule for physicians’

services furnished in 2008. 

Addendum A: Explanation and Use of 

Addendum B 

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. 

Addendum B 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 nonfacility 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 

nonfacility PE RVU column, and the 

contractor determines that this service 

can be performed in the nonfacility 

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 

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Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38233 

(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 CY 2005 PFS 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. 

N = Noncovered service. These codes 

are noncovered services. Medicare 

payment may not be made for these 

codes. If RVUs are shown, they are not 

used for Medicare payment. 

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 BN adjustor is not 

reflected in these physician work RVUs. 

6. Fully implemented nonfacility 

practice expense RVUs. These are the 

fully implemented resource-based PE 

RVUs for nonfacility settings. 

7. Year 2008 Transitional Nonfacility 

practice expense RVUs. These are the 

2008 resource-based PE RVUs for 

nonfacility 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 resource-based PE RVUs for 

facility settings. 

10. Malpractice expense RVUs. These 

are the RVUs for the malpractice 

expense for the service for 2006. 

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. 

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38234 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

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 

0054T .... ............ C ........ Bone surgery using computer ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0055T .... ............ C ........ Bone surgery using computer ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0056T .... ............ C ........ Bone surgery using computer ............ 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 

0065T .... ............ C ........ Ocular photoscreen bilat .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0067T .... ............ C ........ Ct colonography;dx ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0067T .... 26 ....... C ........ Ct colonography;dx ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0067T .... TC ...... C ........ Ct colonography;dx ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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 13.04 15.55 NA NA 0.13 XXX 

0075T .... ............ C ........ Perq stent/chest vert art ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0075T .... 26 ....... C ........ Perq stent/chest vert art ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0075T .... TC ...... 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 0.00 0.00 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 

0076T .... TC ...... 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 

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 

mstockstill on PROD1PC66 with PROPOSALS2

38235 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

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 

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 

0135T .... ............ C ........ Perq cryoablate renal tumor ............... 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 

0144T .... ............ C ........ CT heart wo dye; qual calc ................ 0.00 0.00 0.00 0.00 0.00 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 

0144T .... TC ...... 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 0.00 0.00 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 

0145T .... TC ...... 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 0.00 0.00 0.00 XXX 

0146T .... 26 ....... C ........ CCTA w/wo dye .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0146T .... TC ...... 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 0.00 0.00 0.00 XXX 

0147T .... 26 ....... C ........ CCTA w/wo, quan calcium ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0147T .... TC ...... 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 0.00 0.00 0.00 XXX 

0148T .... 26 ....... C ........ CCTA w/wo, strxr ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0148T .... TC ...... 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 0.00 0.00 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 

0149T .... TC ...... 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 0.00 0.00 0.00 XXX 

0150T .... 26 ....... C ........ CCTA w/wo, disease strxr .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0150T .... TC ...... 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 0.00 0.00 0.00 XXX 

0151T .... 26 ....... C ........ CT heart funct add-on ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0151T .... TC ...... C ........ CT heart funct add-on ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0153T .... ............ C ........ Tcath sensor aneurysm sac ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0154T .... ............ C ........ Study sensor aneurysm sac ............... 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 0.00 0.00 0.00 ZZZ 

0159T .... 26 ....... C ........ Cad breast mri .................................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

0159T .... TC ...... 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 proces 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 

10021 .... ............ A ........ Fna w/o image .................................... 1.27 2.17 2.15 0.38 0.46 0.10 XXX 

10022 .... ............ A ........ Fna w/image ....................................... 1.27 2.14 2.32 0.41 0.40 0.08 XXX 

10040 .... ............ A ........ Acne surgery ...................................... 1.19 1.34 1.17 0.98 0.89 0.05 010 

10060 .... ............ A ........ Drainage of skin abscess ................... 1.19 1.48 1.35 1.06 1.00 0.12 010 

10061 .... ............ A ........ Drainage of skin abscess ................... 2.42 2.03 1.94 1.48 1.50 0.26 010 

10080 .... ............ A ........ Drainage of pilonidal cyst ................... 1.19 2.65 2.88 1.10 1.11 0.11 010 

10081 .... ............ A ........ Drainage of pilonidal cyst ................... 2.47 3.45 3.76 1.44 1.47 0.24 010 

10120 .... ............ A ........ Remove foreign body ......................... 1.23 1.92 2.05 0.93 0.96 0.12 010 

10121 .... ............ A ........ Remove foreign body ......................... 2.71 3.45 3.49 1.63 1.71 0.33 010 

10140 .... ............ A ........ Drainage of hematoma/fluid ............... 1.55 2.21 2.00 1.27 1.28 0.19 010 

10160 .... ............ A ........ Puncture drainage of lesion ............... 1.22 1.82 1.71 1.06 1.07 0.14 010 

mstockstill on PROD1PC66 with PROPOSALS2

38236 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

10180 .... ............ A ........ Complex drainage, wound .................. 2.27 3.22 3.11 1.79 1.89 0.35 010 

11000 .... ............ A ........ Debride infected skin .......................... 0.60 0.71 0.65 0.16 0.19 0.07 000 

11001 .... ............ A ........ Debride infected skin add-on ............. 0.30 0.23 0.23 0.08 0.09 0.04 ZZZ 

11004 .... ............ A ........ Debride genitalia & perineum ............. 10.80 NA NA 3.23 3.56 0.67 000 

11005 .... ............ A ........ Debride abdom wall ............................ 14.24 NA NA 3.80 4.75 0.96 000 

11006 .... ............ A ........ Debride genit/per/abdom wall ............. 13.10 NA NA 4.00 4.39 1.28 000 

11008 .... ............ A ........ Remove mesh from abd wall ............. 5.00 NA NA 1.29 1.67 0.61 ZZZ 

11010 .... ............ A ........ Debride skin, fx ................................... 4.19 6.75 6.80 2.34 2.48 0.66 010 

11011 .... ............ A ........ Debride skin/muscle, fx ...................... 4.94 6.98 7.58 2.02 2.19 0.74 000 

11012 .... ............ A ........ Debride skin/muscle/bone, fx ............. 6.87 8.95 10.53 3.12 3.49 1.16 000 

11040 .... ............ A ........ Debride skin, partial ............................ 0.50 0.66 0.59 0.16 0.19 0.06 000 

11041 .... ............ A ........ Debride skin, full ................................. 0.60 0.70 0.69 0.18 0.26 0.10 000 

11042 .... ............ A ........ Debride skin/tissue ............................. 0.80 0.94 0.96 0.24 0.34 0.13 000 

11043 .... ............ A ........ Debride tissue/muscle ........................ 3.04 3.46 3.45 2.57 2.60 0.32 010 

11044 .... ............ A ........ Debride tissue/muscle/bone ............... 4.11 4.78 4.65 3.54 3.67 0.43 010 

11055 .... ............ R ........ Trim skin lesion .................................. 0.43 0.78 0.68 0.11 0.14 0.05 000 

11056 .... ............ R ........ Trim skin lesions, 2 to 4 ..................... 0.61 0.86 0.75 0.15 0.20 0.07 000 

11057 .... ............ R ........ Trim skin lesions, over 4 .................... 0.79 0.96 0.86 0.20 0.25 0.10 000 

11100 .... ............ A ........ Biopsy, skin lesion .............................. 0.81 1.88 1.57 0.39 0.38 0.03 000 

11101 .... ............ A ........ Biopsy, skin add-on ............................ 0.41 0.41 0.37 0.20 0.20 0.02 ZZZ 

11200 .... ............ A ........ Removal of skin tags .......................... 0.79 1.23 1.14 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 1.50 1.31 0.39 0.38 0.04 000 

11302 .... ............ A ........ Shave skin lesion ............................... 1.05 1.77 1.54 0.49 0.48 0.05 000 

11303 .... ............ A ........ Shave skin lesion ............................... 1.24 2.03 1.80 0.56 0.54 0.07 000 

11305 .... ............ A ........ Shave skin lesion ............................... 0.67 1.04 0.95 0.20 0.24 0.07 000 

11306 .... ............ A ........ Shave skin lesion ............................... 0.99 1.41 1.26 0.38 0.40 0.07 000 

11307 .... ............ A ........ Shave skin lesion ............................... 1.14 1.70 1.50 0.48 0.49 0.07 000 

11308 .... ............ A ........ Shave skin lesion ............................... 1.41 1.69 1.58 0.50 0.55 0.13 000 

11310 .... ............ A ........ Shave skin lesion ............................... 0.73 1.38 1.25 0.32 0.32 0.04 000 

11311 .... ............ A ........ Shave skin lesion ............................... 1.05 1.64 1.44 0.49 0.49 0.05 000 

11312 .... ............ A ........ Shave skin lesion ............................... 1.20 1.92 1.67 0.57 0.56 0.06 000 

11313 .... ............ A ........ Shave skin lesion ............................... 1.62 2.19 2.00 0.74 0.73 0.10 000 

11400 .... ............ A ........ Exc tr-ext b9+marg 0.5 < cm ............. 0.87 1.87 1.93 0.93 0.91 0.06 010 

11401 .... ............ A ........ Exc tr-ext b9+marg 0.6–1 cm ............. 1.25 2.18 2.11 1.15 1.08 0.10 010 

11402 .... ............ A ........ Exc tr-ext b9+marg 1.1–2 cm ............. 1.42 2.39 2.30 1.21 1.14 0.13 010 

11403 .... ............ A ........ Exc tr-ext b9+marg 2.1–3 cm ............. 1.81 2.54 2.47 1.57 1.44 0.17 010 

11404 .... ............ A ........ Exc tr-ext b9+marg 3.1–4 cm ............. 2.08 2.84 2.77 1.63 1.52 0.21 010 

11406 .... ............ A ........ Exc tr-ext b9+marg > 4.0 cm ............. 3.47 3.51 3.28 2.09 1.87 0.32 010 

11420 .... ............ A ........ Exc h-f-nk-sp b9+marg 0.5 < ............. 1.00 1.80 1.79 0.92 0.93 0.09 010 

11421 .... ............ A ........ Exc h-f-nk-sp b9+marg 0.6–1 ............. 1.44 2.20 2.13 1.16 1.14 0.13 010 

11422 .... ............ A ........ Exc h-f-nk-sp b9+marg 1.1–2 ............. 1.65 2.42 2.33 1.53 1.43 0.16 010 

11423 .... ............ A ........ Exc h-f-nk-sp b9+marg 2.1–3 ............. 2.03 2.65 2.62 1.65 1.55 0.20 010 

11424 .... ............ A ........ Exc h-f-nk-sp b9+marg 3.1–4 ............. 2.45 2.96 2.88 1.77 1.69 0.25 010 

11426 .... ............ A ........ Exc h-f-nk-sp b9+marg > 4 cm .......... 4.04 3.57 3.53 2.30 2.21 0.44 010 

11440 .... ............ A ........ Exc face-mm b9+marg 0.5 < cm ........ 1.02 1.99 2.10 1.31 1.31 0.08 010 

11441 .... ............ A ........ Exc face-mm b9+marg 0.6–1 cm ....... 1.50 2.37 2.36 1.55 1.52 0.13 010 

11442 .... ............ A ........ Exc face-mm b9+marg 1.1–2 cm ....... 1.74 2.63 2.58 1.66 1.61 0.16 010 

11443 .... ............ A ........ Exc face-mm b9+marg 2.1–3 cm ....... 2.31 2.88 2.89 1.85 1.83 0.22 010 

11444 .... ............ A ........ Exc face-mm b9+marg 3.1–4 cm ....... 3.16 3.31 3.38 2.11 2.14 0.30 010 

11446 .... ............ A ........ Exc face-mm b9+marg > 4 cm ........... 4.75 4.09 4.06 2.69 2.73 0.43 010 

11450 .... ............ A ........ Removal, sweat gland lesion ............. 3.14 5.07 5.06 2.39 2.21 0.34 090 

11451 .... ............ A ........ Removal, sweat gland lesion ............. 4.35 6.32 6.43 2.90 2.70 0.53 090 

11462 .... ............ A ........ Removal, sweat gland lesion ............. 2.92 5.27 5.20 2.45 2.24 0.32 090 

11463 .... ............ A ........ Removal, sweat gland lesion ............. 4.35 6.47 6.67 2.93 2.82 0.54 090 

11470 .... ............ A ........ Removal, sweat gland lesion ............. 3.66 5.43 5.27 2.62 2.45 0.40 090 

11471 .... ............ A ........ Removal, sweat gland lesion ............. 4.81 6.45 6.58 2.99 2.88 0.58 090 

11600 .... ............ A ........ Exc tr-ext mlg+marg 0.5 < cm ............ 1.58 2.73 2.68 1.14 1.06 0.10 010 

11601 .... ............ A ........ Exc tr-ext mlg+marg 0.6–1 cm ........... 2.02 3.43 3.07 1.51 1.37 0.12 010 

11602 .... ............ A ........ Exc tr-ext mlg+marg 1.1–2 cm ........... 2.22 3.84 3.33 1.70 1.49 0.12 010 

11603 .... ............ A ........ Exc tr-ext mlg+marg 2.1–3 cm ........... 2.77 4.04 3.56 1.88 1.61 0.16 010 

11604 .... ............ A ........ Exc tr-ext mlg+marg 3.1–4 cm ........... 3.12 4.33 3.86 1.94 1.67 0.20 010 

11606 .... ............ A ........ Exc tr-ext mlg+marg > 4 cm ............... 4.97 5.47 4.77 2.47 2.10 0.36 010 

11620 .... ............ A ........ Exc h-f-nk-sp mlg+marg 0.5 < ............ 1.59 2.84 2.72 1.20 1.07 0.09 010 

11621 .... ............ A ........ Exc h-f-nk-sp mlg+marg 0.6–1 ........... 2.03 3.49 3.10 1.54 1.39 0.12 010 

11622 .... ............ A ........ Exc h-f-nk-sp mlg+marg 1.1–2 ........... 2.36 3.89 3.43 1.76 1.58 0.14 010 

11623 .... ............ A ........ Exc h-f-nk-sp mlg+marg 2.1–3 ........... 3.06 4.11 3.72 1.97 1.78 0.20 010 

11624 .... ............ A ........ Exc h-f-nk-sp mlg+marg 3.1–4 ........... 3.57 4.42 4.09 2.10 1.94 0.27 010 

11626 .... ............ A ........ Exc h-f-nk-sp mlg+mar > 4 cm ........... 4.56 4.95 4.79 2.34 2.37 0.45 010 

11640 .... ............ A ........ Exc face-mm malig+marg 0.5 < ......... 1.62 3.04 2.85 1.29 1.20 0.11 010 

11641 .... ............ A ........ Exc face-mm malig+marg 0.6–1 ........ 2.12 3.62 3.33 1.62 1.58 0.16 010 

mstockstill on PROD1PC66 with PROPOSALS2

38237 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

11642 .... ............ A ........ Exc face-mm malig+marg 1.1–2 ........ 2.57 4.04 3.72 1.86 1.79 0.19 010 

11643 .... ............ A ........ Exc face-mm malig+marg 2.1–3 ........ 3.37 4.28 4.04 2.12 2.04 0.26 010 

11644 .... ............ A ........ Exc face-mm malig+marg 3.1–4 ........ 4.29 5.07 4.88 2.48 2.47 0.37 010 

11646 .... ............ A ........ Exc face-mm mlg+marg > 4 cm ......... 6.21 5.90 5.82 3.15 3.31 0.61 010 

11719 .... ............ R ........ Trim nail(s) .......................................... 0.17 0.37 0.31 0.04 0.06 0.02 000 

11720 .... ............ A ........ Debride nail, 1–5 ................................ 0.32 0.45 0.40 0.08 0.10 0.04 000 

11721 .... ............ A ........ Debride nail, 6 or more ...................... 0.54 0.53 0.49 0.14 0.18 0.07 000 

11730 .... ............ A ........ Removal of nail plate .......................... 1.10 1.29 1.17 0.27 0.36 0.14 000 

11732 .... ............ A ........ Remove nail plate, add-on ................. 0.57 0.53 0.49 0.14 0.18 0.07 ZZZ 

11740 .... ............ A ........ Drain blood from under nail ................ 0.37 0.78 0.67 0.42 0.39 0.04 000 

11750 .... ............ A ........ Removal of nail bed ........................... 2.40 2.88 2.54 1.83 1.80 0.22 010 

11752 .... ............ A ........ Remove nail bed/finger tip ................. 3.48 3.97 3.51 2.72 2.87 0.35 010 

11755 .... ............ A ........ Biopsy, nail unit .................................. 1.31 1.98 1.79 0.74 0.76 0.14 000 

11760 .... ............ A ........ Repair of nail bed ............................... 1.60 3.34 3.00 1.41 1.60 0.21 010 

11762 .... ............ A ........ Reconstruction of nail bed .................. 2.91 3.61 3.27 1.64 2.01 0.36 010 

11765 .... ............ A ........ Excision of nail fold, toe ..................... 0.71 2.60 2.21 0.98 0.88 0.08 010 

11770 .... ............ A ........ Removal of pilonidal lesion ................ 2.63 3.43 3.46 1.51 1.51 0.33 010 

11771 .... ............ A ........ Removal of pilonidal lesion ................ 5.98 6.57 6.12 3.66 3.49 0.74 090 

11772 .... ............ A ........ Removal of pilonidal lesion ................ 7.23 7.97 7.74 5.51 5.29 0.89 090 

11900 .... ............ A ........ Injection into skin lesions ................... 0.52 0.92 0.79 0.25 0.23 0.02 000 

11901 .... ............ A ........ Added skin lesions injection ............... 0.80 1.02 0.84 0.40 0.38 0.03 000 

11920 .... ............ R ........ Correct skin color defects ................... 1.61 2.34 3.03 1.10 1.11 0.24 000 

11921 .... ............ R ........ Correct skin color defects ................... 1.93 2.65 3.32 1.26 1.27 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 0.89 1.01 0.36 0.37 0.06 000 

11951 .... ............ R ........ Therapy for contour defects ............... 1.19 0.88 1.24 0.35 0.46 0.11 000 

11952 .... ............ R ........ Therapy for contour defects ............... 1.69 1.63 1.76 0.77 0.74 0.16 000 

11954 .... ............ R ........ Therapy for contour defects ............... 1.85 1.78 2.11 0.77 0.84 0.25 000 

11960 .... ............ A ........ Insert tissue expander(s) .................... 11.01 NA NA 10.53 10.50 1.31 090 

11970 .... ............ A ........ Replace tissue expander .................... 7.86 NA NA 6.17 6.18 1.05 090 

11971 .... ............ A ........ Remove tissue expander(s) ............... 3.21 7.35 8.25 4.00 3.91 0.32 090 

11975 .... ............ N ........ Insert contraceptive cap ..................... 1.48 1.52 1.47 0.34 0.45 0.17 XXX 

11976 .... ............ R ........ Removal of contraceptive cap ............ 1.78 1.72 1.72 0.48 0.58 0.21 000 

11977 .... ............ N ........ Removal/reinsert contra cap .............. 3.30 1.97 2.12 0.76 1.01 0.37 XXX 

11980 .... ............ A ........ Implant hormone pellet(s) ................... 1.48 1.07 1.09 0.49 0.53 0.13 000 

11981 .... ............ A ........ Insert drug implant device .................. 1.48 1.90 1.81 0.59 0.64 0.12 XXX 

11982 .... ............ A ........ Remove drug implant device .............. 1.78 2.02 1.99 0.71 0.78 0.17 XXX 

11983 .... ............ A ........ Remove/insert drug implant ............... 3.30 2.65 2.47 1.34 1.41 0.23 XXX 

12001 .... ............ A ........ Repair superficial wound(s) ................ 1.72 1.72 1.85 0.73 0.75 0.15 010 

12002 .... ............ A ........ Repair superficial wound(s) ................ 1.88 1.78 1.91 0.84 0.87 0.17 010 

12004 .... ............ A ........ Repair superficial wound(s) ................ 2.26 2.06 2.19 0.92 0.97 0.21 010 

12005 .... ............ A ........ Repair superficial wound(s) ................ 2.88 2.50 2.67 1.06 1.13 0.27 010 

12006 .... ............ A ........ Repair superficial wound(s) ................ 3.68 3.03 3.21 1.29 1.40 0.35 010 

12007 .... ............ A ........ Repair superficial wound(s) ................ 4.13 3.33 3.58 1.46 1.64 0.45 010 

12011 .... ............ A ........ Repair superficial wound(s) ................ 1.78 1.89 2.01 0.75 0.77 0.16 010 

12013 .... ............ A ........ Repair superficial wound(s) ................ 2.01 2.04 2.16 0.88 0.91 0.18 010 

12014 .... ............ A ........ Repair superficial wound(s) ................ 2.48 2.27 2.42 0.97 1.02 0.23 010 

12015 .... ............ A ........ Repair superficial wound(s) ................ 3.21 2.76 2.95 1.11 1.18 0.29 010 

12016 .... ............ A ........ Repair superficial wound(s) ................ 3.94 3.14 3.35 1.27 1.40 0.37 010 

12017 .... ............ A ........ Repair superficial wound(s) ................ 4.72 NA NA 1.52 1.70 0.47 010 

12018 .... ............ A ........ Repair superficial wound(s) ................ 5.54 NA NA 1.94 2.11 0.64 010 

12020 .... ............ A ........ Closure of split wound ........................ 2.64 3.66 3.75 1.74 1.84 0.30 010 

12021 .... ............ A ........ Closure of split wound ........................ 1.86 1.83 1.83 1.32 1.37 0.24 010 

12031 .... ............ A ........ Layer closure of wound(s) .................. 2.17 3.88 3.09 1.78 1.37 0.17 010 

12032 .... ............ A ........ Layer closure of wound(s) .................. 2.49 5.21 4.53 2.29 2.04 0.16 010 

12034 .... ............ A ........ Layer closure of wound(s) .................. 2.94 4.59 3.89 2.00 1.73 0.25 010 

12035 .... ............ A ........ Layer closure of wound(s) .................. 3.44 5.26 5.23 2.11 2.13 0.39 010 

12036 .... ............ A ........ Layer closure of wound(s) .................. 4.06 5.36 5.46 2.22 2.39 0.55 010 

12037 .... ............ A ........ Layer closure of wound(s) .................. 4.68 5.95 6.02 2.63 2.80 0.66 010 

12041 .... ............ A ........ Layer closure of wound(s) .................. 2.39 3.86 3.20 1.78 1.45 0.19 010 

12042 .... ............ A ........ Layer closure of wound(s) .................. 2.76 4.49 3.88 2.14 1.80 0.17 010 

12044 .... ............ A ........ Layer closure of wound(s) .................. 3.16 5.38 4.29 1.96 1.78 0.27 010 

12045 .... ............ A ........ Layer closure of wound(s) .................. 3.65 4.99 5.14 2.05 2.17 0.41 010 

12046 .... ............ A ........ Layer closure of wound(s) .................. 4.26 5.67 6.08 2.31 2.53 0.54 010 

12047 .... ............ A ........ Layer closure of wound(s) .................. 4.66 6.44 6.35 2.66 2.85 0.58 010 

12051 .... ............ A ........ Layer closure of wound(s) .................. 2.49 4.11 3.69 1.94 1.69 0.20 010 

12052 .... ............ A ........ Layer closure of wound(s) .................. 2.81 4.86 4.05 2.57 2.00 0.17 010 

12053 .... ............ A ........ Layer closure of wound(s) .................. 3.14 5.37 4.30 2.13 1.83 0.23 010 

12054 .... ............ A ........ Layer closure of wound(s) .................. 3.47 5.40 4.48 2.06 1.85 0.30 010 

12055 .... ............ A ........ Layer closure of wound(s) .................. 4.44 5.96 5.23 2.09 2.12 0.45 010 

12056 .... ............ A ........ Layer closure of wound(s) .................. 5.25 6.57 6.60 2.61 2.80 0.59 010 

12057 .... ............ A ........ Layer closure of wound(s) .................. 5.97 7.71 6.88 2.93 3.33 0.56 010 

mstockstill on PROD1PC66 with PROPOSALS2

38238 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

13100 .... ............ A ........ Repair of wound or lesion .................. 3.14 4.42 4.24 2.47 2.39 0.26 010 

13101 .... ............ A ........ Repair of wound or lesion .................. 3.93 5.94 5.31 2.99 2.84 0.26 010 

13102 .... ............ A ........ Repair wound/lesion add-on ............... 1.24 1.35 1.26 0.53 0.56 0.13 ZZZ 

13120 .... ............ A ........ Repair of wound or lesion .................. 3.32 4.58 4.37 2.59 2.47 0.26 010 

13121 .... ............ A ........ Repair of wound or lesion .................. 4.36 6.71 5.78 3.66 3.23 0.25 010 

13122 .... ............ A ........ Repair wound/lesion add-on ............... 1.44 1.37 1.44 0.59 0.62 0.15 ZZZ 

13131 .... ............ A ........ Repair of wound or lesion .................. 3.80 5.01 4.69 2.89 2.79 0.26 010 

13132 .... ............ A ........ Repair of wound or lesion .................. 6.48 7.90 6.91 4.98 4.58 0.32 010 

13133 .... ............ A ........ Repair wound/lesion add-on ............... 2.19 1.88 1.77 0.99 1.01 0.18 ZZZ 

13150 .... ............ A ........ Repair of wound or lesion .................. 3.82 4.72 4.79 2.74 2.75 0.34 010 

13151 .... ............ A ........ Repair of wound or lesion .................. 4.46 5.52 5.17 3.24 3.19 0.31 010 

13152 .... ............ A ........ Repair of wound or lesion .................. 6.34 7.56 6.80 3.95 4.00 0.40 010 

13153 .... ............ A ........ Repair wound/lesion add-on ............... 2.38 2.05 1.99 1.04 1.09 0.24 ZZZ 

13160 .... ............ A ........ Late closure of wound ........................ 11.84 NA NA 7.00 7.10 1.54 090 

14000 .... ............ A ........ Skin tissue rearrangement ................. 6.83 8.93 8.40 6.05 5.77 0.59 090 

14001 .... ............ A ........ Skin tissue rearrangement ................. 9.60 11.01 10.24 7.51 7.32 0.82 090 

14020 .... ............ A ........ Skin tissue rearrangement ................. 7.66 10.02 9.33 6.90 6.73 0.64 090 

14021 .... ............ A ........ Skin tissue rearrangement ................. 11.18 12.48 11.25 8.70 8.51 0.81 090 

14040 .... ............ A ........ Skin tissue rearrangement ................. 8.44 10.19 9.51 7.01 7.12 0.62 090 

14041 .... ............ A ........ Skin tissue rearrangement ................. 12.67 13.60 12.11 9.40 9.05 0.73 090 

14060 .... ............ A ........ Skin tissue rearrangement ................. 9.07 9.70 9.25 7.21 7.33 0.68 090 

14061 .... ............ A ........ Skin tissue rearrangement ................. 13.67 14.87 13.26 10.24 9.89 0.76 090 

14300 .... ............ A ........ Skin tissue rearrangement ................. 13.26 13.53 12.36 9.49 9.35 1.16 090 

14350 .... ............ A ........ Skin tissue rearrangement ................. 10.82 NA NA 6.82 7.02 1.34 090 

15002 .... ............ A ........ Wnd prep, ch/inf, trk/arm/lg ................ 3.65 4.18 4.14 1.69 1.66 0.49 000 

15003 .... ............ A ........ Wnd prep, ch/inf addl 100 cm ............ 0.80 0.90 0.91 0.27 0.28 0.11 ZZZ 

15004 .... ............ A ........ Wnd prep ch/inf, f/n/hf/g ..................... 4.58 4.84 4.79 2.02 1.99 0.62 000 

15005 .... ............ A ........ Wnd prep, f/n/hf/g, addl cm ................ 1.60 1.23 1.26 0.53 0.55 0.22 ZZZ 

15040 .... ............ A ........ Harvest cultured skin graft ................. 2.00 3.89 4.22 1.05 1.09 0.24 000 

15050 .... ............ A ........ Skin pinch graft ................................... 5.37 7.52 7.25 4.94 5.05 0.57 090 

15100 .... ............ A ........ Skin splt grft, trnk/arm/leg .................. 9.74 9.72 11.18 6.67 7.27 1.28 090 

15101 .... ............ A ........ Skin splt grft t/a/l, add-on ................... 1.72 2.46 3.11 0.85 1.02 0.24 ZZZ 

15110 .... ............ A ........ Epidrm autogrft trnk/arm/leg ............... 10.88 8.72 9.75 6.36 6.72 1.31 090 

15111 .... ............ A ........ Epidrm autogrft t/a/l add-on ................ 1.85 0.87 1.08 0.62 0.71 0.26 ZZZ 

15115 .... ............ A ........ Epidrm a-grft face/nck/hf/g ................. 11.19 9.22 9.23 6.75 7.06 1.15 090 

15116 .... ............ A ........ Epidrm a-grft f/n/hf/g addl ................... 2.50 1.20 1.40 0.87 1.00 0.33 ZZZ 

15120 .... ............ A ........ Skn splt a-grft fac/nck/hf/g .................. 10.96 11.31 11.02 7.46 7.63 1.16 090 

15121 .... ............ A ........ Skn splt a-grft f/n/hf/g add .................. 2.67 3.41 3.96 1.30 1.58 0.36 ZZZ 

15130 .... ............ A ........ Derm autograft, trnk/arm/leg .............. 7.41 7.91 8.92 5.56 5.97 0.97 090 

15131 .... ............ A ........ Derm autograft t/a/l add-on ................ 1.50 0.65 0.87 0.48 0.57 0.21 ZZZ 

15135 .... ............ A ........ Derm autograft face/nck/hf/g .............. 10.91 9.47 9.68 7.06 7.61 1.23 090 

15136 .... ............ A ........ Derm autograft, f/n/hf/g add ............... 1.50 0.66 0.78 0.52 0.60 0.20 ZZZ 

15150 .... ............ A ........ Cult epiderm grft t/arm/leg .................. 9.30 7.02 7.79 5.75 6.14 1.14 090 

15151 .... ............ A ........ Cult epiderm grft t/a/l addl .................. 2.00 0.88 1.10 0.68 0.77 0.28 ZZZ 

15152 .... ............ A ........ Cult epiderm graft t/a/l +% ................. 2.50 1.07 1.32 0.86 0.97 0.35 ZZZ 

15155 .... ............ A ........ Cult epiderm graft, f/n/hf/g .................. 10.05 7.65 7.75 6.31 6.65 1.05 090 

15156 .... ............ A ........ Cult epidrm grft f/n/hfg add ................ 2.75 1.15 1.36 0.95 1.10 0.36 ZZZ 

15157 .... ............ A ........ Cult epiderm grft f/n/hfg +% ............... 3.00 1.34 1.57 1.04 1.21 0.39 ZZZ 

15170 .... ............ A ........ Acell graft trunk/arms/legs .................. 5.99 3.99 3.86 2.60 2.45 0.55 090 

15171 .... ............ A ........ Acell graft t/arm/leg add-on ................ 1.55 0.60 0.65 0.47 0.56 0.19 ZZZ 

15175 .... ............ A ........ Acellular graft, f/n/hf/g ........................ 7.99 4.40 5.07 3.10 3.67 0.82 090 

15176 .... ............ A ........ Acell graft, f/n/hf/g add-on .................. 2.45 1.04 1.08 0.79 0.90 0.29 ZZZ 

15200 .... ............ A ........ Skin full graft, trunk ............................ 8.97 9.89 9.66 6.37 6.30 0.98 090 

15201 .... ............ A ........ Skin full graft trunk add-on ................. 1.32 2.00 2.30 0.47 0.56 0.19 ZZZ 

15220 .... ............ A ........ Skin full graft sclp/arm/leg .................. 7.95 10.45 9.82 6.72 6.70 0.84 090 

15221 .... ............ A ........ Skin full graft add-on .......................... 1.19 2.00 2.17 0.51 0.54 0.16 ZZZ 

15240 .... ............ A ........ Skin full grft face/genit/hf .................... 10.15 12.02 11.11 8.92 8.44 0.92 090 

15241 .... ............ A ........ Skin full graft add-on .......................... 1.86 2.53 2.49 0.82 0.87 0.23 ZZZ 

15260 .... ............ A ........ Skin full graft een & lips ..................... 11.39 13.03 11.63 9.38 8.99 0.69 090 

15261 .... ............ A ........ Skin full graft add-on .......................... 2.23 2.98 2.83 1.17 1.28 0.21 ZZZ 

15300 .... ............ A ........ Apply skinallogrft, t/arm/lg .................. 4.65 3.42 3.31 2.15 2.19 0.49 090 

15301 .... ............ A ........ Apply sknallogrft t/a/l addl .................. 1.00 0.45 0.46 0.32 0.37 0.14 ZZZ 

15320 .... ............ A ........ Apply skin allogrft f/n/hf/g ................... 5.36 3.73 3.68 2.33 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 3.48 3.28 2.14 2.15 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 3.28 3.40 1.99 2.23 0.55 090 

15336 .... ............ A ........ Aply acell grft f/n/hf/g add .................. 1.43 0.72 0.71 0.49 0.53 0.20 ZZZ 

15340 .... ............ A ........ Apply cult skin substitute .................... 3.76 3.62 3.84 2.60 2.70 0.41 010 

15341 .... ............ A ........ Apply cult skin sub add-on ................. 0.50 0.63 0.64 0.13 0.17 0.06 ZZZ 

15360 .... ............ A ........ Apply cult derm sub, t/a/l .................... 3.93 4.81 4.58 3.51 3.26 0.43 090 

15361 .... ............ A ........ Aply cult derm sub t/a/l add ............... 1.15 0.50 0.55 0.32 0.40 0.14 ZZZ 

mstockstill on PROD1PC66 with PROPOSALS2

38239 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

15365 .... ............ A ........ Apply cult derm sub f/n/hf/g ............... 4.21 4.11 4.37 3.02 3.14 0.46 090 

15366 .... ............ A ........ Apply cult derm f/hf/g add .................. 1.45 0.67 0.69 0.47 0.53 0.17 ZZZ 

15400 .... ............ A ........ Apply skin xenograft, t/a/l ................... 4.38 4.92 4.47 3.71 3.87 0.47 090 

15401 .... ............ A ........ Apply skn xenogrft t/a/l add ................ 1.00 1.00 1.45 0.33 0.39 0.14 ZZZ 

15420 .... ............ A ........ Apply skin xgraft, f/n/hf/g .................... 4.89 5.36 5.03 4.13 3.93 0.52 090 

15421 .... ............ A ........ Apply skn xgrft f/n/hf/g add ................ 1.50 1.15 1.24 0.48 0.56 0.21 ZZZ 

15430 .... ............ A ........ Apply acellular xenograft .................... 5.93 6.51 6.80 5.97 6.38 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 10.03 10.74 6.26 6.56 1.34 090 

15572 .... ............ A ........ Form skin pedicle flap ........................ 9.94 9.77 9.65 6.68 6.58 1.20 090 

15574 .... ............ A ........ Form skin pedicle flap ........................ 10.52 10.54 10.61 7.06 7.42 1.20 090 

15576 .... ............ A ........ Form skin pedicle flap ........................ 9.24 9.68 9.72 6.55 6.72 0.87 090 

15600 .... ............ A ........ Skin graft ............................................ 1.95 5.28 6.45 2.74 2.90 0.27 090 

15610 .... ............ A ........ Skin graft ............................................ 2.46 5.52 5.12 3.03 3.23 0.35 090 

15620 .... ............ A ........ Skin graft ............................................ 3.62 6.43 7.10 3.89 3.88 0.35 090 

15630 .... ............ A ........ Skin graft ............................................ 3.95 7.05 7.04 4.31 4.23 0.34 090 

15650 .... ............ A ........ Transfer skin pedicle flap ................... 4.64 7.26 7.18 4.39 4.28 0.42 090 

15731 .... ............ A ........ Forehead flap w/vasc pedicle ............. 14.12 11.92 12.06 9.38 9.50 1.28 090 

15732 .... ............ A ........ Muscle-skin graft, head/neck .............. 19.70 14.70 16.41 11.17 11.73 2.00 090 

15734 .... ............ A ........ Muscle-skin graft, trunk ...................... 19.62 15.67 16.94 11.87 12.17 2.62 090 

15736 .... ............ A ........ Muscle-skin graft, arm ........................ 16.92 13.37 15.90 9.61 10.51 2.46 090 

15738 .... ............ A ........ Muscle-skin graft, leg ......................... 18.92 13.75 15.94 10.21 11.04 2.66 090 

15740 .... ............ A ........ Island pedicle flap graft ...................... 11.57 13.59 11.87 9.47 8.88 0.63 090 

15750 .... ............ A ........ Neurovascular pedicle graft ................ 12.73 NA NA 8.87 8.98 1.42 090 

15756 .... ............ A ........ Free myo/skin flap microvasc ............. 36.74 NA NA 18.66 19.65 4.62 090 

15757 .... ............ A ........ Free skin flap, microvasc ................... 36.95 NA NA 17.98 19.63 3.90 090 

15758 .... ............ A ........ Free fascial flap, microvasc ................ 36.70 NA NA 17.66 19.49 4.24 090 

15760 .... ............ A ........ Composite skin graft ........................... 9.68 10.42 10.21 7.09 7.17 0.85 090 

15770 .... ............ A ........ Derma-fat-fascia graft ......................... 8.73 NA NA 6.65 6.67 1.05 090 

15775 .... ............ R ........ Hair transplant punch grafts ............... 3.95 2.86 3.65 1.23 1.35 0.52 000 

15776 .... ............ R ........ Hair transplant punch grafts ............... 5.53 4.84 4.94 2.15 2.38 0.72 000 

15780 .... ............ A ........ Abrasion treatment of skin ................. 8.50 11.44 11.55 6.70 7.51 0.67 090 

15781 .... ............ A ........ Abrasion treatment of skin ................. 4.91 8.67 7.79 5.65 5.51 0.34 090 

15782 .... ............ A ........ Abrasion treatment of skin ................. 4.36 8.65 9.42 4.94 5.85 0.34 090 

15783 .... ............ A ........ Abrasion treatment of skin ................. 4.33 7.93 7.44 4.99 4.61 0.28 090 

15786 .... ............ A ........ Abrasion, lesion, single ...................... 2.05 3.89 3.61 1.25 1.29 0.11 010 

15787 .... ............ A ........ Abrasion, lesions, add-on ................... 0.33 0.82 0.96 0.08 0.13 0.04 ZZZ 

15788 .... ............ R ........ Chemical peel, face, epiderm ............. 2.09 9.40 7.91 4.11 3.53 0.11 090 

15789 .... ............ R ........ Chemical peel, face, dermal ............... 4.91 9.43 8.73 5.85 5.31 0.20 090 

15792 .... ............ R ........ Chemical peel, nonfacial .................... 1.86 8.88 7.65 4.54 4.32 0.13 090 

15793 .... ............ A ........ Chemical peel, nonfacial .................... 3.82 8.08 6.76 4.91 4.38 0.19 090 

15819 .... ............ A ........ Plastic surgery, neck .......................... 10.45 NA NA 6.71 6.96 0.97 090 

15820 .... ............ A ........ Revision of lower eyelid ..................... 6.09 6.43 6.72 5.24 5.41 0.40 090 

15821 .... ............ A ........ Revision of lower eyelid ..................... 6.66 6.61 7.01 5.33 5.54 0.45 090 

15822 .... ............ A ........ Revision of upper eyelid ..................... 4.51 5.24 5.56 4.11 4.32 0.37 090 

15823 .... ............ A ........ Revision of upper eyelid ..................... 8.12 7.42 7.67 6.15 6.32 0.50 090 

15830 .... ............ R ........ Exc skin abd ....................................... 16.90 NA NA 9.82 10.04 2.93 090 

15832 .... ............ A ........ Excise excessive skin tissue .............. 12.65 NA NA 8.31 8.34 1.66 090 

15833 .... ............ A ........ Excise excessive skin tissue .............. 11.70 NA NA 7.42 7.77 1.49 090 

15834 .... ............ A ........ Excise excessive skin tissue .............. 11.97 NA NA 8.13 7.86 1.61 090 

15835 .... ............ A ........ Excise excessive skin tissue .............. 12.79 NA NA 7.83 7.70 1.60 090 

15836 .... ............ A ........ Excise excessive skin tissue .............. 10.41 NA NA 6.88 6.87 1.34 090 

15837 .... ............ A ........ Excise excessive skin tissue .............. 9.37 8.61 8.61 5.75 6.57 1.18 090 

15838 .... ............ A ........ Excise excessive skin tissue .............. 8.07 NA NA 5.45 5.68 0.58 090 

15839 .... ............ A ........ Excise excessive skin tissue .............. 10.32 9.70 9.21 6.44 6.39 1.22 090 

15840 .... ............ A ........ Graft for face nerve palsy ................... 14.76 NA NA 8.97 9.44 1.32 090 

15841 .... ............ A ........ Graft for face nerve palsy ................... 25.69 NA NA 13.62 14.26 2.55 090 

15842 .... ............ A ........ Flap for face nerve palsy .................... 40.68 NA NA 20.89 22.02 4.94 090 

15845 .... ............ A ........ Skin and muscle repair, face .............. 14.04 NA NA 8.43 8.94 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 1.19 1.38 0.18 0.24 0.05 XXX 

15851 .... ............ A ........ Removal of sutures ............................ 0.86 1.32 1.50 0.24 0.27 0.06 000 

15852 .... ............ A ........ Dressing change not for burn ............. 0.86 NA NA 0.26 0.29 0.09 000 

15860 .... ............ A ........ Test for blood flow in graft ................. 1.95 NA NA 0.64 0.72 0.27 000 

15920 .... ............ A ........ Removal of tail bone ulcer ................. 8.15 NA NA 5.32 5.53 1.04 090 

15922 .... ............ A ........ Removal of tail bone ulcer ................. 10.23 NA NA 7.20 7.19 1.42 090 

15931 .... ............ A ........ Remove sacrum pressure sore .......... 9.96 NA NA 5.54 5.61 1.25 090 

15933 .... ............ A ........ Remove sacrum pressure sore .......... 11.60 NA NA 7.29 7.59 1.52 090 

15934 .... ............ A ........ Remove sacrum pressure sore .......... 13.54 NA NA 7.70 7.87 1.79 090 

15935 .... ............ A ........ Remove sacrum pressure sore .......... 15.58 NA NA 9.15 9.94 2.10 090 

15936 .... ............ A ........ Remove sacrum pressure sore .......... 13.04 NA NA 7.42 7.85 1.77 090 

15937 .... ............ A ........ Remove sacrum pressure sore .......... 15.00 NA NA 8.96 9.42 2.07 090 

mstockstill on PROD1PC66 with PROPOSALS2

38240 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

15940 .... ............ A ........ Remove hip pressure sore ................. 10.11 NA NA 5.78 6.00 1.31 090 

15941 .... ............ A ........ Remove hip pressure sore ................. 12.24 NA NA 8.43 8.98 1.66 090 

15944 .... ............ A ........ Remove hip pressure sore ................. 12.27 NA NA 8.12 8.41 1.65 090 

15945 .... ............ A ........ Remove hip pressure sore ................. 13.57 NA NA 8.81 9.32 1.85 090 

15946 .... ............ A ........ Remove hip pressure sore ................. 23.80 NA NA 13.73 14.14 3.17 090 

15950 .... ............ A ........ Remove thigh pressure sore .............. 7.91 NA NA 5.38 5.41 1.04 090 

15951 .... ............ A ........ Remove thigh pressure sore .............. 11.41 NA NA 7.31 7.72 1.49 090 

15952 .... ............ A ........ Remove thigh pressure sore .............. 12.14 NA NA 7.47 7.68 1.60 090 

15953 .... ............ A ........ Remove thigh pressure sore .............. 13.39 NA NA 8.22 8.78 1.80 090 

15956 .... ............ A ........ Remove thigh pressure sore .............. 16.59 NA NA 9.54 10.20 2.22 090 

15958 .... ............ A ........ Remove thigh pressure sore .............. 16.55 NA NA 10.48 10.76 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 1.10 1.20 0.56 0.57 0.08 000 

16025 .... ............ A ........ Dress/debrid p-thick burn, m .............. 1.85 1.56 1.67 0.85 0.91 0.19 000 

16030 .... ............ A ........ Dress/debrid p-thick burn, l ................ 2.08 2.07 2.10 1.02 1.06 0.24 000 

16035 .... ............ A ........ Incision of burn scab, initi ................... 3.74 NA NA 1.22 1.41 0.46 090 

16036 .... ............ A ........ Escharotomy; addœl incision .............. 1.50 NA NA 0.45 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 2.45 2.37 1.39 1.49 0.11 010 

17106 .... ............ A ........ Destruction of skin lesions ................. 4.62 4.70 4.65 3.30 3.32 0.35 090 

17107 .... ............ A ........ Destruction of skin lesions ................. 9.19 7.01 7.16 4.99 5.27 0.63 090 

17108 .... ............ A ........ Destruction of skin lesions ................. 13.22 8.91 9.20 6.45 7.14 0.54 090 

17110 .... ............ A ........ Destruct b9 lesion, 1–14 .................... 0.67 1.77 1.70 0.88 0.79 0.05 010 

17111 .... ............ A ........ Destruct lesion, 15 or more ................ 0.94 2.24 1.97 1.11 0.96 0.05 010 

17250 .... ............ A ........ Chemical cautery, tissue .................... 0.50 1.30 1.27 0.38 0.36 0.06 000 

17260 .... ............ A ........ Destruction of skin lesions ................. 0.93 1.41 1.35 0.71 0.70 0.04 010 

17261 .... ............ A ........ Destruction of skin lesions ................. 1.19 2.49 2.06 1.07 0.96 0.05 010 

17262 .... ............ A ........ Destruction of skin lesions ................. 1.60 2.83 2.36 1.28 1.15 0.06 010 

17263 .... ............ A ........ Destruction of skin lesions ................. 1.81 3.07 2.56 1.38 1.24 0.07 010 

17264 .... ............ A ........ Destruction of skin lesions ................. 1.96 3.27 2.75 1.45 1.29 0.08 010 

17266 .... ............ A ........ Destruction of skin lesions ................. 2.36 3.50 3.01 1.60 1.42 0.09 010 

17270 .... ............ A ........ Destruction of skin lesions ................. 1.34 2.43 2.07 1.10 0.99 0.05 010 

17271 .... ............ A ........ Destruction of skin lesions ................. 1.51 2.66 2.22 1.23 1.11 0.06 010 

17272 .... ............ A ........ Destruction of skin lesions ................. 1.79 2.97 2.48 1.38 1.25 0.07 010 

17273 .... ............ A ........ Destruction of skin lesions ................. 2.07 3.21 2.71 1.50 1.36 0.08 010 

17274 .... ............ A ........ Destruction of skin lesions ................. 2.61 3.61 3.10 1.76 1.61 0.10 010 

17276 .... ............ A ........ Destruction of skin lesions ................. 3.22 3.89 3.42 1.99 1.84 0.16 010 

17280 .... ............ A ........ Destruction of skin lesions ................. 1.19 2.36 1.99 1.04 0.93 0.05 010 

17281 .... ............ A ........ Destruction of skin lesions ................. 1.74 2.74 2.33 1.34 1.22 0.07 010 

17282 .... ............ A ........ Destruction of skin lesions ................. 2.06 3.15 2.66 1.51 1.38 0.08 010 

17283 .... ............ A ........ Destruction of skin lesions ................. 2.66 3.56 3.06 1.79 1.64 0.11 010 

17284 .... ............ A ........ Destruction of skin lesions ................. 3.23 3.98 3.46 2.05 1.91 0.13 010 

17286 .... ............ A ........ Destruction of skin lesions ................. 4.45 4.46 4.07 2.51 2.48 0.23 010 

17311 .... ............ A ........ Mohs, 1 stage, h/n/hf/g ....................... 6.20 10.71 10.76 3.10 3.14 0.24 000 

17312 .... ............ A ........ Mohs addl stage ................................. 3.30 6.88 6.91 1.65 1.67 0.13 ZZZ 

17313 .... ............ A ........ Mohs, 1 stage, t/a/l ............................. 5.56 9.88 9.93 2.78 2.81 0.22 000 

17314 .... ............ A ........ Mohs, addl stage, t/a/l ........................ 3.06 6.37 6.40 1.53 1.54 0.12 ZZZ 

17315 .... ............ A ........ Mohs surg, addl block ........................ 0.87 1.14 1.15 0.43 0.44 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 1.02 0.95 0.06 010 

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 1.89 1.92 0.27 0.28 0.08 000 

19001 .... ............ A ........ Drain breast lesion add-on ................. 0.42 0.26 0.25 0.14 0.14 0.04 ZZZ 

19020 .... ............ A ........ Incision of breast lesion ...................... 3.74 6.57 6.45 3.02 2.85 0.45 090 

19030 .... ............ A ........ Injection for breast x-ray ..................... 1.53 2.65 2.72 0.55 0.50 0.09 000 

19100 .... ............ A ........ Bx breast percut w/o image ............... 1.27 2.06 2.07 0.33 0.38 0.16 000 

19101 .... ............ A ........ Biopsy of breast, open ....................... 3.20 4.33 4.41 1.77 1.84 0.39 010 

19102 .... ............ A ........ Bx breast percut w/image ................... 2.00 3.44 3.60 0.69 0.66 0.14 000 

19103 .... ............ A ........ Bx breast percut w/device .................. 3.69 10.02 10.68 1.20 1.19 0.30 000 

19105 .... ............ A ........ Cryosurg ablate fa, each .................... 3.69 45.89 45.89 0.99 0.99 0.30 000 

19110 .... ............ A ........ Nipple exploration ............................... 4.35 6.15 6.00 3.14 3.02 0.57 090 

19112 .... ............ A ........ Excise breast duct fistula ................... 3.72 6.16 6.12 3.10 2.90 0.48 090 

19120 .... ............ A ........ Removal of breast lesion .................... 5.84 5.04 4.79 3.35 3.21 0.73 090 

19125 .... ............ A ........ Excision, breast lesion ........................ 6.59 5.51 5.15 3.63 3.46 0.80 090 

19126 .... ............ A ........ Excision, addl breast lesion ................ 2.93 NA NA 0.75 0.88 0.38 ZZZ 

19260 .... ............ A ........ Removal of chest wall lesion .............. 17.60 NA NA 10.08 10.65 2.14 090 

19271 .... ............ A ........ Revision of chest wall ......................... 21.86 NA NA 15.73 16.86 2.63 090 

19272 .... ............ A ........ Extensive chest wall surgery .............. 24.82 NA NA 16.86 17.92 3.00 090 

19290 .... ............ A ........ Place needle wire, breast ................... 1.27 2.87 2.83 0.45 0.42 0.07 000 

19291 .... ............ A ........ Place needle wire, breast ................... 0.63 1.13 1.16 0.22 0.21 0.04 ZZZ 

mstockstill on PROD1PC66 with PROPOSALS2

38241 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

19295 .... ............ A ........ Place breast clip, percut ..................... 0.00 2.25 2.46 0.00 1.35 0.01 ZZZ 

19296 .... ............ A ........ Place po breast cath for rad ............... 3.63 84.88 104.91 1.19 1.36 0.36 000 

19297 .... ............ A ........ Place breast cath for rad .................... 1.72 NA NA 0.44 0.55 0.17 ZZZ 

19298 .... ............ A ........ Place breast rad tube/caths ............... 6.00 21.81 32.20 2.14 2.29 0.43 000 

19300 .... ............ A ........ Removal of breast tissue .................... 5.20 7.97 7.43 3.83 3.54 0.69 090 

19301 .... ............ A ........ Partial mastectomy ............................. 10.00 NA NA 4.61 3.82 0.79 090 

19302 .... ............ A ........ P-mastectomy w/ln removal ............... 13.88 NA NA 6.12 6.27 1.80 090 

19303 .... ............ A ........ Mast, simple, complete ....................... 15.67 NA NA 6.97 5.68 1.18 090 

19304 .... ............ A ........ Mast, subq .......................................... 7.81 NA NA 4.91 4.81 1.04 090 

19305 .... ............ A ........ Mast, radical ....................................... 17.23 NA NA 8.09 8.02 1.93 090 

19306 .... ............ A ........ Mast, rad, urban type ......................... 17.85 NA NA 8.68 8.39 2.08 090 

19307 .... ............ A ........ Mast, mod rad .................................... 17.95 NA NA 8.72 8.39 2.13 090 

19316 .... ............ A ........ Suspension of breast .......................... 10.98 NA NA 6.96 7.29 1.64 090 

19318 .... ............ A ........ Reduction of large breast ................... 15.91 NA NA 9.94 10.61 2.93 090 

19324 .... ............ A ........ Enlarge breast .................................... 6.65 NA NA 4.45 4.71 0.84 090 

19325 .... ............ A ........ Enlarge breast with implant ................ 8.52 NA NA 6.42 6.51 1.33 090 

19328 .... ............ A ........ Removal of breast implant ................. 6.35 NA NA 4.98 5.03 0.91 090 

19330 .... ............ A ........ Removal of implant material ............... 8.39 NA NA 5.94 6.05 1.26 090 

19340 .... ............ A ........ Immediate breast prosthesis .............. 6.32 NA NA 2.83 2.99 1.06 ZZZ 

19342 .... ............ A ........ Delayed breast prosthesis .................. 12.40 NA NA 8.94 8.98 1.84 090 

19350 .... ............ A ........ Breast reconstruction .......................... 8.99 9.86 11.89 6.60 6.91 1.41 090 

19355 .... ............ A ........ Correct inverted nipple(s) ................... 8.37 7.41 8.90 4.69 4.75 0.92 090 

19357 .... ............ A ........ Breast reconstruction .......................... 20.57 NA NA 15.40 15.59 2.94 090 

19361 .... ............ A ........ Breast reconstr w/lat flap .................... 23.17 NA NA 16.83 14.71 2.93 090 

19364 .... ............ A ........ Breast reconstruction .......................... 42.40 NA NA 22.28 23.13 6.24 090 

19366 .... ............ A ........ Breast reconstruction .......................... 21.70 NA NA 9.91 10.81 3.25 090 

19367 .... ............ A ........ Breast reconstruction .......................... 26.59 NA NA 15.24 16.05 4.04 090 

19368 .... ............ A ........ Breast reconstruction .......................... 33.61 NA NA 18.12 18.63 5.54 090 

19369 .... ............ A ........ Breast reconstruction .......................... 31.02 NA NA 16.41 17.40 4.51 090 

19370 .... ............ A ........ Surgery of breast capsule .................. 8.99 NA NA 6.79 6.88 1.29 090 

19371 .... ............ A ........ Removal of breast capsule ................. 10.42 NA NA 7.69 7.80 1.62 090 

19380 .... ............ A ........ Revise breast reconstruction .............. 10.21 NA NA 7.62 7.70 1.44 090 

19396 .... ............ A ........ Design custom breast implant ............ 2.17 4.50 2.80 1.29 1.14 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 2.74 2.72 1.51 1.62 0.25 010 

20005 .... ............ A ........ Incision of deep abscess .................... 3.55 3.62 3.57 1.99 2.13 0.46 010 

20100 .... ............ A ........ Explore wound, neck .......................... 10.33 NA NA 3.59 4.04 1.21 010 

20101 .... ............ A ........ Explore wound, chest ......................... 3.22 6.53 6.20 1.53 1.57 0.44 010 

20102 .... ............ A ........ Explore wound, abdomen ................... 3.95 6.88 7.17 1.83 1.87 0.49 010 

20103 .... ............ A ........ Explore wound, extremity ................... 5.31 7.72 8.15 2.77 3.08 0.75 010 

20150 .... ............ A ........ Excise epiphyseal bar ........................ 14.60 NA NA 7.67 7.38 2.04 090 

20200 .... ............ A ........ Muscle biopsy ..................................... 1.46 3.06 3.06 0.69 0.72 0.23 000 

20205 .... ............ A ........ Deep muscle biopsy ........................... 2.35 3.79 3.84 1.10 1.15 0.33 000 

20206 .... ............ A ........ Needle biopsy, muscle ....................... 0.99 5.17 5.80 0.57 0.59 0.07 000 

20220 .... ............ A ........ Bone biopsy, trocar/needle ................. 1.27 2.69 3.61 0.68 0.73 0.08 000 

20225 .... ............ A ........ Bone biopsy, trocar/needle ................. 1.87 11.89 18.29 1.03 1.08 0.22 000 

20240 .... ............ A ........ Bone biopsy, excisional ...................... 3.25 NA NA 2.02 2.30 0.44 010 

20245 .... ............ A ........ Bone biopsy, excisional ...................... 8.77 NA NA 5.73 6.16 1.31 010 

20250 .... ............ A ........ Open bone biopsy .............................. 5.16 NA NA 3.63 3.58 1.02 010 

20251 .... ............ A ........ Open bone biopsy .............................. 5.69 NA NA 3.86 4.02 1.15 010 

20500 .... ............ A ........ Injection of sinus tract ........................ 1.25 1.32 1.78 0.87 1.20 0.12 010 

20501 .... ............ A ........ Inject sinus tract for x-ray ................... 0.76 2.35 2.61 0.28 0.25 0.04 000 

20520 .... ............ A ........ Removal of foreign body .................... 1.87 2.58 2.75 1.44 1.60 0.21 010 

20525 .... ............ A ........ Removal of foreign body .................... 3.51 7.03 8.09 2.19 2.41 0.51 010 

20526 .... ............ A ........ Ther injection, carp tunnel .................. 0.94 0.81 0.89 0.41 0.47 0.13 000 

20550 .... ............ A ........ Inj tendon sheath/ligament ................. 0.75 0.62 0.67 0.28 0.26 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 0.25 0.22 0.05 000 

20553 .... ............ A ........ Inject trigger points, =/> 3 .................. 0.75 0.64 0.73 0.27 0.24 0.04 000 

20600 .... ............ A ........ Drain/inject, joint/bursa ....................... 0.66 0.65 0.66 0.31 0.33 0.08 000 

20605 .... ............ A ........ Drain/inject, joint/bursa ....................... 0.68 0.73 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 0.69 0.70 0.32 0.34 0.10 000 

20615 .... ............ A ........ Treatment of bone cyst ...................... 2.30 2.68 3.10 1.41 1.62 0.20 010 

20650 .... ............ A ........ Insert and remove bone pin ............... 2.25 2.41 2.40 1.42 1.50 0.31 010 

20660 .... ............ A ........ Apply, rem fixation device .................. 2.51 3.30 3.19 1.49 1.56 0.59 000 

20661 .... ............ A ........ Application of head brace ................... 5.14 NA NA 6.05 5.48 1.14 090 

20662 .... ............ A ........ Application of pelvis brace ................. 6.26 NA NA 4.91 5.21 0.56 090 

20663 .... ............ A ........ Application of thigh brace ................... 5.62 NA NA 4.84 4.89 0.94 090 

20664 .... ............ A ........ Halo brace application ........................ 9.86 NA NA 7.83 7.50 1.75 090 

20665 .... ............ A ........ Removal of fixation device ................. 1.33 1.37 1.78 0.98 1.17 0.19 010 

20670 .... ............ A ........ Removal of support implant ............... 1.76 6.54 9.06 1.65 1.88 0.28 010 

mstockstill on PROD1PC66 with PROPOSALS2

38242 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

20680 .... ............ A ........ Removal of support implant ............... 5.90 8.07 8.44 4.05 3.90 0.56 090 

20690 .... ............ A ........ Apply bone fixation device ................. 3.67 NA NA 2.24 2.39 0.59 090 

20692 .... ............ A ........ Apply bone fixation device ................. 6.40 NA NA 3.18 3.49 1.05 090 

20693 .... ............ A ........ Adjust bone fixation device ................ 5.97 NA NA 4.45 4.96 0.98 090 

20694 .... ............ A ........ Remove bone fixation device ............. 4.20 5.27 6.22 3.51 3.78 0.71 090 

20802 .... ............ A ........ Replantation, arm, complete .............. 42.30 NA NA 13.20 19.01 3.82 090 

20805 .... ............ A ........ Replant forearm, complete ................. 51.14 NA NA 23.87 29.46 4.85 090 

20808 .... ............ A ........ Replantation hand, complete .............. 62.77 NA NA 37.05 40.08 6.88 090 

20816 .... ............ A ........ Replantation digit, complete ............... 31.74 NA NA 25.24 31.41 4.53 090 

20822 .... ............ A ........ Replantation digit, complete ............... 26.42 NA NA 23.69 28.95 4.19 090 

20824 .... ............ A ........ Replantation thumb, complete ............ 31.74 NA NA 24.76 30.85 4.62 090 

20827 .... ............ A ........ Replantation thumb, complete ............ 27.24 NA NA 23.43 30.06 3.67 090 

20838 .... ............ A ........ Replantation foot, complete ................ 42.56 NA NA 14.01 18.06 1.12 090 

20900 .... ............ A ........ Removal of bone for graft .................. 5.77 9.15 8.82 4.88 5.29 0.94 090 

20902 .... ............ A ........ Removal of bone for graft .................. 7.98 NA NA 5.97 6.41 1.30 090 

20910 .... ............ A ........ Remove cartilage for graft .................. 5.41 NA NA 4.55 4.89 0.71 090 

20912 .... ............ A ........ Remove cartilage for graft .................. 6.42 NA NA 4.96 5.34 0.69 090 

20920 .... ............ A ........ Removal of fascia for graft ................. 5.42 NA NA 4.35 4.30 0.66 090 

20922 .... ............ A ........ Removal of fascia for graft ................. 6.84 7.56 7.55 5.02 4.95 0.70 090 

20924 .... ............ A ........ Removal of tendon for graft ............... 6.59 NA NA 4.94 5.43 1.04 090 

20926 .... ............ A ........ Removal of tissue for graft ................. 5.70 NA NA 4.49 4.61 0.87 090 

20931 .... ............ A ........ Spinal bone allograft ........................... 1.81 NA NA 0.69 0.81 0.43 ZZZ 

20937 .... ............ A ........ Spinal bone autograft ......................... 2.79 NA NA 1.09 1.28 0.54 ZZZ 

20938 .... ............ A ........ Spinal bone autograft ......................... 3.02 NA NA 1.16 1.37 0.64 ZZZ 

20950 .... ............ A ........ Fluid pressure, muscle ....................... 1.26 4.18 5.51 0.88 0.93 0.20 000 

20955 .... ............ A ........ Fibula bone graft, microvasc .............. 40.02 NA NA 18.61 21.42 4.90 090 

20956 .... ............ A ........ Iliac bone graft, microvasc ................. 40.93 NA NA 20.42 22.67 7.03 090 

20957 .... ............ A ........ Mt bone graft, microvasc .................... 42.33 NA NA 15.50 17.91 7.07 090 

20962 .... ............ A ........ Other bone graft, microvasc ............... 39.21 NA NA 21.53 24.02 6.57 090 

20969 .... ............ A ........ Bone/skin graft, microvasc ................. 45.11 NA NA 21.25 23.86 4.80 090 

20970 .... ............ A ........ Bone/skin graft, iliac crest .................. 44.26 NA NA 21.03 23.12 6.62 090 

20972 .... ............ A ........ Bone/skin graft, metatarsal ................. 44.19 NA NA 14.42 18.07 5.32 090 

20973 .... ............ A ........ Bone/skin graft, great toe ................... 46.95 NA NA 14.14 19.83 5.56 090 

20974 .... ............ A ........ Electrical bone stimulation .................. 0.62 0.97 0.84 0.48 0.51 0.11 000 

20975 .... ............ A ........ Electrical bone stimulation .................. 2.60 NA NA 1.46 1.59 0.51 000 

20979 .... ............ A ........ Us bone stimulation ............................ 0.62 0.60 0.70 0.20 0.27 0.09 000 

20982 .... ............ A ........ Ablate, bone tumor(s) perq ................ 7.27 79.27 94.26 2.71 2.78 0.69 000 

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 6.42 6.68 1.11 090 

21015 .... ............ A ........ Resection of facial tumor .................... 5.59 NA NA 4.30 4.67 0.70 090 

21025 .... ............ A ........ Excision of bone, lower jaw ................ 11.07 12.59 12.41 8.80 9.07 1.32 090 

21026 .... ............ A ........ Excision of facial bone(s) ................... 5.54 8.82 8.33 5.94 6.12 0.60 090 

21029 .... ............ A ........ Contour of face bone lesion ............... 8.26 9.60 9.44 6.59 6.76 0.94 090 

21030 .... ............ A ........ Excise max/zygoma b9 tumor ............ 4.80 7.19 6.76 4.70 4.87 0.54 090 

21031 .... ............ A ........ Remove exostosis, mandible ............. 3.26 5.91 5.55 3.48 3.56 0.48 090 

21032 .... ............ A ........ Remove exostosis, maxilla ................. 3.28 6.04 5.69 3.37 3.44 0.47 090 

21034 .... ............ A ........ Excise max/zygoma mlg tumor .......... 17.17 13.98 14.84 10.19 11.34 1.72 090 

21040 .... ............ A ........ Excise mandible lesion ....................... 4.80 7.21 6.81 4.66 4.70 0.54 090 

21044 .... ............ A ........ Removal of jaw bone lesion ............... 12.61 NA NA 8.14 8.67 1.12 090 

21045 .... ............ A ........ Extensive jaw surgery ........................ 18.13 NA NA 10.87 11.50 1.52 090 

21046 .... ............ A ........ Remove mandible cyst complex ........ 13.97 NA NA 11.59 11.77 1.86 090 

21047 .... ............ A ........ Excise lwr jaw cyst w/repair ............... 19.83 NA NA 10.32 11.81 2.13 090 

21048 .... ............ A ........ Remove maxilla cyst complex ............ 14.47 NA NA 11.45 11.80 1.77 090 

21049 .... ............ A ........ Excis uppr jaw cyst w/repair ............... 19.08 NA NA 10.36 11.51 1.59 090 

21050 .... ............ A ........ Removal of jaw joint ........................... 11.54 NA NA 8.21 8.84 1.47 090 

21060 .... ............ A ........ Remove jaw joint cartilage ................. 10.91 NA NA 7.24 7.99 1.38 090 

21070 .... ............ A ........ Remove coronoid process .................. 8.50 NA NA 6.30 6.69 1.27 090 

21076 .... ............ A ........ Prepare face/oral prosthesis .............. 13.40 7.83 10.12 4.78 7.41 2.00 010 

21077 .... ............ A ........ Prepare face/oral prosthesis .............. 33.70 18.06 24.81 11.99 19.09 4.56 090 

21079 .... ............ A ........ Prepare face/oral prosthesis .............. 22.31 13.62 17.61 8.24 12.73 3.16 090 

21080 .... ............ A ........ Prepare face/oral prosthesis .............. 25.06 15.78 20.19 9.17 14.30 3.75 090 

21081 .... ............ A ........ Prepare face/oral prosthesis .............. 22.85 14.72 18.53 8.55 13.04 3.21 090 

21082 .... ............ A ........ Prepare face/oral prosthesis .............. 20.84 14.77 17.10 8.38 12.09 3.12 090 

21083 .... ............ A ........ Prepare face/oral prosthesis .............. 19.27 14.58 16.72 7.89 11.19 2.89 090 

21084 .... ............ A ........ Prepare face/oral prosthesis .............. 22.48 16.52 19.45 9.08 13.37 2.19 090 

21085 .... ............ A ........ Prepare face/oral prosthesis .............. 8.99 6.80 7.56 3.57 5.19 1.27 010 

21086 .... ............ A ........ Prepare face/oral prosthesis .............. 24.88 12.65 18.24 8.58 14.05 3.72 090 

21087 .... ............ A ........ Prepare face/oral prosthesis .............. 24.88 12.80 18.10 8.70 14.00 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 14.76 12.98 5.52 5.06 0.34 090 

21110 .... ............ A ........ Interdental fixation .............................. 5.80 13.02 11.33 9.72 9.07 0.72 090 

mstockstill on PROD1PC66 with PROPOSALS2

38243 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

21116 .... ............ A ........ Injection, jaw joint x-ray ...................... 0.81 2.50 3.39 0.23 0.28 0.06 000 

21120 .... ............ A ........ Reconstruction of chin ........................ 4.99 9.59 10.17 6.62 7.11 0.60 090 

21121 .... ............ A ........ Reconstruction of chin ........................ 7.70 10.67 10.20 7.63 7.72 0.90 090 

21122 .... ............ A ........ Reconstruction of chin ........................ 8.59 NA NA 8.45 8.42 1.07 090 

21123 .... ............ A ........ Reconstruction of chin ........................ 11.22 NA NA 6.98 9.42 1.40 090 

21125 .... ............ A ........ Augmentation, lower jaw bone ........... 10.68 63.67 60.26 6.47 7.51 0.79 090 

21127 .... ............ A ........ Augmentation, lower jaw bone ........... 12.24 84.66 64.16 7.56 8.58 1.52 090 

21137 .... ............ A ........ Reduction of forehead ........................ 10.12 NA NA 7.45 7.42 1.32 090 

21138 .... ............ A ........ Reduction of forehead ........................ 12.73 NA NA 7.71 8.81 1.75 090 

21139 .... ............ A ........ Reduction of forehead ........................ 14.90 NA NA 6.95 9.26 1.18 090 

21141 .... ............ A ........ Reconstruct midface, lefort ................. 19.27 NA NA 12.00 12.77 2.36 090 

21142 .... ............ A ........ Reconstruct midface, lefort ................. 19.98 NA NA 10.06 11.54 2.39 090 

21143 .... ............ A ........ Reconstruct midface, lefort ................. 20.75 NA NA 11.86 12.57 1.66 090 

21145 .... ............ A ........ Reconstruct midface, lefort ................. 23.64 NA NA 13.11 13.44 2.85 090 

21146 .... ............ A ........ Reconstruct midface, lefort ................. 24.54 NA NA 9.15 12.24 3.10 090 

21147 .... ............ A ........ Reconstruct midface, lefort ................. 26.14 NA NA 15.48 14.98 1.85 090 

21150 .... ............ A ........ Reconstruct midface, lefort ................. 25.78 NA NA 16.97 16.21 2.56 090 

21151 .... ............ A ........ Reconstruct midface, lefort ................. 28.84 NA NA 11.56 17.26 2.31 090 

21154 .... ............ A ........ Reconstruct midface, lefort ................. 31.05 NA NA 18.20 21.26 2.49 090 

21155 .... ............ A ........ Reconstruct midface, lefort ................. 34.98 NA NA 18.27 20.25 6.66 090 

21159 .... ............ A ........ Reconstruct midface, lefort ................. 42.90 NA NA 15.08 22.09 8.20 090 

21160 .... ............ A ........ Reconstruct midface, lefort ................. 46.95 NA NA 23.29 25.52 4.14 090 

21172 .... ............ A ........ Reconstruct orbit/forehead ................. 28.07 NA NA 13.87 13.81 3.56 090 

21175 .... ............ A ........ Reconstruct orbit/forehead ................. 33.43 NA NA 13.63 15.64 4.84 090 

21179 .... ............ A ........ Reconstruct entire forehead ............... 22.53 NA NA 11.33 12.70 2.81 090 

21180 .... ............ A ........ Reconstruct entire forehead ............... 25.46 NA NA 13.14 14.20 3.49 090 

21181 .... ............ A ........ Contour cranial bone lesion ............... 10.18 NA NA 6.85 7.20 1.32 090 

21182 .... ............ A ........ Reconstruct cranial bone .................... 32.45 NA NA 15.45 17.10 2.81 090 

21183 .... ............ A ........ Reconstruct cranial bone .................... 35.57 NA NA 19.33 19.46 4.48 090 

21184 .... ............ A ........ Reconstruct cranial bone .................... 38.49 NA NA 15.78 19.80 5.72 090 

21188 .... ............ A ........ Reconstruction of midface .................. 22.97 NA NA 15.69 17.16 1.70 090 

21193 .... ............ A ........ Reconst lwr jaw w/o graft ................... 18.65 NA NA 9.92 11.29 2.24 090 

21194 .... ............ A ........ Reconst lwr jaw w/graft ...................... 21.54 NA NA 12.22 12.86 2.03 090 

21195 .... ............ A ........ Reconst lwr jaw w/o fixation ............... 18.88 NA NA 13.15 14.04 1.64 090 

21196 .... ............ A ........ Reconst lwr jaw w/fixation .................. 20.55 NA NA 14.03 14.76 2.08 090 

21198 .... ............ A ........ Reconstr lwr jaw segment .................. 15.48 NA NA 11.92 12.19 1.44 090 

21199 .... ............ A ........ Reconstr lwr jaw w/advance ............... 16.62 NA NA 7.63 8.26 1.39 090 

21206 .... ............ A ........ Reconstruct upper jaw bone .............. 15.36 NA NA 10.92 11.83 1.33 090 

21208 .... ............ A ........ Augmentation of facial bones ............. 11.15 33.03 27.58 8.06 8.78 1.09 090 

21209 .... ............ A ........ Reduction of facial bones ................... 7.58 12.17 11.52 7.41 7.76 0.90 090 

21210 .... ............ A ........ Face bone graft .................................. 11.40 43.32 34.16 7.68 8.54 1.30 090 

21215 .... ............ A ........ Lower jaw bone graft .......................... 11.94 85.72 63.87 8.02 8.71 1.53 090 

21230 .... ............ A ........ Rib cartilage graft ............................... 11.06 NA NA 7.00 7.51 1.29 090 

21235 .... ............ A ........ Ear cartilage graft ............................... 7.31 10.10 9.93 6.20 6.28 0.61 090 

21240 .... ............ A ........ Reconstruction of jaw joint ................. 15.77 NA NA 9.55 10.82 2.25 090 

21242 .... ............ A ........ Reconstruction of jaw joint ................. 14.32 NA NA 9.13 10.29 1.79 090 

21243 .... ............ A ........ Reconstruction of jaw joint ................. 24.03 NA NA 14.33 15.86 3.26 090 

21244 .... ............ A ........ Reconstruction of lower jaw ............... 13.35 NA NA 11.55 11.74 1.25 090 

21245 .... ............ A ........ Reconstruction of jaw ......................... 12.88 14.20 14.18 8.65 9.16 1.19 090 

21246 .... ............ A ........ Reconstruction of jaw ......................... 12.78 NA NA 7.48 8.15 1.35 090 

21247 .... ............ A ........ Reconstruct lower jaw bone ............... 24.05 NA NA 12.79 14.96 2.84 090 

21248 .... ............ A ........ Reconstruction of jaw ......................... 12.54 12.62 12.38 7.57 8.49 1.55 090 

21249 .... ............ A ........ Reconstruction of jaw ......................... 18.57 15.81 16.34 9.72 11.27 2.49 090 

21255 .... ............ A ........ Reconstruct lower jaw bone ............... 18.14 NA NA 13.78 14.91 2.39 090 

21256 .... ............ A ........ Reconstruction of orbit ....................... 17.42 NA NA 9.68 10.80 1.50 090 

21260 .... ............ A ........ Revise eye sockets ............................ 17.74 NA NA 12.98 12.27 0.97 090 

21261 .... ............ A ........ Revise eye sockets ............................ 33.78 NA NA 14.67 19.46 3.43 090 

21263 .... ............ A ........ Revise eye sockets ............................ 30.72 NA NA 13.97 16.52 2.63 090 

21267 .... ............ A ........ Revise eye sockets ............................ 20.45 NA NA 16.17 18.00 1.71 090 

21268 .... ............ A ........ Revise eye sockets ............................ 26.78 NA NA 13.06 17.13 3.66 090 

21270 .... ............ A ........ Augmentation, cheek bone ................. 10.52 11.19 11.43 5.96 6.61 0.72 090 

21275 .... ............ A ........ Revision, orbitofacial bones ............... 11.65 NA NA 7.19 7.74 1.29 090 

21280 .... ............ A ........ Revision of eyelid ............................... 6.92 NA NA 5.68 5.84 0.42 090 

21282 .... ............ A ........ Revision of eyelid ............................... 4.11 NA NA 4.17 4.35 0.26 090 

21295 .... ............ A ........ Revision of jaw muscle/bone .............. 1.82 NA NA 2.22 2.44 0.16 090 

21296 .... ............ A ........ Revision of jaw muscle/bone .............. 4.67 NA NA 4.12 4.75 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 1.97 2.12 0.11 0.13 0.05 000 

21315 .... ............ A ........ Treatment of nose fracture ................. 1.78 4.68 4.42 1.77 1.81 0.14 010 

21320 .... ............ A ........ Treatment of nose fracture ................. 1.86 4.27 4.06 1.36 1.47 0.18 010 

21325 .... ............ A ........ Treatment of nose fracture ................. 4.07 NA NA 6.91 7.74 0.31 090 

21330 .... ............ A ........ Treatment of nose fracture ................. 5.68 NA NA 7.59 8.64 0.56 090 

mstockstill on PROD1PC66 with PROPOSALS2

38244 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

21335 .... ............ A ........ Treatment of nose fracture ................. 8.91 NA NA 8.47 8.94 0.74 090 

21336 .... ............ A ........ Treat nasal septal fracture ................. 6.56 NA NA 8.64 9.06 0.55 090 

21337 .... ............ A ........ Treat nasal septal fracture ................. 3.26 6.11 6.08 3.54 3.53 0.28 090 

21338 .... ............ A ........ Treat nasoethmoid fracture ................ 6.76 NA NA 9.89 11.93 0.82 090 

21339 .... ............ A ........ Treat nasoethmoid fracture ................ 8.39 NA NA 9.78 12.01 0.96 090 

21340 .... ............ A ........ Treatment of nose fracture ................. 11.33 NA NA 7.28 7.83 1.15 090 

21343 .... ............ A ........ Treatment of sinus fracture ................ 14.11 NA NA 12.76 14.10 1.47 090 

21344 .... ............ A ........ Treatment of sinus fracture ................ 21.36 NA NA 13.12 14.85 2.44 090 

21345 .... ............ A ........ Treat nose/jaw fracture ....................... 8.87 10.33 9.99 6.48 6.76 0.92 090 

21346 .... ............ A ........ Treat nose/jaw fracture ....................... 11.29 NA NA 10.85 11.53 1.21 090 

21347 .... ............ A ........ Treat nose/jaw fracture ....................... 13.37 NA NA 11.79 13.98 1.47 090 

21348 .... ............ A ........ Treat nose/jaw fracture ....................... 17.36 NA NA 11.03 10.28 2.49 090 

21355 .... ............ A ........ Treat cheek bone fracture .................. 4.32 5.89 6.02 3.25 3.33 0.34 010 

21356 .... ............ A ........ Treat cheek bone fracture .................. 4.70 6.96 7.02 4.07 4.30 0.46 010 

21360 .... ............ A ........ Treat cheek bone fracture .................. 7.03 NA NA 5.41 5.66 0.74 090 

21365 .... ............ A ........ Treat cheek bone fracture .................. 16.52 NA NA 9.16 9.99 1.70 090 

21366 .... ............ A ........ Treat cheek bone fracture .................. 18.44 NA NA 10.42 10.88 2.50 090 

21385 .... ............ A ........ Treat eye socket fracture ................... 9.46 NA NA 7.13 7.68 0.97 090 

21386 .... ............ A ........ Treat eye socket fracture ................... 9.46 NA NA 6.05 6.53 0.97 090 

21387 .... ............ A ........ Treat eye socket fracture ................... 10.00 NA NA 7.47 8.20 1.08 090 

21390 .... ............ A ........ Treat eye socket fracture ................... 11.07 NA NA 7.05 7.44 0.90 090 

21395 .... ............ A ........ Treat eye socket fracture ................... 14.62 NA NA 8.33 8.62 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 7.54 3.06 3.29 0.38 090 

21406 .... ............ A ........ Treat eye socket fracture ................... 7.31 NA NA 5.34 5.68 0.73 090 

21407 .... ............ A ........ Treat eye socket fracture ................... 8.91 NA NA 5.94 6.41 0.94 090 

21408 .... ............ A ........ Treat eye socket fracture ................... 12.67 NA NA 7.42 8.26 1.44 090 

21421 .... ............ A ........ Treat mouth roof fracture ................... 5.80 12.43 10.83 9.20 8.73 0.73 090 

21422 .... ............ A ........ Treat mouth roof fracture ................... 8.62 NA NA 7.05 7.54 0.99 090 

21423 .... ............ A ........ Treat mouth roof fracture ................... 10.71 NA NA 7.43 8.37 1.27 090 

21431 .... ............ A ........ Treat craniofacial fracture ................... 7.74 NA NA 10.80 9.93 0.70 090 

21432 .... ............ A ........ Treat craniofacial fracture ................... 8.76 NA NA 6.83 7.52 0.81 090 

21433 .... ............ A ........ Treat craniofacial fracture ................... 26.13 NA NA 12.30 14.39 2.79 090 

21435 .... ............ A ........ Treat craniofacial fracture ................... 20.02 NA NA 11.15 11.86 1.99 090 

21436 .... ............ A ........ Treat craniofacial fracture ................... 30.01 NA NA 13.27 15.94 3.10 090 

21440 .... ............ A ........ Treat dental ridge fracture .................. 3.28 10.03 8.61 7.43 6.83 0.38 090 

21445 .... ............ A ........ Treat dental ridge fracture .................. 6.04 12.27 11.05 8.47 8.45 0.78 090 

21450 .... ............ A ........ Treat lower jaw fracture ...................... 3.55 10.48 8.91 7.70 7.28 0.33 090 

21451 .... ............ A ........ Treat lower jaw fracture ...................... 5.46 12.94 11.15 9.66 9.03 0.63 090 

21452 .... ............ A ........ Treat lower jaw fracture ...................... 2.29 11.86 12.42 5.97 5.28 0.27 090 

21453 .... ............ A ........ Treat lower jaw fracture ...................... 6.40 14.78 12.76 11.65 11.19 0.74 090 

21454 .... ............ A ........ Treat lower jaw fracture ...................... 7.17 NA NA 5.77 6.02 0.82 090 

21461 .... ............ A ........ Treat lower jaw fracture ...................... 9.07 41.49 32.92 12.79 12.70 0.98 090 

21462 .... ............ A ........ Treat lower jaw fracture ...................... 10.77 42.89 35.16 13.44 13.05 1.27 090 

21465 .... ............ A ........ Treat lower jaw fracture ...................... 12.88 NA NA 8.18 9.03 1.50 090 

21470 .... ............ A ........ Treat lower jaw fracture ...................... 17.24 NA NA 10.25 11.14 1.97 090 

21480 .... ............ A ........ Reset dislocated jaw .......................... 0.61 1.50 1.63 0.18 0.19 0.06 000 

21485 .... ............ A ........ Reset dislocated jaw .......................... 4.58 12.06 10.16 9.09 8.39 0.51 090 

21490 .... ............ A ........ Repair dislocated jaw ......................... 12.71 NA NA 8.23 8.92 1.97 090 

21495 .... ............ A ........ Treat hyoid bone fracture ................... 6.55 NA NA 10.43 9.30 0.46 090 

21497 .... ............ A ........ Interdental wiring ................................ 4.45 12.20 10.29 9.34 8.47 0.50 090 

21499 .... ............ C ........ Head surgery procedure ..................... 0.00 0.00 1.58 0.00 0.17 0.00 YYY 

21501 .... ............ A ........ Drain neck/chest lesion ...................... 3.87 6.51 6.44 3.50 3.65 0.43 090 

21502 .... ............ A ........ Drain chest lesion ............................... 7.43 NA NA 4.55 5.13 0.97 090 

21510 .... ............ A ........ Drainage of bone lesion ..................... 6.06 NA NA 4.77 5.21 0.80 090 

21550 .... ............ A ........ Biopsy of neck/chest .......................... 2.08 4.33 3.94 1.79 1.74 0.16 010 

21555 .... ............ A ........ Remove lesion, neck/chest ................ 4.40 5.74 5.63 3.42 3.31 0.56 090 

21556 .... ............ A ........ Remove lesion, neck/chest ................ 5.63 NA NA 4.12 4.09 0.65 090 

21557 .... ............ A ........ Remove tumor, neck/chest ................. 8.91 NA NA 4.51 4.92 1.08 090 

21600 .... ............ A ........ Partial removal of rib .......................... 7.14 NA NA 5.92 5.81 0.99 090 

21610 .... ............ A ........ Partial removal of rib .......................... 15.76 NA NA 8.90 8.77 3.08 090 

21615 .... ............ A ........ Removal of rib .................................... 10.31 NA NA 5.17 5.98 1.45 090 

21616 .... ............ A ........ Removal of rib and nerves ................. 12.54 NA NA 6.48 7.36 1.87 090 

21620 .... ............ A ........ Partial removal of sternum ................. 7.16 NA NA 4.75 5.38 0.98 090 

21627 .... ............ A ........ Sternal debridement ........................... 7.18 NA NA 5.51 5.93 1.02 090 

21630 .... ............ A ........ Extensive sternum surgery ................. 19.01 NA NA 10.35 11.16 2.59 090 

21632 .... ............ A ........ Extensive sternum surgery ................. 19.51 NA NA 9.28 10.25 2.66 090 

21685 .... ............ A ........ Hyoid myotomy & suspension ............ 14.89 NA NA 8.80 9.25 1.06 090 

21700 .... ............ A ........ Revision of neck muscle .................... 6.23 NA NA 4.41 4.36 0.32 090 

21705 .... ............ A ........ Revision of neck muscle/rib ............... 9.83 NA NA 4.35 5.02 1.43 090 

21720 .... ............ A ........ Revision of neck muscle .................... 5.72 NA NA 4.02 3.30 0.91 090 

21725 .... ............ A ........ Revision of neck muscle .................... 7.10 NA NA 5.14 5.20 1.21 090 

mstockstill on PROD1PC66 with PROPOSALS2

38245 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

21740 .... ............ A ........ Reconstruction of sternum ................. 17.47 NA NA 8.04 8.41 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 5.30 5.73 1.63 090 

21800 .... ............ A ........ Treatment of rib fracture ..................... 0.98 1.35 1.34 1.41 1.36 0.09 090 

21805 .... ............ A ........ Treatment of rib fracture ..................... 2.80 NA NA 3.27 3.28 0.38 090 

21810 .... ............ A ........ Treatment of rib fracture(s) ................ 6.92 NA NA 5.34 5.13 0.94 090 

21820 .... ............ A ........ Treat sternum fracture ........................ 1.31 1.81 1.82 1.88 1.81 0.16 090 

21825 .... ............ A ........ Treat sternum fracture ........................ 7.65 NA NA 5.35 5.89 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 4.42 3.85 1.89 1.68 0.14 010 

21925 .... ............ A ........ Biopsy soft tissue of back .................. 4.54 5.30 5.26 3.34 3.31 0.60 090 

21930 .... ............ A ........ Remove lesion, back or flank ............. 5.06 6.00 5.86 3.75 3.58 0.66 090 

21935 .... ............ A ........ Remove tumor, back .......................... 18.38 NA NA 8.45 9.06 2.48 090 

22010 .... ............ A ........ I&d, p-spine, c/t/cerv-thor ................... 12.57 NA NA 8.35 8.54 1.74 090 

22015 .... ............ A ........ I&d, p-spine, l/s/ls ............................... 12.46 NA NA 8.35 8.50 1.72 090 

22100 .... ............ A ........ Remove part of neck vertebra ............ 10.80 NA NA 8.20 7.85 2.14 090 

22101 .... ............ A ........ Remove part, thorax vertebra ............ 10.88 NA NA 8.10 7.91 1.91 090 

22102 .... ............ A ........ Remove part, lumbar vertebra ........... 10.88 NA NA 7.96 7.92 1.88 090 

22103 .... ............ A ........ Remove extra spine segment ............ 2.34 NA NA 0.91 1.06 0.44 ZZZ 

22110 .... ............ A ........ Remove part of neck vertebra ............ 13.80 NA NA 9.12 9.15 2.77 090 

22112 .... ............ A ........ Remove part, thorax vertebra ............ 13.87 NA NA 9.03 9.15 2.53 090 

22114 .... ............ A ........ Remove part, lumbar vertebra ........... 13.87 NA NA 8.99 9.14 2.64 090 

22116 .... ............ A ........ Remove extra spine segment ............ 2.32 NA NA 0.90 1.03 0.50 ZZZ 

22210 .... ............ A ........ Revision of neck spine ....................... 25.13 NA NA 14.61 15.05 5.46 090 

22212 .... ............ A ........ Revision of thorax spine ..................... 20.74 NA NA 12.48 12.89 3.91 090 

22214 .... ............ A ........ Revision of lumbar spine .................... 20.77 NA NA 12.58 13.21 3.92 090 

22216 .... ............ A ........ Revise, extra spine segment .............. 6.03 NA NA 2.35 2.75 1.29 ZZZ 

22220 .... ............ A ........ Revision of neck spine ....................... 22.69 NA NA 13.42 13.55 5.08 090 

22222 .... ............ A ........ Revision of thorax spine ..................... 22.84 NA NA 10.60 11.15 4.13 090 

22224 .... ............ A ........ Revision of lumbar spine .................... 22.84 NA NA 12.98 13.65 4.19 090 

22226 .... ............ A ........ Revise, extra spine segment .............. 6.03 NA NA 2.30 2.67 1.29 ZZZ 

22305 .... ............ A ........ Treat spine process fracture .............. 2.08 2.14 2.23 1.80 1.86 0.39 090 

22310 .... ............ A ........ Treat spine fracture ............................ 3.69 2.98 2.89 2.50 2.43 0.50 090 

22315 .... ............ A ........ Treat spine fracture ............................ 9.91 9.88 9.77 7.45 7.39 1.86 090 

22318 .... ............ A ........ Treat odontoid fx w/o graft ................. 22.54 NA NA 13.35 13.38 5.30 090 

22319 .... ............ A ........ Treat odontoid fx w/graft .................... 25.15 NA NA 13.54 14.23 6.05 090 

22325 .... ............ A ........ Treat spine fracture ............................ 19.62 NA NA 12.18 12.11 3.88 090 

22326 .... ............ A ........ Treat neck spine fracture ................... 20.64 NA NA 12.11 12.43 4.43 090 

22327 .... ............ A ........ Treat thorax spine fracture ................. 20.52 NA NA 12.38 12.37 3.99 090 

22328 .... ............ A ........ Treat each add spine fx ..................... 4.60 NA NA 1.78 2.03 0.94 ZZZ 

22505 .... ............ A ........ Manipulation of spine ......................... 1.87 NA NA 1.11 1.02 0.36 010 

22520 .... ............ A ........ Percut vertebroplasty thor .................. 9.17 43.46 52.37 4.61 4.76 1.72 010 

22521 .... ............ A ........ Percut vertebroplasty lumb ................. 8.60 44.62 50.12 4.38 4.59 1.60 010 

22522 .... ............ A ........ Percut vertebroplasty add l ............... 4.30 NA NA 1.52 1.57 0.82 ZZZ 

22523 .... ............ A ........ Percut kyphoplasty, thor ..................... 9.21 NA NA 4.70 5.30 1.72 010 

22524 .... ............ A ........ Percut kyphoplasty, lumbar ................ 8.81 NA NA 4.55 5.12 1.60 010 

22525 .... ............ A ........ Percut kyphoplasty, add-on ................ 4.47 NA NA 1.71 1.98 0.82 ZZZ 

22526 .... ............ A ........ Idet, single level .................................. 6.07 46.11 46.38 2.04 2.07 1.16 010 

22527 .... ............ A ........ Idet, 1 or more levels ......................... 3.03 39.85 39.88 0.70 0.70 0.58 ZZZ 

22532 .... ............ A ........ Lat thorax spine fusion ....................... 25.81 NA NA 13.50 14.23 4.35 090 

22533 .... ............ A ........ Lat lumbar spine fusion ...................... 24.61 NA NA 13.63 13.59 3.16 090 

22534 .... ............ A ........ Lat thor/lumb, addœl seg .................... 5.99 NA NA 2.30 2.67 1.25 ZZZ 

22548 .... ............ A ........ Neck spine fusion ............................... 26.86 NA NA 15.03 15.46 5.61 090 

22554 .... ............ A ........ Neck spine fusion ............................... 17.54 NA NA 10.70 11.55 4.46 090 

22556 .... ............ A ........ Thorax spine fusion ............................ 24.50 NA NA 13.03 13.90 4.35 090 

22558 .... ............ A ........ Lumbar spine fusion ........................... 23.33 NA NA 11.47 12.40 3.16 090 

22585 .... ............ A ........ Additional spinal fusion ....................... 5.52 NA NA 2.08 2.44 1.25 ZZZ 

22590 .... ............ A ........ Spine & skull spinal fusion ................. 21.56 NA NA 13.16 13.25 4.79 090 

22595 .... ............ A ........ Neck spinal fusion .............................. 20.44 NA NA 12.73 12.78 4.41 090 

22600 .... ............ A ........ Neck spine fusion ............................... 17.20 NA NA 11.24 11.24 3.73 090 

22610 .... ............ A ........ Thorax spine fusion ............................ 17.08 NA NA 10.86 11.15 3.53 090 

22612 .... ............ A ........ Lumbar spine fusion ........................... 23.38 NA NA 12.56 13.41 4.47 090 

22614 .... ............ A ........ Spine fusion, extra segment ............... 6.43 NA NA 2.48 2.93 1.38 ZZZ 

22630 .... ............ A ........ Lumbar spine fusion ........................... 21.89 NA NA 12.60 13.13 4.73 090 

22632 .... ............ A ........ Spine fusion, extra segment ............... 5.22 NA NA 2.01 2.34 1.16 ZZZ 

22800 .... ............ A ........ Fusion of spine ................................... 19.30 NA NA 11.19 11.98 3.76 090 

22802 .... ............ A ........ Fusion of spine ................................... 31.91 NA NA 16.07 17.86 6.17 090 

22804 .... ............ A ........ Fusion of spine ................................... 37.30 NA NA 18.23 20.48 7.00 090 

22808 .... ............ A ........ Fusion of spine ................................... 27.31 NA NA 14.12 15.18 4.93 090 

22810 .... ............ A ........ Fusion of spine ................................... 31.30 NA NA 15.01 16.68 5.15 090 

22812 .... ............ A ........ Fusion of spine ................................... 34.00 NA NA 17.46 18.67 5.30 090 

mstockstill on PROD1PC66 with PROPOSALS2

38246 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

22818 .... ............ A ........ Kyphectomy, 1–2 segments ............... 34.18 NA NA 16.71 17.80 6.47 090 

22819 .... ............ A ........ Kyphectomy, 3 or more ...................... 39.18 NA NA 18.99 19.62 7.67 090 

22830 .... ............ A ........ Exploration of spinal fusion ................ 11.13 NA NA 7.08 7.53 2.30 090 

22840 .... ............ A ........ Insert spine fixation device ................. 12.52 NA NA 4.83 5.68 2.79 ZZZ 

22842 .... ............ A ........ Insert spine fixation device ................. 12.56 NA NA 4.85 5.69 2.75 ZZZ 

22843 .... ............ A ........ Insert spine fixation device ................. 13.44 NA NA 5.21 5.92 2.86 ZZZ 

22844 .... ............ A ........ Insert spine fixation device ................. 16.42 NA NA 6.47 7.62 3.19 ZZZ 

22845 .... ............ A ........ Insert spine fixation device ................. 11.94 NA NA 4.54 5.32 2.86 ZZZ 

22846 .... ............ A ........ Insert spine fixation device ................. 12.40 NA NA 4.72 5.54 2.96 ZZZ 

22847 .... ............ A ........ Insert spine fixation device ................. 13.78 NA NA 5.26 6.17 3.00 ZZZ 

22848 .... ............ A ........ Insert pelv fixation device ................... 5.99 NA NA 2.36 2.77 1.15 ZZZ 

22849 .... ............ A ........ Reinsert spinal fixation ....................... 19.08 NA NA 10.22 11.00 3.90 090 

22850 .... ............ A ........ Remove spine fixation device ............ 9.74 NA NA 6.43 6.73 2.05 090 

22851 .... ............ A ........ Apply spine prosth device .................. 6.70 NA NA 2.57 2.98 1.49 ZZZ 

22852 .... ............ A ........ Remove spine fixation device ............ 9.29 NA NA 6.19 6.50 1.90 090 

22855 .... ............ A ........ Remove spine fixation device ............ 15.77 NA NA 9.23 9.47 3.52 090 

22857 .... ............ R ........ Lumbar artif diskectomy ..................... 26.93 NA NA 16.22 11.27 3.56 090 

22862 .... ............ R ........ Revise lumbar artif disc ...................... 32.43 NA NA 10.05 10.06 5.36 090 

22865 .... ............ R ........ Remove lumb artif disc ....................... 31.55 NA NA 9.85 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 3.51 3.37 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 7.83 8.17 3.72 4.07 0.68 090 

23020 .... ............ A ........ Release shoulder joint ........................ 9.24 NA NA 6.48 7.03 1.54 090 

23030 .... ............ A ........ Drain shoulder lesion .......................... 3.44 6.24 6.82 2.40 2.65 0.57 010 

23031 .... ............ A ........ Drain shoulder bursa .......................... 2.76 6.46 7.16 2.21 2.47 0.46 010 

23035 .... ............ A ........ Drain shoulder bone lesion ................ 9.04 NA NA 7.02 7.65 1.47 090 

23040 .... ............ A ........ Exploratory shoulder surgery ............. 9.63 NA NA 6.74 7.31 1.60 090 

23044 .... ............ A ........ Exploratory shoulder surgery ............. 7.48 NA NA 5.51 5.98 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 7.69 7.67 3.59 3.78 0.63 090 

23075 .... ............ A ........ Removal of shoulder lesion ................ 2.41 3.67 3.67 1.71 1.75 0.34 010 

23076 .... ............ A ........ Removal of shoulder lesion ................ 7.77 NA NA 5.30 5.43 1.13 090 

23077 .... ............ A ........ Remove tumor of shoulder ................. 18.08 NA NA 9.61 9.95 2.34 090 

23100 .... ............ A ........ Biopsy of shoulder joint ...................... 6.09 NA NA 4.98 5.35 1.04 090 

23101 .... ............ A ........ Shoulder joint surgery ........................ 5.63 NA NA 4.52 4.93 0.96 090 

23105 .... ............ A ........ Remove shoulder joint lining .............. 8.36 NA NA 6.09 6.62 1.42 090 

23106 .... ............ A ........ Incision of collarbone joint .................. 6.02 NA NA 4.77 5.21 0.99 090 

23107 .... ............ A ........ Explore treat shoulder joint ................ 8.75 NA NA 6.25 6.83 1.49 090 

23120 .... ............ A ........ Partial removal, collar bone ................ 7.23 NA NA 5.46 5.97 1.23 090 

23125 .... ............ A ........ Removal of collar bone ...................... 9.52 NA NA 6.38 6.97 1.62 090 

23130 .... ............ A ........ Remove shoulder bone, part .............. 7.63 NA NA 6.07 6.61 1.30 090 

23140 .... ............ A ........ Removal of bone lesion ...................... 7.01 NA NA 4.88 5.04 1.08 090 

23145 .... ............ A ........ Removal of bone lesion ...................... 9.28 NA NA 6.49 6.86 1.49 090 

23146 .... ............ A ........ Removal of bone lesion ...................... 7.96 NA NA 5.90 6.52 1.35 090 

23150 .... ............ A ........ Removal of humerus lesion ................ 8.79 NA NA 6.25 6.56 1.32 090 

23155 .... ............ A ........ Removal of humerus lesion ................ 10.72 NA NA 7.25 7.81 1.81 090 

23156 .... ............ A ........ Removal of humerus lesion ................ 8.99 NA NA 6.29 6.86 1.50 090 

23170 .... ............ A ........ Remove collar bone lesion ................. 7.10 NA NA 4.99 5.52 1.12 090 

23172 .... ............ A ........ Remove shoulder blade lesion ........... 7.20 NA NA 5.51 5.82 1.01 090 

23174 .... ............ A ........ Remove humerus lesion ..................... 9.90 NA NA 7.16 7.79 1.65 090 

23180 .... ............ A ........ Remove collar bone lesion ................. 8.85 NA NA 7.00 8.01 1.47 090 

23182 .... ............ A ........ Remove shoulder blade lesion ........... 8.47 NA NA 6.97 7.75 1.37 090 

23184 .... ............ A ........ Remove humerus lesion ..................... 9.76 NA NA 7.49 8.41 1.63 090 

23190 .... ............ A ........ Partial removal of scapula .................. 7.36 NA NA 5.30 5.76 1.17 090 

23195 .... ............ A ........ Removal of head of humerus ............. 10.24 NA NA 6.91 7.30 1.71 090 

23200 .... ............ A ........ Removal of collar bone ...................... 12.69 NA NA 7.09 7.98 1.94 090 

23210 .... ............ A ........ Removal of shoulder blade ................ 13.16 NA NA 7.82 8.48 2.03 090 

23220 .... ............ A ........ Partial removal of humerus ................ 15.36 NA NA 9.15 9.98 2.49 090 

23221 .... ............ A ........ Partial removal of humerus ................ 18.41 NA NA 10.64 10.51 3.06 090 

23222 .... ............ A ........ Partial removal of humerus ................ 25.44 NA NA 13.39 14.63 3.95 090 

23330 .... ............ A ........ Remove shoulder foreign body .......... 1.87 3.32 3.51 1.50 1.70 0.24 010 

23331 .... ............ A ........ Remove shoulder foreign body .......... 7.51 NA NA 5.82 6.32 1.27 090 

23332 .... ............ A ........ Remove shoulder foreign body .......... 12.23 NA NA 7.96 8.66 2.03 090 

23350 .... ............ A ........ Injection for shoulder x-ray ................. 1.00 2.71 3.06 0.36 0.33 0.06 000 

23395 .... ............ A ........ Muscle transfer,shoulder/arm ............. 18.29 NA NA 11.21 12.06 2.94 090 

23397 .... ............ A ........ Muscle transfers ................................. 16.62 NA NA 9.55 10.50 2.74 090 

23400 .... ............ A ........ Fixation of shoulder blade .................. 13.73 NA NA 8.55 9.32 2.30 090 

23405 .... ............ A ........ Incision of tendon & muscle ............... 8.43 NA NA 5.92 6.43 1.45 090 

23406 .... ............ A ........ Incise tendon(s) & muscle(s) .............. 10.90 NA NA 6.91 7.64 1.88 090 

23410 .... ............ A ........ Repair rotator cuff, acute .................... 12.63 NA NA 7.79 8.61 2.17 090 

23412 .... ............ A ........ Repair rotator cuff, chronic ................. 13.55 NA NA 8.17 9.05 2.32 090 

mstockstill on PROD1PC66 with PROPOSALS2

38247 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

23415 .... ............ A ........ Release of shoulder ligament ............. 10.09 NA NA 6.59 7.30 1.74 090 

23420 .... ............ A ........ Repair of shoulder .............................. 14.75 NA NA 9.71 10.30 2.32 090 

23430 .... ............ A ........ Repair biceps tendon ......................... 10.05 NA NA 6.78 7.45 1.74 090 

23440 .... ............ A ........ Remove/transplant tendon ................. 10.53 NA NA 6.78 7.53 1.83 090 

23450 .... ............ A ........ Repair shoulder capsule ..................... 13.58 NA NA 8.19 9.02 2.33 090 

23455 .... ............ A ........ Repair shoulder capsule ..................... 14.55 NA NA 8.57 9.52 2.50 090 

23460 .... ............ A ........ Repair shoulder capsule ..................... 15.68 NA NA 9.37 10.38 2.67 090 

23462 .... ............ A ........ Repair shoulder capsule ..................... 15.60 NA NA 9.09 9.93 2.60 090 

23465 .... ............ A ........ Repair shoulder capsule ..................... 16.16 NA NA 9.52 10.37 2.77 090 

23466 .... ............ A ........ Repair shoulder capsule ..................... 15.55 NA NA 10.00 10.71 2.47 090 

23470 .... ............ A ........ Reconstruct shoulder joint .................. 17.75 NA NA 10.14 11.21 2.99 090 

23472 .... ............ A ........ Reconstruct shoulder joint .................. 22.47 NA NA 12.17 13.32 3.67 090 

23480 .... ............ A ........ Revision of collar bone ....................... 11.42 NA NA 7.29 8.05 1.95 090 

23485 .... ............ A ........ Revision of collar bone ....................... 13.79 NA NA 8.21 9.08 2.34 090 

23490 .... ............ A ........ Reinforce clavicle ............................... 12.04 NA NA 6.77 7.70 1.47 090 

23491 .... ............ A ........ Reinforce shoulder bones .................. 14.40 NA NA 8.73 9.76 2.47 090 

23500 .... ............ A ........ Treat clavicle fracture ......................... 2.13 2.63 2.75 2.70 2.60 0.30 090 

23505 .... ............ A ........ Treat clavicle fracture ......................... 3.74 3.99 4.20 3.60 3.73 0.61 090 

23515 .... ............ A ........ Treat clavicle fracture ......................... 7.47 NA NA 5.56 6.07 1.28 090 

23520 .... ............ A ........ Treat clavicle dislocation .................... 2.21 2.75 2.78 2.82 2.75 0.34 090 

23525 .... ............ A ........ Treat clavicle dislocation .................... 3.67 4.15 4.40 3.63 3.84 0.46 090 

23530 .... ............ A ........ Treat clavicle dislocation .................... 7.37 NA NA 5.31 5.62 1.20 090 

23532 .... ............ A ........ Treat clavicle dislocation .................... 8.08 NA NA 6.01 6.50 1.38 090 

23540 .... ............ A ........ Treat clavicle dislocation .................... 2.28 2.65 2.75 2.72 2.53 0.29 090 

23545 .... ............ A ........ Treat clavicle dislocation .................... 3.32 3.72 3.96 3.24 3.31 0.35 090 

23550 .... ............ A ........ Treat clavicle dislocation .................... 7.48 NA NA 5.53 5.95 1.25 090 

23552 .... ............ A ........ Treat clavicle dislocation .................... 8.70 NA NA 6.25 6.79 1.46 090 

23570 .... ............ A ........ Treat shoulder blade fx ...................... 2.28 2.77 2.90 2.91 2.88 0.36 090 

23575 .... ............ A ........ Treat shoulder blade fx ...................... 4.12 4.57 4.69 4.07 4.16 0.59 090 

23585 .... ............ A ........ Treat scapula fracture ........................ 9.15 NA NA 6.49 7.08 1.54 090 

23600 .... ............ A ........ Treat humerus fracture ....................... 3.00 4.05 4.30 3.63 3.60 0.48 090 

23605 .... ............ A ........ Treat humerus fracture ....................... 4.94 5.36 5.77 4.58 4.85 0.84 090 

23615 .... ............ A ........ Treat humerus fracture ....................... 10.93 NA NA 8.27 8.56 1.62 090 

23616 .... ............ A ........ Treat humerus fracture ....................... 21.68 NA NA 11.47 12.83 3.70 090 

23620 .... ............ A ........ Treat humerus fracture ....................... 2.46 3.39 3.50 3.13 3.06 0.40 090 

23625 .... ............ A ........ Treat humerus fracture ....................... 3.99 4.43 4.69 3.90 4.09 0.67 090 

23630 .... ............ A ........ Treat humerus fracture ....................... 7.47 NA NA 5.64 6.15 1.27 090 

23650 .... ............ A ........ Treat shoulder dislocation .................. 3.44 3.26 3.52 2.80 2.78 0.30 090 

23655 .... ............ A ........ Treat shoulder dislocation .................. 4.64 NA NA 4.13 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 4.83 5.08 4.25 4.49 0.71 090 

23670 .... ............ A ........ Treat dislocation/fracture .................... 8.02 NA NA 5.89 6.36 1.36 090 

23675 .... ............ A ........ Treat dislocation/fracture .................... 6.13 6.10 6.47 5.11 5.48 1.01 090 

23680 .... ............ A ........ Treat dislocation/fracture .................... 10.30 NA NA 6.92 7.53 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 8.75 9.40 2.36 090 

23802 .... ............ A ........ Fusion of shoulder joint ...................... 18.17 NA NA 11.21 10.67 2.71 090 

23900 .... ............ A ........ Amputation of arm & girdle ................ 20.57 NA NA 10.44 11.13 3.19 090 

23920 .... ............ A ........ Amputation at shoulder joint ............... 16.03 NA NA 9.14 9.61 2.47 090 

23921 .... ............ A ........ Amputation follow-up surgery ............. 5.61 NA NA 4.84 4.97 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 4.93 5.63 1.97 2.14 0.43 010 

23931 .... ............ A ........ Drainage of arm bursa ....................... 1.81 4.32 5.11 1.75 1.96 0.28 010 

23935 .... ............ A ........ Drain arm/elbow bone lesion .............. 6.27 NA NA 5.08 5.51 1.05 090 

24000 .... ............ A ........ Exploratory elbow surgery .................. 5.99 NA NA 4.74 5.09 0.97 090 

24006 .... ............ A ........ Release elbow joint ............................ 9.62 NA NA 6.58 7.19 1.50 090 

24065 .... ............ A ........ Biopsy arm/elbow soft tissue .............. 2.10 4.14 3.68 1.92 1.83 0.17 010 

24066 .... ............ A ........ Biopsy arm/elbow soft tissue .............. 5.26 8.20 8.57 3.91 4.02 0.80 090 

24075 .... ............ A ........ Remove arm/elbow lesion .................. 3.96 7.12 7.24 3.25 3.33 0.56 090 

24076 .... ............ A ........ Remove arm/elbow lesion .................. 6.36 NA NA 4.57 4.72 0.95 090 

24077 .... ............ A ........ Remove tumor of arm/elbow .............. 11.95 NA NA 6.86 7.33 1.73 090 

24100 .... ............ A ........ Biopsy elbow joint lining ..................... 4.98 NA NA 4.08 4.33 0.85 090 

24101 .... ............ A ........ Explore/treat elbow joint ..................... 6.19 NA NA 5.03 5.49 1.03 090 

24102 .... ............ A ........ Remove elbow joint lining .................. 8.15 NA NA 5.80 6.34 1.33 090 

24105 .... ............ A ........ Removal of elbow bursa ..................... 3.67 NA NA 4.01 4.20 0.61 090 

24110 .... ............ A ........ Remove humerus lesion ..................... 7.46 NA NA 5.64 6.16 1.28 090 

24115 .... ............ A ........ Remove/graft bone lesion .................. 10.00 NA NA 4.30 6.18 1.68 090 

24116 .... ............ A ........ Remove/graft bone lesion .................. 12.11 NA NA 7.69 8.38 2.06 090 

24120 .... ............ A ........ Remove elbow lesion ......................... 6.71 NA NA 5.17 5.56 1.10 090 

24125 .... ............ A ........ Remove/graft bone lesion .................. 8.02 NA NA 5.99 6.08 1.06 090 

24126 .... ............ A ........ Remove/graft bone lesion .................. 8.50 NA NA 5.99 6.55 1.16 090 

24130 .... ............ A ........ Removal of head of radius ................. 6.31 NA NA 5.12 5.57 1.04 090 

mstockstill on PROD1PC66 with PROPOSALS2

38248 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

24134 .... ............ A ........ Removal of arm bone lesion .............. 10.10 NA NA 7.46 8.17 1.64 090 

24136 .... ............ A ........ Remove radius bone lesion ................ 8.29 NA NA 5.77 6.48 1.38 090 

24138 .... ............ A ........ Remove elbow bone lesion ................ 8.33 NA NA 6.47 7.17 1.34 090 

24140 .... ............ A ........ Partial removal of arm bone ............... 9.43 NA NA 7.13 8.14 1.51 090 

24145 .... ............ A ........ Partial removal of radius .................... 7.70 NA NA 6.20 7.15 1.25 090 

24147 .... ............ A ........ Partial removal of elbow ..................... 7.69 NA NA 6.83 7.73 1.30 090 

24149 .... ............ A ........ Radical resection of elbow ................. 15.92 NA NA 10.74 11.21 2.35 090 

24150 .... ............ A ........ Extensive humerus surgery ................ 13.70 NA NA 8.50 9.26 2.33 090 

24151 .... ............ A ........ Extensive humerus surgery ................ 16.08 NA NA 9.71 10.63 2.60 090 

24152 .... ............ A ........ Extensive radius surgery .................... 10.24 NA NA 6.19 6.99 1.48 090 

24153 .... ............ A ........ Extensive radius surgery .................... 11.73 NA NA 4.86 5.22 0.74 090 

24155 .... ............ A ........ Removal of elbow joint ....................... 11.97 NA NA 7.40 7.94 1.93 090 

24160 .... ............ A ........ Remove elbow joint implant ............... 7.89 NA NA 5.81 6.36 1.30 090 

24164 .... ............ A ........ Remove radius head implant ............. 6.34 NA NA 4.88 5.33 1.03 090 

24200 .... ............ A ........ Removal of arm foreign body ............. 1.78 2.72 3.07 1.36 1.50 0.20 010 

24201 .... ............ A ........ Removal of arm foreign body ............. 4.61 7.76 8.80 3.66 3.95 0.72 090 

24220 .... ............ A ........ Injection for elbow x-ray ..................... 1.31 2.65 3.12 0.47 0.44 0.08 000 

24300 .... ............ A ........ Manipulate elbow w/anesth ................ 3.86 NA NA 5.13 5.43 0.65 090 

24301 .... ............ A ........ Muscle/tendon transfer ....................... 10.26 NA NA 6.83 7.52 1.66 090 

24305 .... ............ A ........ Arm tendon lengthening ..................... 7.51 NA NA 5.63 6.18 1.15 090 

24310 .... ............ A ........ Revision of arm tendon ...................... 6.03 NA NA 4.72 5.17 0.96 090 

24320 .... ............ A ........ Repair of arm tendon ......................... 10.74 NA NA 7.03 7.30 1.74 090 

24330 .... ............ A ........ Revision of arm muscles .................... 9.67 NA NA 6.63 7.26 1.60 090 

24331 .... ............ A ........ Revision of arm muscles .................... 10.83 NA NA 6.95 7.75 1.78 090 

24332 .... ............ A ........ Tenolysis, triceps ................................ 7.77 NA NA 5.91 6.32 1.23 090 

24340 .... ............ A ........ Repair of biceps tendon ..................... 7.96 NA NA 5.96 6.48 1.36 090 

24341 .... ............ A ........ Repair arm tendon/muscle ................. 9.24 NA NA 7.50 7.72 1.36 090 

24342 .... ............ A ........ Repair of ruptured tendon .................. 10.74 NA NA 7.06 7.81 1.86 090 

24343 .... ............ A ........ Repr elbow lat ligmnt w/tiss ............... 8.99 NA NA 6.97 7.58 1.43 090 

24344 .... ............ A ........ Reconstruct elbow lat ligmnt .............. 14.97 NA NA 9.95 10.76 2.37 090 

24345 .... ............ A ........ Repr elbw med ligmnt w/tissu ............ 8.99 NA NA 6.92 7.49 1.44 090 

24346 .... ............ A ........ Reconstruct elbow med ligmnt ........... 14.97 NA NA 10.01 10.69 2.34 090 

24350 .... ............ A ........ Repair of tennis elbow ........................ 5.32 NA NA 4.85 5.22 0.87 090 

24351 .... ............ A ........ Repair of tennis elbow ........................ 5.97 NA NA 4.98 5.46 1.02 090 

24352 .... ............ A ........ Repair of tennis elbow ........................ 6.49 NA NA 5.19 5.70 1.10 090 

24354 .... ............ A ........ Repair of tennis elbow ........................ 6.54 NA NA 5.20 5.69 1.07 090 

24356 .... ............ A ........ Revision of tennis elbow .................... 6.74 NA NA 5.29 5.81 1.11 090 

24360 .... ............ A ........ Reconstruct elbow joint ...................... 12.53 NA NA 7.87 8.70 2.06 090 

24361 .... ............ A ........ Reconstruct elbow joint ...................... 14.27 NA NA 8.75 9.68 2.19 090 

24362 .... ............ A ........ Reconstruct elbow joint ...................... 15.18 NA NA 5.71 8.48 2.61 090 

24363 .... ............ A ........ Replace elbow joint ............................ 22.47 NA NA 12.18 12.97 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 6.29 6.92 1.52 090 

24400 .... ............ A ........ Revision of humerus ........................... 11.19 NA NA 7.50 8.20 1.93 090 

24410 .... ............ A ........ Revision of humerus ........................... 14.96 NA NA 9.26 9.81 2.58 090 

24420 .... ............ A ........ Revision of humerus ........................... 13.58 NA NA 8.48 9.58 2.18 090 

24430 .... ............ A ........ Repair of humerus .............................. 15.07 NA NA 9.24 9.51 2.22 090 

24435 .... ............ A ........ Repair humerus with graft .................. 14.74 NA NA 9.81 10.36 2.28 090 

24470 .... ............ A ........ Revision of elbow joint ....................... 8.81 NA NA 5.73 6.84 1.48 090 

24495 .... ............ A ........ Decompression of forearm ................. 8.30 NA NA 6.36 7.60 1.18 090 

24498 .... ............ A ........ Reinforce humerus ............................. 12.16 NA NA 7.67 8.48 2.07 090 

24500 .... ............ A ........ Treat humerus fracture ....................... 3.29 4.42 4.64 3.79 3.74 0.50 090 

24505 .... ............ A ........ Treat humerus fracture ....................... 5.25 5.81 6.22 4.86 5.13 0.89 090 

24515 .... ............ A ........ Treat humerus fracture ....................... 11.97 NA NA 8.04 8.73 2.03 090 

24516 .... ............ A ........ Treat humerus fracture ....................... 12.07 NA NA 7.65 8.40 2.03 090 

24530 .... ............ A ........ Treat humerus fracture ....................... 3.57 4.71 4.96 3.99 4.02 0.57 090 

24535 .... ............ A ........ Treat humerus fracture ....................... 6.96 6.80 7.33 5.85 6.24 1.18 090 

24538 .... ............ A ........ Treat humerus fracture ....................... 9.63 NA NA 7.18 7.95 1.64 090 

24545 .... ............ A ........ Treat humerus fracture ....................... 10.88 NA NA 7.19 7.84 1.83 090 

24546 .... ............ A ........ Treat humerus fracture ....................... 15.99 NA NA 9.43 10.40 2.74 090 

24560 .... ............ A ........ Treat humerus fracture ....................... 2.87 4.08 4.27 3.41 3.30 0.44 090 

24565 .... ............ A ........ Treat humerus fracture ....................... 5.64 5.90 6.25 5.02 5.27 0.93 090 

24566 .... ............ A ........ Treat humerus fracture ....................... 8.86 NA NA 6.83 7.52 1.30 090 

24575 .... ............ A ........ Treat humerus fracture ....................... 11.02 NA NA 7.18 7.81 1.87 090 

24576 .... ............ A ........ Treat humerus fracture ....................... 2.94 4.38 4.58 3.69 3.71 0.46 090 

24577 .... ............ A ........ Treat humerus fracture ....................... 5.87 6.00 6.47 5.06 5.45 0.95 090 

24579 .... ............ A ........ Treat humerus fracture ....................... 11.96 NA NA 7.83 8.34 2.03 090 

24582 .... ............ A ........ Treat humerus fracture ....................... 9.89 NA NA 8.15 8.64 1.48 090 

24586 .... ............ A ........ Treat elbow fracture ........................... 15.64 NA NA 9.33 10.30 2.65 090 

24587 .... ............ A ........ Treat elbow fracture ........................... 15.65 NA NA 9.32 10.19 2.53 090 

24600 .... ............ A ........ Treat elbow dislocation ....................... 4.28 3.84 4.35 3.26 3.39 0.50 090 

24605 .... ............ A ........ Treat elbow dislocation ....................... 5.50 NA NA 4.89 5.14 0.89 090 

mstockstill on PROD1PC66 with PROPOSALS2

38249 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

24615 .... ............ A ........ Treat elbow dislocation ....................... 9.72 NA NA 6.55 7.20 1.60 090 

24620 .... ............ A ........ Treat elbow fracture ........................... 7.07 NA NA 5.46 5.86 1.07 090 

24635 .... ............ A ........ Treat elbow fracture ........................... 13.56 NA NA 8.36 11.52 2.29 090 

24640 .... ............ A ........ Treat elbow dislocation ....................... 1.22 1.51 1.67 0.82 0.81 0.12 010 

24650 .... ............ A ........ Treat radius fracture ........................... 2.22 3.41 3.60 2.98 2.87 0.35 090 

24655 .... ............ A ........ Treat radius fracture ........................... 4.48 5.15 5.56 4.37 4.59 0.70 090 

24665 .... ............ A ........ Treat radius fracture ........................... 8.22 NA NA 6.50 7.01 1.41 090 

24666 .... ............ A ........ Treat radius fracture ........................... 9.74 NA NA 6.94 7.52 1.62 090 

24670 .... ............ A ........ Treat ulnar fracture ............................. 2.60 3.70 3.91 3.13 3.10 0.41 090 

24675 .... ............ A ........ Treat ulnar fracture ............................. 4.79 5.35 5.67 4.55 4.76 0.81 090 

24685 .... ............ A ........ Treat ulnar fracture ............................. 8.92 NA NA 6.43 6.99 1.52 090 

24800 .... ............ A ........ Fusion of elbow joint .......................... 11.27 NA NA 6.86 7.94 1.63 090 

24802 .... ............ A ........ Fusion/graft of elbow joint .................. 14.18 NA NA 8.03 9.30 2.38 090 

24900 .... ............ A ........ Amputation of upper arm .................... 10.04 NA NA 6.40 6.75 1.53 090 

24920 .... ............ A ........ Amputation of upper arm .................... 10.02 NA NA 6.01 6.56 1.61 090 

24925 .... ............ A ........ Amputation follow-up surgery ............. 7.19 NA NA 4.93 5.51 1.14 090 

24930 .... ............ A ........ Amputation follow-up surgery ............. 10.72 NA NA 6.15 6.66 1.68 090 

24931 .... ............ A ........ Amputate upper arm & implant .......... 13.32 NA NA 5.06 5.95 1.90 090 

24935 .... ............ A ........ Revision of amputation ....................... 16.30 NA NA 10.49 8.99 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 5.03 5.96 0.55 090 

25001 .... ............ A ........ Incise flexor carpi radialis ................... 3.68 NA NA 3.92 4.07 0.55 090 

25020 .... ............ A ........ Decompress forearm 1 space ............ 5.97 NA NA 6.89 8.23 0.93 090 

25023 .... ............ A ........ Decompress forearm 1 space ............ 13.69 NA NA 11.36 13.18 2.04 090 

25024 .... ............ A ........ Decompress forearm 2 spaces .......... 10.62 NA NA 7.07 7.30 1.36 090 

25025 .... ............ A ........ Decompress forearm 2 spaces .......... 17.77 NA NA 9.63 9.72 1.83 090 

25028 .... ............ A ........ Drainage of forearm lesion ................. 5.30 NA NA 6.15 7.17 0.81 090 

25031 .... ............ A ........ Drainage of forearm bursa ................. 4.18 NA NA 5.42 6.68 0.63 090 

25035 .... ............ A ........ Treat forearm bone lesion .................. 7.54 NA NA 8.74 11.19 1.24 090 

25040 .... ............ A ........ Explore/treat wrist joint ....................... 7.41 NA NA 5.85 6.59 1.15 090 

25065 .... ............ A ........ Biopsy forearm soft tissues ................ 2.01 4.32 3.77 1.98 1.94 0.15 010 

25066 .... ............ A ........ Biopsy forearm soft tissues ................ 4.18 NA NA 5.45 6.26 0.64 090 

25075 .... ............ A ........ Removal forearm lesion subcu ........... 3.78 NA NA 4.87 5.38 0.55 090 

25076 .... ............ A ........ Removal forearm lesion deep ............ 4.97 NA NA 6.84 8.20 0.74 090 

25077 .... ............ A ........ Remove tumor, forearm/wrist ............. 9.90 NA NA 8.81 10.47 1.42 090 

25085 .... ............ A ........ Incision of wrist capsule ..................... 5.55 NA NA 5.38 6.27 0.85 090 

25100 .... ............ A ........ Biopsy of wrist joint ............................ 3.94 NA NA 4.22 4.76 0.59 090 

25101 .... ............ A ........ Explore/treat wrist joint ....................... 4.74 NA NA 4.80 5.35 0.75 090 

25105 .... ............ A ........ Remove wrist joint lining .................... 5.91 NA NA 5.75 6.54 0.92 090 

25107 .... ............ A ........ Remove wrist joint cartilage ............... 7.50 NA NA 7.00 7.71 0.99 090 

25109 .... ............ A ........ Excise tendon forearm/wrist ............... 6.81 NA NA 5.26 5.30 0.96 090 

25110 .... ............ A ........ Remove wrist tendon lesion ............... 3.96 NA NA 5.22 6.15 0.62 090 

25111 .... ............ A ........ Remove wrist tendon lesion ............... 3.44 NA NA 4.06 4.39 0.53 090 

25112 .... ............ A ........ Reremove wrist tendon lesion ............ 4.58 NA NA 4.52 4.89 0.70 090 

25115 .... ............ A ........ Remove wrist/forearm lesion .............. 9.89 NA NA 10.13 12.10 1.31 090 

25116 .... ............ A ........ Remove wrist/forearm lesion .............. 7.38 NA NA 8.98 11.08 1.11 090 

25118 .... ............ A ........ Excise wrist tendon sheath ................ 4.42 NA NA 4.60 5.18 0.68 090 

25119 .... ............ A ........ Partial removal of ulna ....................... 6.10 NA NA 5.83 6.72 0.96 090 

25120 .... ............ A ........ Removal of forearm lesion ................. 6.16 NA NA 7.90 9.99 1.00 090 

25125 .... ............ A ........ Remove/graft forearm lesion .............. 7.55 NA NA 8.68 10.77 1.06 090 

25126 .... ............ A ........ Remove/graft forearm lesion .............. 7.62 NA NA 8.69 10.87 1.27 090 

25130 .... ............ A ........ Removal of wrist lesion ...................... 5.32 NA NA 5.17 5.80 0.80 090 

25135 .... ............ A ........ Remove & graft wrist lesion ............... 6.96 NA NA 6.06 6.81 1.02 090 

25136 .... ............ A ........ Remove & graft wrist lesion ............... 6.03 NA NA 5.53 6.06 1.03 090 

25145 .... ............ A ........ Remove forearm bone lesion ............. 6.43 NA NA 8.01 10.06 1.01 090 

25150 .... ............ A ........ Partial removal of ulna ....................... 7.27 NA NA 6.30 7.27 1.14 090 

25151 .... ............ A ........ Partial removal of radius .................... 7.57 NA NA 8.45 10.60 1.18 090 

25170 .... ............ A ........ Extensive forearm surgery ................. 11.34 NA NA 10.36 12.79 1.78 090 

25210 .... ............ A ........ Removal of wrist bone ........................ 6.01 NA NA 5.49 6.16 0.88 090 

25215 .... ............ A ........ Removal of wrist bones ...................... 8.02 NA NA 6.79 7.78 1.19 090 

25230 .... ............ A ........ Partial removal of radius .................... 5.28 NA NA 4.94 5.55 0.79 090 

25240 .... ............ A ........ Partial removal of ulna ....................... 5.22 NA NA 5.23 6.10 0.81 090 

25246 .... ............ A ........ Injection for wrist x-ray ....................... 1.45 2.72 3.05 0.53 0.49 0.09 000 

25248 .... ............ A ........ Remove forearm foreign body ............ 5.20 NA NA 6.57 7.54 0.72 090 

25250 .... ............ A ........ Removal of wrist prosthesis ............... 6.66 NA NA 5.25 5.70 1.01 090 

25251 .... ............ A ........ Removal of wrist prosthesis ............... 9.70 NA NA 6.72 7.33 1.26 090 

25259 .... ............ A ........ Manipulate wrist w/anesthes .............. 3.86 NA NA 5.12 5.43 0.62 090 

25260 .... ............ A ........ Repair forearm tendon/muscle ........... 7.89 NA NA 9.13 11.24 1.19 090 

25263 .... ............ A ........ Repair forearm tendon/muscle ........... 7.90 NA NA 8.93 11.11 1.18 090 

25265 .... ............ A ........ Repair forearm tendon/muscle ........... 9.96 NA NA 9.89 12.13 1.47 090 

25270 .... ............ A ........ Repair forearm tendon/muscle ........... 6.06 NA NA 7.73 9.91 0.95 090 

mstockstill on PROD1PC66 with PROPOSALS2

38250 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

25272 .... ............ A ........ Repair forearm tendon/muscle ........... 7.10 NA NA 8.30 10.56 1.11 090 

25274 .... ............ A ........ Repair forearm tendon/muscle ........... 8.82 NA NA 9.19 11.42 1.36 090 

25275 .... ............ A ........ Repair forearm tendon sheath ........... 8.82 NA NA 6.46 7.04 1.31 090 

25280 .... ............ A ........ Revise wrist/forearm tendon ............... 7.28 NA NA 8.36 10.52 1.08 090 

25290 .... ............ A ........ Incise wrist/forearm tendon ................ 5.34 NA NA 9.03 12.03 0.82 090 

25295 .... ............ A ........ Release wrist/forearm tendon ............ 6.61 NA NA 8.09 10.14 1.00 090 

25300 .... ............ A ........ Fusion of tendons at wrist .................. 8.88 NA NA 7.09 7.80 1.26 090 

25301 .... ............ A ........ Fusion of tendons at wrist .................. 8.47 NA NA 6.64 7.38 1.29 090 

25310 .... ............ A ........ Transplant forearm tendon ................. 8.26 NA NA 8.74 10.91 1.21 090 

25312 .... ............ A ........ Transplant forearm tendon ................. 9.70 NA NA 9.52 11.75 1.41 090 

25315 .... ............ A ........ Revise palsy hand tendon(s) .............. 10.56 NA NA 9.89 12.18 1.58 090 

25316 .... ............ A ........ Revise palsy hand tendon(s) .............. 12.76 NA NA 10.53 13.47 1.75 090 

25320 .... ............ A ........ Repair/revise wrist joint ...................... 12.38 NA NA 10.29 10.87 1.61 090 

25332 .... ............ A ........ Revise wrist joint ................................ 11.60 NA NA 7.60 8.42 1.84 090 

25335 .... ............ A ........ Realignment of hand .......................... 13.25 NA NA 9.11 10.01 1.93 090 

25337 .... ............ A ........ Reconstruct ulna/radioulnar ................ 11.44 NA NA 9.38 10.24 1.61 090 

25350 .... ............ A ........ Revision of radius ............................... 8.97 NA NA 9.14 11.58 1.46 090 

25355 .... ............ A ........ Revision of radius ............................... 10.41 NA NA 9.79 12.25 1.74 090 

25360 .... ............ A ........ Revision of ulna .................................. 8.62 NA NA 9.05 11.47 1.41 090 

25365 .... ............ A ........ Revise radius & ulna .......................... 12.77 NA NA 11.01 13.34 2.16 090 

25370 .... ............ A ........ Revise radius or ulna ......................... 13.93 NA NA 11.86 13.98 2.29 090 

25375 .... ............ A ........ Revise radius & ulna .......................... 13.41 NA NA 11.22 13.84 2.27 090 

25390 .... ............ A ........ Shorten radius or ulna ........................ 10.58 NA NA 9.88 12.25 1.65 090 

25391 .... ............ A ........ Lengthen radius or ulna ..................... 14.14 NA NA 11.47 14.05 2.22 090 

25392 .... ............ A ........ Shorten radius & ulna ......................... 14.44 NA NA 11.70 13.86 2.11 090 

25393 .... ............ A ........ Lengthen radius & ulna ...................... 16.42 NA NA 12.42 15.17 2.77 090 

25394 .... ............ A ........ Repair carpal bone, shorten ............... 10.71 NA NA 6.94 7.49 1.59 090 

25400 .... ............ A ........ Repair radius or ulna .......................... 11.16 NA NA 10.08 12.65 1.83 090 

25405 .... ............ A ........ Repair/graft radius or ulna .................. 14.87 NA NA 11.75 14.54 2.33 090 

25415 .... ............ A ........ Repair radius & ulna ........................... 13.66 NA NA 11.23 13.84 2.18 090 

25420 .... ............ A ........ Repair/graft radius & ulna .................. 16.89 NA NA 12.74 15.52 2.62 090 

25425 .... ............ A ........ Repair/graft radius or ulna .................. 13.58 NA NA 14.21 17.80 2.09 090 

25426 .... ............ A ........ Repair/graft radius & ulna .................. 16.31 NA NA 11.95 14.34 2.55 090 

25430 .... ............ A ........ Vasc graft into carpal bone ................ 9.57 NA NA 7.01 7.19 1.27 090 

25431 .... ............ A ........ Repair nonunion carpal bone ............. 10.75 NA NA 7.13 7.80 1.91 090 

25440 .... ............ A ........ Repair/graft wrist bone ....................... 10.56 NA NA 7.33 8.40 1.63 090 

25441 .... ............ A ........ Reconstruct wrist joint ........................ 13.15 NA NA 8.07 9.13 2.08 090 

25442 .... ............ A ........ Reconstruct wrist joint ........................ 10.98 NA NA 7.46 8.17 1.53 090 

25443 .... ............ A ........ Reconstruct wrist joint ........................ 10.52 NA NA 7.21 7.90 1.37 090 

25444 .... ............ A ........ Reconstruct wrist joint ........................ 11.28 NA NA 7.44 8.29 1.72 090 

25445 .... ............ A ........ Reconstruct wrist joint ........................ 9.76 NA NA 6.67 7.35 1.55 090 

25446 .... ............ A ........ Wrist replacement ............................... 17.16 NA NA 9.96 10.95 2.48 090 

25447 .... ............ A ........ Repair wrist joint(s) ............................. 10.95 NA NA 7.83 8.26 1.61 090 

25449 .... ............ A ........ Remove wrist joint implant ................. 14.80 NA NA 8.94 9.85 2.22 090 

25450 .... ............ A ........ Revision of wrist joint ......................... 7.94 NA NA 5.85 8.26 1.36 090 

25455 .... ............ A ........ Revision of wrist joint ......................... 9.57 NA NA 9.69 9.73 0.96 090 

25490 .... ............ A ........ Reinforce radius ................................. 9.61 NA NA 9.33 11.56 1.43 090 

25491 .... ............ A ........ Reinforce ulna .................................... 10.03 NA NA 9.63 12.06 1.60 090 

25492 .... ............ A ........ Reinforce radius and ulna .................. 12.52 NA NA 11.08 13.11 2.15 090 

25500 .... ............ A ........ Treat fracture of radius ....................... 2.51 3.29 3.44 2.85 2.79 0.35 090 

25505 .... ............ A ........ Treat fracture of radius ....................... 5.30 5.81 6.18 4.97 5.20 0.90 090 

25515 .... ............ A ........ Treat fracture of radius ....................... 9.37 NA NA 6.69 7.09 1.59 090 

25520 .... ............ A ........ Treat fracture of radius ....................... 6.35 5.66 6.32 5.12 5.64 1.08 090 

25525 .... ............ A ........ Treat fracture of radius ....................... 12.69 NA NA 8.67 9.35 2.13 090 

25526 .... ............ A ........ Treat fracture of radius ....................... 13.43 NA NA 10.14 11.84 2.20 090 

25530 .... ............ A ........ Treat fracture of ulna .......................... 2.15 3.46 3.61 2.96 2.91 0.34 090 

25535 .... ............ A ........ Treat fracture of ulna .......................... 5.22 5.54 5.80 4.82 5.08 0.89 090 

25545 .... ............ A ........ Treat fracture of ulna .......................... 9.09 NA NA 6.61 7.14 1.53 090 

25560 .... ............ A ........ Treat fracture radius & ulna ............... 2.50 3.34 3.52 2.83 2.72 0.35 090 

25565 .... ............ A ........ Treat fracture radius & ulna ............... 5.71 5.88 6.31 4.91 5.18 0.93 090 

25574 .... ............ A ........ Treat fracture radius & ulna ............... 7.47 NA NA 6.58 6.90 1.21 090 

25575 .... ............ A ........ Treat fracture radius/ulna ................... 12.02 NA NA 8.92 9.23 1.82 090 

25600 .... ............ A ........ Treat fracture radius/ulna ................... 2.69 3.66 3.88 3.15 3.06 0.42 090 

25605 .... ............ A ........ Treat fracture radius/ulna ................... 7.02 6.84 7.05 6.12 6.18 1.00 090 

25606 .... ............ A ........ Treat fx distal radial ............................ 8.10 NA NA 6.68 8.22 1.26 090 

25607 .... ............ A ........ Treat fx rad extra-articul ..................... 9.35 NA NA 7.18 7.23 1.36 090 

25608 .... ............ A ........ Treat fx rad intra-articul ...................... 10.86 NA NA 7.78 7.85 1.84 090 

25609 .... ............ A ........ Treat fx radial 3+ frag ......................... 14.12 NA NA 9.65 9.73 2.38 090 

25622 .... ............ A ........ Treat wrist bone fracture .................... 2.68 3.88 4.08 3.33 3.22 0.41 090 

25624 .... ............ A ........ Treat wrist bone fracture .................... 4.62 5.59 5.94 4.75 4.91 0.76 090 

25628 .... ............ A ........ Treat wrist bone fracture .................... 9.50 NA NA 7.29 7.57 1.37 090 

25630 .... ............ A ........ Treat wrist bone fracture .................... 2.94 3.73 3.96 3.23 3.09 0.45 090 

mstockstill on PROD1PC66 with PROPOSALS2

38251 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

25635 .... ............ A ........ Treat wrist bone fracture .................... 4.47 5.07 5.56 4.31 4.15 0.74 090 

25645 .... ............ A ........ Treat wrist bone fracture .................... 7.31 NA NA 5.74 6.20 1.20 090 

25650 .... ............ A ........ Treat wrist bone fracture .................... 3.12 3.82 4.07 3.43 3.30 0.45 090 

25651 .... ............ A ........ Pin ulnar styloid fracture ..................... 5.68 NA NA 5.11 5.30 0.86 090 

25652 .... ............ A ........ Treat fracture ulnar styloid ................. 7.92 NA NA 6.14 6.59 1.21 090 

25660 .... ............ A ........ Treat wrist dislocation ......................... 4.84 NA NA 4.29 4.54 0.58 090 

25670 .... ............ A ........ Treat wrist dislocation ......................... 7.98 NA NA 6.00 6.50 1.28 090 

25671 .... ............ A ........ Pin radioulnar dislocation ................... 6.32 NA NA 5.47 5.82 1.00 090 

25675 .... ............ A ........ Treat wrist dislocation ......................... 4.75 4.68 5.20 3.97 4.34 0.62 090 

25676 .... ............ A ........ Treat wrist dislocation ......................... 8.17 NA NA 6.33 6.81 1.34 090 

25680 .... ............ A ........ Treat wrist fracture ............................. 6.08 NA NA 4.36 4.56 0.78 090 

25685 .... ............ A ........ Treat wrist fracture ............................. 9.97 NA NA 6.80 7.29 1.60 090 

25690 .... ............ A ........ Treat wrist dislocation ......................... 5.58 NA NA 4.89 5.19 0.88 090 

25695 .... ............ A ........ Treat wrist dislocation ......................... 8.40 NA NA 6.19 6.65 1.32 090 

25800 .... ............ A ........ Fusion of wrist joint ............................ 9.95 NA NA 7.25 8.18 1.57 090 

25805 .... ............ A ........ Fusion/graft of wrist joint .................... 11.59 NA NA 8.14 9.21 1.81 090 

25810 .... ............ A ........ Fusion/graft of wrist joint .................... 11.75 NA NA 8.49 9.22 1.68 090 

25820 .... ............ A ........ Fusion of hand bones ......................... 7.52 NA NA 6.28 7.07 1.22 090 

25825 .... ............ A ........ Fuse hand bones with graft ................ 9.54 NA NA 7.50 8.39 1.41 090 

25830 .... ............ A ........ Fusion, radioulnar jnt/ulna .................. 10.69 NA NA 10.40 12.42 1.55 090 

25900 .... ............ A ........ Amputation of forearm ........................ 9.46 NA NA 9.44 10.97 1.30 090 

25905 .... ............ A ........ Amputation of forearm ........................ 9.48 NA NA 8.74 10.47 1.40 090 

25907 .... ............ A ........ Amputation follow-up surgery ............. 7.98 NA NA 8.53 10.02 1.10 090 

25909 .... ............ A ........ Amputation follow-up surgery ............. 9.20 NA NA 9.07 10.67 1.44 090 

25915 .... ............ A ........ Amputation of forearm ........................ 17.38 NA NA 8.12 13.50 2.94 090 

25920 .... ............ A ........ Amputate hand at wrist ...................... 8.92 NA NA 6.45 7.20 1.35 090 

25922 .... ............ A ........ Amputate hand at wrist ...................... 7.54 NA NA 6.12 6.66 1.12 090 

25924 .... ............ A ........ Amputation follow-up surgery ............. 8.70 NA NA 6.02 7.18 1.32 090 

25927 .... ............ A ........ Amputation of hand ............................ 8.98 NA NA 8.50 10.11 1.27 090 

25929 .... ............ A ........ Amputation follow-up surgery ............. 7.71 NA NA 5.66 5.73 1.14 090 

25931 .... ............ A ........ Amputation follow-up surgery ............. 7.93 NA NA 8.20 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 4.02 4.79 1.51 1.57 0.18 010 

26011 .... ............ A ........ Drainage of finger abscess ................ 2.21 6.20 7.51 1.95 2.14 0.33 010 

26020 .... ............ A ........ Drain hand tendon sheath .................. 4.97 NA NA 4.71 5.04 0.73 090 

26025 .... ............ A ........ Drainage of palm bursa ...................... 4.99 NA NA 4.44 4.79 0.76 090 

26030 .... ............ A ........ Drainage of palm bursa(s) .................. 6.16 NA NA 4.98 5.36 0.92 090 

26034 .... ............ A ........ Treat hand bone lesion ...................... 6.49 NA NA 5.55 5.96 1.01 090 

26035 .... ............ A ........ Decompress fingers/hand ................... 11.14 NA NA 8.12 7.99 1.47 090 

26037 .... ............ A ........ Decompress fingers/hand ................... 7.48 NA NA 5.49 5.92 1.13 090 

26040 .... ............ A ........ Release palm contracture .................. 3.38 NA NA 3.56 3.82 0.53 090 

26045 .... ............ A ........ Release palm contracture .................. 5.62 NA NA 4.87 5.26 0.93 090 

26055 .... ............ A ........ Incise finger tendon sheath ................ 3.00 8.95 11.66 3.80 3.88 0.43 090 

26060 .... ............ A ........ Incision of finger tendon ..................... 2.85 NA NA 3.03 3.28 0.45 090 

26070 .... ............ A ........ Explore/treat hand joint ...................... 3.73 NA NA 3.04 3.20 0.48 090 

26075 .... ............ A ........ Explore/treat finger joint ..................... 3.83 NA NA 3.35 3.58 0.53 090 

26080 .... ............ A ........ Explore/treat finger joint ..................... 4.36 NA NA 4.29 4.58 0.66 090 

26100 .... ............ A ........ Biopsy hand joint lining ...................... 3.71 NA NA 3.65 3.88 0.54 090 

26105 .... ............ A ........ Biopsy finger joint lining ..................... 3.75 NA NA 3.66 3.96 0.59 090 

26110 .... ............ A ........ Biopsy finger joint lining ..................... 3.57 NA NA 3.59 3.82 0.53 090 

26115 .... ............ A ........ Removal hand lesion subcut .............. 3.92 9.75 11.43 4.21 4.50 0.59 090 

26116 .... ............ A ........ Removal hand lesion, deep ................ 5.61 NA NA 5.28 5.65 0.84 090 

26117 .... ............ A ........ Remove tumor, hand/finger ................ 8.62 NA NA 6.16 6.63 1.26 090 

26121 .... ............ A ........ Release palm contracture .................. 7.61 NA NA 5.90 6.45 1.17 090 

26123 .... ............ A ........ Release palm contracture .................. 10.63 NA NA 8.18 8.54 1.43 090 

26125 .... ............ A ........ Release palm contracture .................. 4.60 NA NA 1.88 2.17 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 5.44 5.97 1.07 090 

26140 .... ............ A ........ Revise finger joint, each ..................... 6.23 NA NA 5.13 5.60 0.92 090 

26145 .... ............ A ........ Tendon excision, palm/finger ............. 6.38 NA NA 5.16 5.62 0.97 090 

26160 .... ............ A ........ Remove tendon sheath lesion ............ 3.46 8.94 10.67 3.91 4.02 0.49 090 

26170 .... ............ A ........ Removal of palm tendon, each .......... 4.82 NA NA 4.35 4.66 0.69 090 

26180 .... ............ A ........ Removal of finger tendon ................... 5.24 NA NA 4.68 5.07 0.78 090 

26185 .... ............ A ........ Remove finger bone ........................... 6.32 NA NA 5.69 5.88 0.81 090 

26200 .... ............ A ........ Remove hand bone lesion ................. 5.56 NA NA 4.53 4.95 0.88 090 

26205 .... ............ A ........ Remove/graft bone lesion .................. 7.82 NA NA 5.83 6.37 1.20 090 

26210 .... ............ A ........ Removal of finger lesion ..................... 5.21 NA NA 4.71 5.08 0.79 090 

26215 .... ............ A ........ Remove/graft finger lesion ................. 7.16 NA NA 5.51 5.92 0.98 090 

26230 .... ............ A ........ Partial removal of hand bone ............. 6.38 NA NA 4.93 5.44 1.01 090 

26235 .... ............ A ........ Partial removal, finger bone ............... 6.24 NA NA 4.92 5.38 0.95 090 

26236 .... ............ A ........ Partial removal, finger bone ............... 5.37 NA NA 4.55 4.94 0.81 090 

26250 .... ............ A ........ Extensive hand surgery ...................... 7.61 NA NA 5.69 5.98 1.07 090 

mstockstill on PROD1PC66 with PROPOSALS2

38252 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

26255 .... ............ A ........ Extensive hand surgery ...................... 12.80 NA NA 8.22 8.85 1.69 090 

26260 .... ............ A ........ Extensive finger surgery ..................... 7.09 NA NA 5.45 5.81 1.01 090 

26261 .... ............ A ........ Extensive finger surgery ..................... 9.28 NA NA 6.73 6.50 1.14 090 

26262 .... ............ A ........ Partial removal of finger ..................... 5.72 NA NA 4.73 5.02 0.88 090 

26320 .... ............ A ........ Removal of implant from hand ........... 4.02 NA NA 3.77 4.05 0.59 090 

26340 .... ............ A ........ Manipulate finger w/anesth ................ 2.62 NA NA 4.57 4.74 0.39 090 

26350 .... ............ A ........ Repair finger/hand tendon .................. 6.07 NA NA 9.35 12.00 0.93 090 

26352 .... ............ A ........ Repair/graft hand tendon .................... 7.75 NA NA 9.89 12.65 1.13 090 

26356 .... ............ A ........ Repair finger/hand tendon .................. 10.22 NA NA 13.51 15.98 1.21 090 

26357 .... ............ A ........ Repair finger/hand tendon .................. 8.65 NA NA 10.19 12.92 1.33 090 

26358 .... ............ A ........ Repair/graft hand tendon .................... 9.22 NA NA 10.77 13.72 1.38 090 

26370 .... ............ A ........ Repair finger/hand tendon .................. 7.17 NA NA 9.35 12.26 1.12 090 

26372 .... ............ A ........ Repair/graft hand tendon .................... 8.89 NA NA 10.36 13.47 1.40 090 

26373 .... ............ A ........ Repair finger/hand tendon .................. 8.29 NA NA 9.98 13.05 1.23 090 

26390 .... ............ A ........ Revise hand/finger tendon ................. 9.31 NA NA 9.04 11.17 1.40 090 

26392 .... ............ A ........ Repair/graft hand tendon .................... 10.38 NA NA 10.98 13.87 1.57 090 

26410 .... ............ A ........ Repair hand tendon ............................ 4.68 NA NA 7.49 9.73 0.73 090 

26412 .... ............ A ........ Repair/graft hand tendon .................... 6.37 NA NA 8.46 10.88 0.97 090 

26415 .... ............ A ........ Excision, hand/finger tendon .............. 8.40 NA NA 7.35 9.46 0.98 090 

26416 .... ............ A ........ Graft hand or finger tendon ................ 9.44 NA NA 8.90 11.71 0.79 090 

26418 .... ............ A ........ Repair finger tendon ........................... 4.33 NA NA 7.98 10.17 0.67 090 

26420 .... ............ A ........ Repair/graft finger tendon ................... 6.83 NA NA 8.64 11.15 1.07 090 

26426 .... ............ A ........ Repair finger/hand tendon .................. 6.21 NA NA 8.40 10.81 0.95 090 

26428 .... ............ A ........ Repair/graft finger tendon ................... 7.28 NA NA 9.07 11.50 1.09 090 

26432 .... ............ A ........ Repair finger tendon ........................... 4.07 NA NA 6.63 8.46 0.64 090 

26433 .... ............ A ........ Repair finger tendon ........................... 4.61 NA NA 6.86 8.84 0.72 090 

26434 .... ............ A ........ Repair/graft finger tendon ................... 6.15 NA NA 7.79 9.68 0.93 090 

26437 .... ............ A ........ Realignment of tendons ..................... 5.88 NA NA 7.64 9.62 0.89 090 

26440 .... ............ A ........ Release palm/finger tendon ............... 5.07 NA NA 8.31 10.89 0.75 090 

26442 .... ............ A ........ Release palm & finger tendon ............ 9.50 NA NA 11.63 13.79 1.20 090 

26445 .... ............ A ........ Release hand/finger tendon ............... 4.36 NA NA 8.05 10.60 0.65 090 

26449 .... ............ A ........ Release forearm/hand tendon ............ 8.34 NA NA 11.18 13.50 1.06 090 

26450 .... ............ A ........ Incision of palm tendon ...................... 3.71 NA NA 5.04 6.20 0.59 090 

26455 .... ............ A ........ Incision of finger tendon ..................... 3.68 NA NA 5.00 6.15 0.58 090 

26460 .... ............ A ........ Incise hand/finger tendon ................... 3.50 NA NA 4.97 6.06 0.55 090 

26471 .... ............ A ........ Fusion of finger tendons ..................... 5.79 NA NA 7.63 9.44 0.88 090 

26474 .... ............ A ........ Fusion of finger tendons ..................... 5.38 NA NA 7.44 9.43 0.76 090 

26476 .... ............ A ........ Tendon lengthening ............................ 5.24 NA NA 7.17 9.09 0.79 090 

26477 .... ............ A ........ Tendon shortening .............................. 5.21 NA NA 7.40 9.25 0.81 090 

26478 .... ............ A ........ Lengthening of hand tendon .............. 5.86 NA NA 7.62 9.73 0.90 090 

26479 .... ............ A ........ Shortening of hand tendon ................. 5.80 NA NA 7.60 9.60 0.92 090 

26480 .... ............ A ........ Transplant hand tendon ..................... 6.76 NA NA 9.47 12.28 1.02 090 

26483 .... ............ A ........ Transplant/graft hand tendon ............. 8.36 NA NA 10.06 12.81 1.26 090 

26485 .... ............ A ........ Transplant palm tendon ...................... 7.77 NA NA 9.90 12.64 1.15 090 

26489 .... ............ A ........ Transplant/graft palm tendon ............. 9.74 NA NA 10.64 11.29 1.26 090 

26490 .... ............ A ........ Revise thumb tendon ......................... 8.48 NA NA 8.71 10.80 1.21 090 

26492 .... ............ A ........ Tendon transfer with graft .................. 9.70 NA NA 9.66 11.66 1.40 090 

26494 .... ............ A ........ Hand tendon/muscle transfer ............. 8.54 NA NA 9.05 11.00 1.28 090 

26496 .... ............ A ........ Revise thumb tendon ......................... 9.66 NA NA 9.40 11.33 1.45 090 

26497 .... ............ A ........ Finger tendon transfer ........................ 9.64 NA NA 9.38 11.49 1.41 090 

26498 .... ............ A ........ Finger tendon transfer ........................ 14.07 NA NA 11.46 13.83 2.11 090 

26499 .... ............ A ........ Revision of finger ................................ 9.05 NA NA 8.66 10.87 1.35 090 

26500 .... ............ A ........ Hand tendon reconstruction ............... 6.02 NA NA 7.60 9.56 0.90 090 

26502 .... ............ A ........ Hand tendon reconstruction ............... 7.20 NA NA 8.18 10.13 1.13 090 

26508 .... ............ A ........ Release thumb contracture ................ 6.07 NA NA 7.64 9.68 0.98 090 

26510 .... ............ A ........ Thumb tendon transfer ....................... 5.49 NA NA 7.47 9.42 0.79 090 

26516 .... ............ A ........ Fusion of knuckle joint ........................ 7.21 NA NA 8.13 10.20 1.10 090 

26517 .... ............ A ........ Fusion of knuckle joints ...................... 8.96 NA NA 8.86 11.25 1.41 090 

26518 .... ............ A ........ Fusion of knuckle joints ...................... 9.15 NA NA 8.79 11.16 1.35 090 

26520 .... ............ A ........ Release knuckle contracture .............. 5.36 NA NA 8.69 11.31 0.80 090 

26525 .... ............ A ........ Release finger contracture ................. 5.39 NA NA 8.71 11.36 0.81 090 

26530 .... ............ A ........ Revise knuckle joint ............................ 6.76 NA NA 5.39 5.78 1.04 090 

26531 .... ............ A ........ Revise knuckle with implant ............... 7.99 NA NA 6.12 6.64 1.17 090 

26535 .... ............ A ........ Revise finger joint ............................... 5.30 NA NA 4.03 3.90 0.71 090 

26536 .... ............ A ........ Revise/implant finger joint .................. 6.44 NA NA 9.05 9.37 0.96 090 

26540 .... ............ A ........ Repair hand joint ................................ 6.49 NA NA 7.89 9.90 0.99 090 

26541 .... ............ A ........ Repair hand joint with graft ................ 8.69 NA NA 8.95 11.19 1.28 090 

26542 .... ............ A ........ Repair hand joint with graft ................ 6.84 NA NA 8.04 10.05 1.02 090 

26545 .... ............ A ........ Reconstruct finger joint ....................... 6.99 NA NA 8.30 10.23 1.05 090 

26546 .... ............ A ........ Repair nonunion hand ........................ 10.53 NA NA 11.33 13.20 1.44 090 

26548 .... ............ A ........ Reconstruct finger joint ....................... 8.10 NA NA 8.64 10.78 1.20 090 

26550 .... ............ A ........ Construct thumb replacement ............ 21.54 NA NA 14.40 16.17 2.46 090 

mstockstill on PROD1PC66 with PROPOSALS2

38253 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

26551 .... ............ A ........ Great toe-hand transfer ...................... 48.23 NA NA 17.12 25.55 7.98 090 

26553 .... ............ A ........ Single transfer, toe-hand .................... 47.92 NA NA 27.43 23.93 2.42 090 

26554 .... ............ A ........ Double transfer, toe-hand ................... 56.73 NA NA 36.06 34.01 9.44 090 

26555 .... ............ A ........ Positional change of finger ................. 16.94 NA NA 13.85 16.03 2.49 090 

26556 .... ............ A ........ Toe joint transfer ................................ 49.43 NA NA 17.98 25.63 2.58 090 

26560 .... ............ A ........ Repair of web finger ........................... 5.43 NA NA 6.52 8.26 0.85 090 

26561 .... ............ A ........ Repair of web finger ........................... 10.98 NA NA 9.36 10.87 1.45 090 

26562 .... ............ A ........ Repair of web finger ........................... 16.40 NA NA 8.64 13.81 2.24 090 

26565 .... ............ A ........ Correct metacarpal flaw ..................... 6.80 NA NA 7.99 9.99 1.00 090 

26567 .... ............ A ........ Correct finger deformity ...................... 6.88 NA NA 7.96 9.99 1.04 090 

26568 .... ............ A ........ Lengthen metacarpal/finger ................ 9.15 NA NA 10.50 12.91 1.49 090 

26580 .... ............ A ........ Repair hand deformity ........................ 19.50 NA NA 9.66 11.93 2.29 090 

26587 .... ............ A ........ Reconstruct extra finger ..................... 14.36 NA NA 7.95 8.67 1.53 090 

26590 .... ............ A ........ Repair finger deformity ....................... 18.51 NA NA 12.27 12.82 2.78 090 

26591 .... ............ A ........ Repair muscles of hand ..................... 3.30 NA NA 6.07 7.88 0.48 090 

26593 .... ............ A ........ Release muscles of hand ................... 5.38 NA NA 7.64 9.41 0.78 090 

26596 .... ............ A ........ Excision constricting tissue ................ 9.02 NA NA 7.36 8.11 1.43 090 

26600 .... ............ A ........ Treat metacarpal fracture ................... 2.48 3.81 3.72 3.47 3.06 0.30 090 

26605 .... ............ A ........ Treat metacarpal fracture ................... 2.92 4.06 4.31 3.48 3.57 0.49 090 

26607 .... ............ A ........ Treat metacarpal fracture ................... 5.40 NA NA 4.87 5.58 0.87 090 

26608 .... ............ A ........ Treat metacarpal fracture ................... 5.43 NA NA 5.21 5.74 0.88 090 

26615 .... ............ A ........ Treat metacarpal fracture ................... 5.38 NA NA 4.70 5.01 0.86 090 

26641 .... ............ A ........ Treat thumb dislocation ...................... 4.01 4.02 4.32 3.39 3.48 0.39 090 

26645 .... ............ A ........ Treat thumb fracture ........................... 4.47 4.58 4.88 3.90 4.05 0.67 090 

26650 .... ............ A ........ Treat thumb fracture ........................... 5.80 NA NA 5.07 5.98 0.94 090 

26665 .... ............ A ........ Treat thumb fracture ........................... 7.72 NA NA 5.84 6.24 0.90 090 

26670 .... ............ A ........ Treat hand dislocation ........................ 3.74 3.59 3.92 3.01 2.97 0.39 090 

26675 .... ............ A ........ Treat hand dislocation ........................ 4.71 5.22 5.29 4.49 4.43 0.77 090 

26676 .... ............ A ........ Pin hand dislocation ........................... 5.60 NA NA 5.54 6.13 0.91 090 

26685 .... ............ A ........ Treat hand dislocation ........................ 7.09 NA NA 5.35 5.76 1.09 090 

26686 .... ............ A ........ Treat hand dislocation ........................ 8.06 NA NA 6.05 6.50 1.24 090 

26700 .... ............ A ........ Treat knuckle dislocation .................... 3.74 3.27 3.52 2.91 2.90 0.35 090 

26705 .... ............ A ........ Treat knuckle dislocation .................... 4.26 4.73 5.04 4.03 4.18 0.66 090 

26706 .... ............ A ........ Pin knuckle dislocation ....................... 5.19 NA NA 4.68 4.89 0.81 090 

26715 .... ............ A ........ Treat knuckle dislocation .................... 5.79 NA NA 4.86 5.20 0.91 090 

26720 .... ............ A ........ Treat finger fracture, each .................. 1.70 2.56 2.67 2.29 2.18 0.24 090 

26725 .... ............ A ........ Treat finger fracture, each .................. 3.39 4.06 4.42 3.39 3.45 0.53 090 

26727 .... ............ A ........ Treat finger fracture, each .................. 5.30 NA NA 5.15 5.70 0.84 090 

26735 .... ............ A ........ Treat finger fracture, each .................. 6.03 NA NA 4.94 5.26 0.95 090 

26740 .... ............ A ........ Treat finger fracture, each .................. 1.99 2.98 3.05 2.69 2.69 0.31 090 

26742 .... ............ A ........ Treat finger fracture, each .................. 3.90 4.24 4.63 3.55 3.73 0.58 090 

26746 .... ............ A ........ Treat finger fracture, each .................. 5.86 NA NA 4.91 5.25 0.91 090 

26750 .... ............ A ........ Treat finger fracture, each .................. 1.74 2.23 2.36 2.24 2.13 0.22 090 

26755 .... ............ A ........ Treat finger fracture, each .................. 3.15 3.72 4.09 2.92 2.97 0.42 090 

26756 .... ............ A ........ Pin finger fracture, each ..................... 4.46 NA NA 4.83 5.28 0.71 090 

26765 .... ............ A ........ Treat finger fracture, each .................. 4.21 NA NA 4.00 4.20 0.66 090 

26770 .... ............ A ........ Treat finger dislocation ....................... 3.07 2.90 3.17 2.53 2.47 0.27 090 

26775 .... ............ A ........ Treat finger dislocation ....................... 3.78 4.60 4.89 3.86 3.83 0.54 090 

26776 .... ............ A ........ Pin finger dislocation .......................... 4.87 NA NA 4.95 5.49 0.77 090 

26785 .... ............ A ........ Treat finger dislocation ....................... 4.25 NA NA 4.03 4.29 0.68 090 

26820 .... ............ A ........ Thumb fusion with graft ...................... 8.33 NA NA 8.81 11.02 1.30 090 

26841 .... ............ A ........ Fusion of thumb .................................. 7.21 NA NA 8.61 10.94 1.18 090 

26842 .... ............ A ........ Thumb fusion with graft ...................... 8.37 NA NA 8.87 11.14 1.32 090 

26843 .... ............ A ........ Fusion of hand joint ............................ 7.67 NA NA 8.40 10.34 1.15 090 

26844 .... ............ A ........ Fusion/graft of hand joint .................... 8.86 NA NA 9.01 11.22 1.33 090 

26850 .... ............ A ........ Fusion of knuckle ............................... 7.03 NA NA 8.20 10.22 1.06 090 

26852 .... ............ A ........ Fusion of knuckle with graft ............... 8.59 NA NA 9.06 10.99 1.22 090 

26860 .... ............ A ........ Fusion of finger joint ........................... 4.76 NA NA 7.47 9.34 0.73 090 

26861 .... ............ A ........ Fusion of finger jnt, add-on ................ 1.74 NA NA 0.70 0.82 0.27 ZZZ 

26862 .... ............ A ........ Fusion/graft of finger joint ................... 7.44 NA NA 8.59 10.49 1.10 090 

26863 .... ............ A ........ Fuse/graft added joint ......................... 3.89 NA NA 1.59 1.86 0.56 ZZZ 

26910 .... ............ A ........ Amputate metacarpal bone ................ 7.67 NA NA 8.23 9.74 1.16 090 

26951 .... ............ A ........ Amputation of finger/thumb ................ 5.85 NA NA 8.33 9.25 0.71 090 

26952 .... ............ A ........ Amputation of finger/thumb ................ 6.37 NA NA 7.86 9.78 0.95 090 

26989 .... ............ C ........ Hand/finger surgery ............................ 0.00 0.00 8.41 0.00 8.41 0.00 YYY 

26990 .... ............ A ........ Drainage of pelvis lesion .................... 7.84 NA NA 6.19 6.72 1.22 090 

26991 .... ............ A ........ Drainage of pelvis bursa .................... 6.97 8.57 9.86 4.87 5.15 1.11 090 

26992 .... ............ A ........ Drainage of bone lesion ..................... 13.37 NA NA 8.42 9.44 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 6.12 1.12 090 

27005 .... ............ A ........ Incision of hip tendon ......................... 9.96 NA NA 6.52 7.22 1.73 090 

mstockstill on PROD1PC66 with PROPOSALS2

38254 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

27006 .... ............ A ........ Incision of hip tendons ....................... 9.99 NA NA 6.77 7.39 1.70 090 

27025 .... ............ A ........ Incision of hip/thigh fascia .................. 12.66 NA NA 8.23 8.37 1.85 090 

27030 .... ............ A ........ Drainage of hip joint ........................... 13.54 NA NA 8.05 8.86 2.27 090 

27033 .... ............ A ........ Exploration of hip joint ........................ 13.99 NA NA 8.40 9.17 2.33 090 

27035 .... ............ A ........ Denervation of hip joint ...................... 17.23 NA NA 8.56 10.09 2.16 090 

27036 .... ............ A ........ Excision of hip joint/muscle ................ 14.18 NA NA 8.93 9.48 2.27 090 

27040 .... ............ A ........ Biopsy of soft tissues ......................... 2.89 5.16 5.17 1.87 1.92 0.27 010 

27041 .... ............ A ........ Biopsy of soft tissues ......................... 10.07 NA NA 5.74 6.19 1.35 090 

27047 .... ............ A ........ Remove hip/pelvis lesion .................... 7.51 6.97 7.06 4.48 4.64 1.03 090 

27048 .... ............ A ........ Remove hip/pelvis lesion .................... 6.44 NA NA 4.59 4.70 0.92 090 

27049 .... ............ A ........ Remove tumor, hip/pelvis ................... 15.20 NA NA 8.17 8.30 2.07 090 

27050 .... ............ A ........ Biopsy of sacroiliac joint ..................... 4.65 NA NA 3.00 3.84 0.60 090 

27052 .... ............ A ........ Biopsy of hip joint ............................... 7.27 NA NA 5.64 5.77 1.08 090 

27054 .... ............ A ........ Removal of hip joint lining .................. 9.09 NA NA 6.49 6.92 1.47 090 

27060 .... ............ A ........ Removal of ischial bursa .................... 5.78 NA NA 4.36 4.38 0.80 090 

27062 .... ............ A ........ Remove femur lesion/bursa ............... 5.66 NA NA 4.59 4.90 0.93 090 

27065 .... ............ A ........ Removal of hip bone lesion ................ 6.44 NA NA 4.99 5.24 1.01 090 

27066 .... ............ A ........ Removal of hip bone lesion ................ 11.06 NA NA 7.43 7.94 1.80 090 

27067 .... ............ A ........ Remove/graft hip bone lesion ............ 14.57 NA NA 8.85 9.76 1.85 090 

27070 .... ............ A ........ Partial removal of hip bone ................ 11.44 NA NA 8.03 8.57 1.75 090 

27071 .... ............ A ........ Partial removal of hip bone ................ 12.25 NA NA 8.47 9.31 1.93 090 

27075 .... ............ A ........ Extensive hip surgery ......................... 36.77 NA NA 16.17 17.78 5.66 090 

27076 .... ............ A ........ Extensive hip surgery ......................... 24.25 NA NA 12.89 13.69 3.71 090 

27077 .... ............ A ........ Extensive hip surgery ......................... 42.54 NA NA 20.04 21.36 6.14 090 

27078 .... ............ A ........ Extensive hip surgery ......................... 14.54 NA NA 8.78 9.37 2.23 090 

27079 .... ............ A ........ Extensive hip surgery ......................... 14.91 NA NA 8.00 8.69 1.95 090 

27080 .... ............ A ........ Removal of tail bone .......................... 6.80 NA NA 4.56 4.73 0.93 090 

27086 .... ............ A ........ Remove hip foreign body ................... 1.89 3.58 4.09 1.46 1.65 0.25 010 

27087 .... ............ A ........ Remove hip foreign body ................... 8.72 NA NA 5.64 6.15 1.35 090 

27090 .... ............ A ........ Removal of hip prosthesis .................. 11.57 NA NA 7.41 8.10 1.95 090 

27091 .... ............ A ........ Removal of hip prosthesis .................. 24.15 NA NA 12.95 13.50 3.85 090 

27093 .... ............ A ........ Injection for hip x-ray .......................... 1.30 3.13 3.77 0.48 0.47 0.13 000 

27095 .... ............ A ........ Injection for hip x-ray .......................... 1.50 3.69 4.69 0.51 0.51 0.14 000 

27096 .... ............ A ........ Inject sacroiliac joint ........................... 1.40 2.50 3.42 0.33 0.33 0.08 000 

27097 .... ............ A ........ Revision of hip tendon ........................ 9.16 NA NA 6.33 6.38 1.57 090 

27098 .... ............ A ........ Transfer tendon to pelvis .................... 9.20 NA NA 4.92 5.97 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 8.36 1.73 090 

27110 .... ............ A ........ Transfer of iliopsoas muscle .............. 13.63 NA NA 8.28 8.76 2.19 090 

27111 .... ............ A ........ Transfer of iliopsoas muscle .............. 12.46 NA NA 8.08 8.62 1.95 090 

27120 .... ............ A ........ Reconstruction of hip socket .............. 19.10 NA NA 10.83 11.34 3.09 090 

27122 .... ............ A ........ Reconstruction of hip socket .............. 15.95 NA NA 9.45 10.26 2.62 090 

27125 .... ............ A ........ Partial hip replacement ....................... 16.46 NA NA 9.61 10.14 2.55 090 

27130 .... ............ A ........ Total hip arthroplasty .......................... 21.61 NA NA 11.80 12.57 3.51 090 

27132 .... ............ A ........ Total hip arthroplasty .......................... 25.49 NA NA 13.47 14.58 4.05 090 

27134 .... ............ A ........ Revise hip joint replacement .............. 30.13 NA NA 14.75 16.30 4.95 090 

27137 .... ............ A ........ Revise hip joint replacement .............. 22.55 NA NA 11.77 12.87 3.68 090 

27138 .... ............ A ........ Revise hip joint replacement .............. 23.55 NA NA 12.15 13.30 3.85 090 

27140 .... ............ A ........ Transplant femur ridge ....................... 12.66 NA NA 7.88 8.64 2.12 090 

27146 .... ............ A ........ Incision of hip bone ............................ 18.72 NA NA 10.70 11.43 2.97 090 

27147 .... ............ A ........ Revision of hip bone ........................... 21.87 NA NA 12.04 12.65 3.58 090 

27151 .... ............ A ........ Incision of hip bones .......................... 23.92 NA NA 12.92 10.37 3.92 090 

27156 .... ............ A ........ Revision of hip bones ......................... 26.03 NA NA 13.76 14.89 4.22 090 

27158 .... ............ A ........ Revision of pelvis ............................... 20.89 NA NA 11.55 10.52 3.17 090 

27161 .... ............ A ........ Incision of neck of femur .................... 17.74 NA NA 10.38 11.25 2.95 090 

27165 .... ............ A ........ Incision/fixation of femur ..................... 20.06 NA NA 11.60 12.29 3.11 090 

27170 .... ............ A ........ Repair/graft femur head/neck ............. 17.46 NA NA 9.78 10.55 2.82 090 

27175 .... ............ A ........ Treat slipped epiphysis ....................... 9.29 NA NA 5.16 6.03 1.46 090 

27176 .... ............ A ........ Treat slipped epiphysis ....................... 12.78 NA NA 8.19 8.62 2.23 090 

27177 .... ............ A ........ Treat slipped epiphysis ....................... 15.94 NA NA 9.65 10.28 2.62 090 

27178 .... ............ A ........ Treat slipped epiphysis ....................... 12.78 NA NA 7.98 8.25 2.09 090 

27179 .... ............ A ........ Revise head/neck of femur ................ 13.83 NA NA 8.58 9.29 2.26 090 

27181 .... ............ A ........ Treat slipped epiphysis ....................... 15.98 NA NA 9.76 10.00 1.57 090 

27185 .... ............ A ........ Revision of femur epiphysis ............... 9.67 NA NA 6.64 7.09 2.40 090 

27187 .... ............ A ........ Reinforce hip bones ........................... 14.09 NA NA 8.70 9.52 2.38 090 

27193 .... ............ A ........ Treat pelvic ring fracture .................... 5.98 4.62 4.86 4.75 4.90 0.96 090 

27194 .... ............ A ........ Treat pelvic ring fracture .................... 10.08 NA NA 6.63 7.14 1.65 090 

27200 .... ............ A ........ Treat tail bone fracture ....................... 1.87 2.06 2.15 2.21 2.16 0.28 090 

27202 .... ............ A ........ Treat tail bone fracture ....................... 7.25 NA NA 10.28 13.71 1.06 090 

27215 .... ............ A ........ Treat pelvic fracture(s) ....................... 10.45 NA NA 6.58 6.83 1.98 090 

27216 .... ............ A ........ Treat pelvic ring fracture .................... 15.73 NA NA 9.17 9.40 2.64 090 

27217 .... ............ A ........ Treat pelvic ring fracture .................... 14.65 NA NA 8.64 9.41 2.42 090 

mstockstill on PROD1PC66 with PROPOSALS2

38255 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

27218 .... ............ A ........ Treat pelvic ring fracture .................... 20.93 NA NA 11.36 11.39 3.49 090 

27220 .... ............ A ........ Treat hip socket fracture .................... 6.72 5.23 5.48 5.14 5.39 1.07 090 

27222 .... ............ A ........ Treat hip socket fracture .................... 13.97 NA NA 8.52 9.25 2.20 090 

27226 .... ............ A ........ Treat hip wall fracture ......................... 15.45 NA NA 8.94 8.39 2.49 090 

27227 .... ............ A ........ Treat hip fracture(s) ............................ 25.21 NA NA 13.42 14.43 4.06 090 

27228 .... ............ A ........ Treat hip fracture(s) ............................ 29.13 NA NA 14.90 16.29 4.67 090 

27230 .... ............ A ........ Treat thigh fracture ............................. 5.69 4.92 5.23 4.85 4.99 0.95 090 

27232 .... ............ A ........ Treat thigh fracture ............................. 11.66 NA NA 6.11 6.62 1.86 090 

27235 .... ............ A ........ Treat thigh fracture ............................. 12.88 NA NA 7.99 8.74 2.12 090 

27236 .... ............ A ........ Treat thigh fracture ............................. 17.43 NA NA 10.15 10.62 2.72 090 

27238 .... ............ A ........ Treat thigh fracture ............................. 5.64 NA NA 4.64 4.90 0.89 090 

27240 .... ............ A ........ Treat thigh fracture ............................. 13.66 NA NA 8.21 8.82 2.17 090 

27244 .... ............ A ........ Treat thigh fracture ............................. 17.08 NA NA 9.64 10.49 2.78 090 

27245 .... ............ A ........ Treat thigh fracture ............................. 21.09 NA NA 11.37 12.58 3.53 090 

27246 .... ............ A ........ Treat thigh fracture ............................. 4.75 3.90 4.19 3.94 4.18 0.81 090 

27248 .... ............ A ........ Treat thigh fracture ............................. 10.80 NA NA 6.94 7.59 1.82 090 

27250 .... ............ A ........ Treat hip dislocation ........................... 7.21 NA NA 4.26 4.45 0.62 090 

27252 .... ............ A ........ Treat hip dislocation ........................... 10.92 NA NA 6.48 6.97 1.66 090 

27253 .... ............ A ........ Treat hip dislocation ........................... 13.46 NA NA 8.18 9.00 2.25 090 

27254 .... ............ A ........ Treat hip dislocation ........................... 18.80 NA NA 10.56 11.30 3.18 090 

27256 .... ............ A ........ Treat hip dislocation ........................... 4.25 2.50 2.99 1.40 1.74 0.46 010 

27257 .... ............ A ........ Treat hip dislocation ........................... 5.35 NA NA 2.48 2.66 0.69 010 

27258 .... ............ A ........ Treat hip dislocation ........................... 16.04 NA NA 9.50 10.19 2.65 090 

27259 .... ............ A ........ Treat hip dislocation ........................... 23.03 NA NA 12.81 13.49 3.75 090 

27265 .... ............ A ........ Treat hip dislocation ........................... 5.12 NA NA 3.92 4.37 0.63 090 

27266 .... ............ A ........ Treat hip dislocation ........................... 7.67 NA NA 5.50 5.93 1.29 090 

27275 .... ............ A ........ Manipulation of hip joint ..................... 2.29 NA NA 1.85 1.98 0.39 010 

27280 .... ............ A ........ Fusion of sacroiliac joint ..................... 14.49 NA NA 8.89 9.61 2.54 090 

27282 .... ............ A ........ Fusion of pubic bones ........................ 11.71 NA NA 7.78 7.91 1.87 090 

27284 .... ............ A ........ Fusion of hip joint ............................... 24.91 NA NA 12.00 13.53 3.93 090 

27286 .... ............ A ........ Fusion of hip joint ............................... 24.97 NA NA 12.65 14.37 3.13 090 

27290 .... ............ A ........ Amputation of leg at hip ..................... 24.38 NA NA 12.14 13.17 3.44 090 

27295 .... ............ A ........ Amputation of leg at hip ..................... 19.54 NA NA 9.61 10.50 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 8.15 9.12 4.64 4.89 1.04 090 

27303 .... ............ A ........ Drainage of bone lesion ..................... 8.52 NA NA 5.99 6.50 1.43 090 

27305 .... ............ A ........ Incise thigh tendon & fascia ............... 6.09 NA NA 4.68 4.92 1.01 090 

27306 .... ............ A ........ Incision of thigh tendon ...................... 4.66 NA NA 4.07 4.40 0.85 090 

27307 .... ............ A ........ Incision of thigh tendons .................... 5.97 NA NA 4.73 5.07 1.04 090 

27310 .... ............ A ........ Exploration of knee joint ..................... 9.88 NA NA 6.78 7.19 1.61 090 

27323 .... ............ A ........ Biopsy, thigh soft tissues .................... 2.30 4.17 3.83 1.93 1.90 0.24 010 

27324 .... ............ A ........ Biopsy, thigh soft tissues .................... 4.95 NA NA 3.81 4.00 0.75 090 

27325 .... ............ A ........ Neurectomy, hamstring ...................... 7.09 NA NA 4.97 4.96 1.09 090 

27326 .... ............ A ........ Neurectomy, popliteal ......................... 6.36 NA NA 5.11 5.20 1.06 090 

27327 .... ............ A ........ Removal of thigh lesion ...................... 4.52 5.98 5.99 3.55 3.64 0.64 090 

27328 .... ............ A ........ Removal of thigh lesion ...................... 5.62 NA NA 4.05 4.21 0.84 090 

27329 .... ............ A ........ Remove tumor, thigh/knee ................. 15.68 NA NA 8.47 8.76 2.15 090 

27330 .... ............ A ........ Biopsy, knee joint lining ...................... 5.02 NA NA 4.25 4.39 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 6.63 1.43 090 

27333 .... ............ A ........ Removal of knee cartilage .................. 7.43 NA NA 5.68 6.19 1.26 090 

27334 .... ............ A ........ Remove knee joint lining .................... 9.07 NA NA 6.43 6.94 1.51 090 

27335 .... ............ A ........ Remove knee joint lining .................... 10.43 NA NA 7.02 7.63 1.75 090 

27340 .... ............ A ........ Removal of kneecap bursa ................ 4.23 NA NA 4.02 4.29 0.72 090 

27345 .... ............ A ........ Removal of knee cyst ......................... 5.98 NA NA 4.87 5.25 1.00 090 

27347 .... ............ A ........ Remove knee cyst .............................. 6.58 NA NA 5.24 5.33 0.98 090 

27350 .... ............ A ........ Removal of kneecap ........................... 8.54 NA NA 6.24 6.75 1.41 090 

27355 .... ............ A ........ Remove femur lesion ......................... 7.89 NA NA 5.81 6.30 1.32 090 

27356 .... ............ A ........ Remove femur lesion/graft ................. 9.97 NA NA 6.83 7.35 1.65 090 

27357 .... ............ A ........ Remove femur lesion/graft ................. 11.02 NA NA 7.48 8.11 1.96 090 

27358 .... ............ A ........ Remove femur lesion/fixation ............. 4.73 NA NA 1.81 2.18 0.82 ZZZ 

27360 .... ............ A ........ Partial removal, leg bone(s) ............... 11.34 NA NA 8.04 8.81 1.84 090 

27365 .... ............ A ........ Extensive leg surgery ......................... 17.93 NA NA 10.43 11.08 2.80 090 

27370 .... ............ A ........ Injection for knee x-ray ....................... 0.96 2.98 3.31 0.36 0.33 0.08 000 

27372 .... ............ A ........ Removal of foreign body .................... 5.12 8.25 9.16 4.03 4.36 0.84 090 

27380 .... ............ A ........ Repair of kneecap tendon .................. 7.34 NA NA 6.04 6.67 1.24 090 

27381 .... ............ A ........ Repair/graft kneecap tendon .............. 10.64 NA NA 7.56 8.33 1.80 090 

27385 .... ............ A ........ Repair of thigh muscle ....................... 8.00 NA NA 6.30 6.98 1.36 090 

27386 .... ............ A ........ Repair/graft of thigh muscle ............... 10.99 NA NA 7.92 8.73 1.86 090 

27390 .... ............ A ........ Incision of thigh tendon ...................... 5.44 NA NA 4.46 4.81 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 6.67 7.14 1.57 090 

mstockstill on PROD1PC66 with PROPOSALS2

38256 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

27393 .... ............ A ........ Lengthening of thigh tendon ............... 6.50 NA NA 4.95 5.40 1.10 090 

27394 .... ............ A ........ Lengthening of thigh tendons ............. 8.68 NA NA 6.14 6.69 1.47 090 

27395 .... ............ A ........ Lengthening of thigh tendons ............. 12.10 NA NA 7.93 8.64 2.05 090 

27396 .... ............ A ........ Transplant of thigh tendon ................. 8.04 NA NA 5.83 6.44 1.34 090 

27397 .... ............ A ........ Transplants of thigh tendons .............. 12.46 NA NA 8.35 8.71 1.83 090 

27400 .... ............ A ........ Revise thigh muscles/tendons ............ 9.21 NA NA 6.49 6.82 1.31 090 

27403 .... ............ A ........ Repair of knee cartilage ..................... 8.51 NA NA 6.02 6.61 1.44 090 

27405 .... ............ A ........ Repair of knee ligament ..................... 8.96 NA NA 6.38 6.95 1.51 090 

27407 .... ............ A ........ Repair of knee ligament ..................... 10.71 NA NA 6.84 7.56 1.79 090 

27409 .... ............ A ........ Repair of knee ligaments ................... 13.57 NA NA 8.26 9.14 2.25 090 

27412 .... ............ A ........ Autochondrocyte implant knee ........... 24.53 NA NA 13.69 14.25 4.36 090 

27415 .... ............ A ........ Osteochondral knee allograft ............. 19.79 NA NA 11.80 12.19 4.36 090 

27418 .... ............ A ........ Repair degenerated kneecap ............. 11.46 NA NA 7.57 8.25 1.89 090 

27420 .... ............ A ........ Revision of unstable kneecap ............ 10.14 NA NA 6.91 7.52 1.72 090 

27422 .... ............ A ........ Revision of unstable kneecap ............ 10.09 NA NA 6.88 7.51 1.71 090 

27424 .... ............ A ........ Revision/removal of kneecap ............. 10.12 NA NA 6.90 7.50 1.71 090 

27425 .... ............ A ........ Lat retinacular release open ............... 5.28 NA NA 4.69 5.11 0.90 090 

27427 .... ............ A ........ Reconstruction, knee .......................... 9.67 NA NA 6.69 7.25 1.63 090 

27428 .... ............ A ........ Reconstruction, knee .......................... 15.33 NA NA 10.04 10.66 2.43 090 

27429 .... ............ A ........ Reconstruction, knee .......................... 17.24 NA NA 11.27 11.86 2.71 090 

27430 .... ............ A ........ Revision of thigh muscles .................. 10.04 NA NA 6.84 7.43 1.70 090 

27435 .... ............ A ........ Incision of knee joint ........................... 10.68 NA NA 7.58 8.05 1.70 090 

27437 .... ............ A ........ Revise kneecap .................................. 8.82 NA NA 6.19 6.72 1.49 090 

27438 .... ............ A ........ Revise kneecap with implant .............. 11.77 NA NA 7.51 8.04 1.96 090 

27440 .... ............ A ........ Revision of knee joint ......................... 10.97 NA NA 7.01 6.53 1.82 090 

27441 .... ............ A ........ Revision of knee joint ......................... 11.42 NA NA 7.35 7.06 1.89 090 

27442 .... ............ A ........ Revision of knee joint ......................... 12.25 NA NA 7.65 8.31 2.10 090 

27443 .... ............ A ........ Revision of knee joint ......................... 11.29 NA NA 7.35 8.05 1.91 090 

27445 .... ............ A ........ Revision of knee joint ......................... 18.52 NA NA 10.44 11.42 3.09 090 

27446 .... ............ A ........ Revision of knee joint ......................... 16.26 NA NA 9.30 10.31 2.81 090 

27447 .... ............ A ........ Total knee arthroplasty ....................... 23.04 NA NA 12.61 13.63 3.80 090 

27448 .... ............ A ........ Incision of thigh .................................. 11.48 NA NA 7.32 7.99 1.95 090 

27450 .... ............ A ........ Incision of thigh .................................. 14.47 NA NA 8.85 9.72 2.43 090 

27454 .... ............ A ........ Realignment of thigh bone ................. 18.97 NA NA 10.74 11.63 3.13 090 

27455 .... ............ A ........ Realignment of knee .......................... 13.24 NA NA 8.31 9.12 2.25 090 

27457 .... ............ A ........ Realignment of knee .......................... 13.92 NA NA 8.24 9.09 2.35 090 

27465 .... ............ A ........ Shortening of thigh bone .................... 18.44 NA NA 10.31 10.28 2.48 090 

27466 .... ............ A ........ Lengthening of thigh bone .................. 17.13 NA NA 10.08 10.97 2.78 090 

27468 .... ............ A ........ Shorten/lengthen thighs ...................... 19.82 NA NA 11.20 11.80 3.31 090 

27470 .... ............ A ........ Repair of thigh .................................... 16.97 NA NA 10.18 11.00 2.80 090 

27472 .... ............ A ........ Repair/graft of thigh ............................ 18.57 NA NA 10.66 11.69 3.08 090 

27475 .... ............ A ........ Surgery to stop leg growth ................. 8.82 NA NA 6.20 6.82 1.36 090 

27477 .... ............ A ........ Surgery to stop leg growth ................. 10.03 NA NA 6.60 7.18 1.74 090 

27479 .... ............ A ........ Surgery to stop leg growth ................. 13.04 NA NA 8.90 8.63 2.79 090 

27485 .... ............ A ........ Surgery to stop leg growth ................. 9.02 NA NA 6.19 6.81 1.53 090 

27486 .... ............ A ........ Revise/replace knee joint ................... 20.92 NA NA 11.66 12.60 3.37 090 

27487 .... ............ A ........ Revise/replace knee joint ................... 26.91 NA NA 14.02 15.32 4.40 090 

27488 .... ............ A ........ Removal of knee prosthesis ............... 17.40 NA NA 10.27 11.00 2.75 090 

27495 .... ............ A ........ Reinforce thigh ................................... 16.40 NA NA 9.61 10.53 2.72 090 

27496 .... ............ A ........ Decompression of thigh/knee ............. 6.66 NA NA 4.95 5.29 0.99 090 

27497 .... ............ A ........ Decompression of thigh/knee ............. 7.70 NA NA 4.97 5.15 1.15 090 

27498 .... ............ A ........ Decompression of thigh/knee ............. 8.54 NA NA 5.21 5.61 1.24 090 

27499 .... ............ A ........ Decompression of thigh/knee ............. 9.31 NA NA 5.97 6.38 1.47 090 

27500 .... ............ A ........ Treatment of thigh fracture ................. 6.21 5.34 5.75 4.57 4.80 1.02 090 

27501 .... ............ A ........ Treatment of thigh fracture ................. 6.34 5.00 5.41 4.91 5.16 1.03 090 

27502 .... ............ A ........ Treatment of thigh fracture ................. 11.24 NA NA 6.86 7.50 1.79 090 

27503 .... ............ A ........ Treatment of thigh fracture ................. 11.13 NA NA 7.21 7.76 1.85 090 

27506 .... ............ A ........ Treatment of thigh fracture ................. 19.42 NA NA 11.38 12.06 3.04 090 

27507 .... ............ A ........ Treatment of thigh fracture ................. 14.39 NA NA 8.15 9.01 2.43 090 

27508 .... ............ A ........ Treatment of thigh fracture ................. 6.08 5.67 6.07 5.04 5.27 0.97 090 

27509 .... ............ A ........ Treatment of thigh fracture ................. 8.02 NA NA 6.53 7.25 1.34 090 

27510 .... ............ A ........ Treatment of thigh fracture ................. 9.68 NA NA 6.27 6.82 1.53 090 

27511 .... ............ A ........ Treatment of thigh fracture ................. 13.94 NA NA 9.04 10.13 2.38 090 

27513 .... ............ A ........ Treatment of thigh fracture ................. 19.45 NA NA 11.75 12.84 3.13 090 

27514 .... ............ A ........ Treatment of thigh fracture ................. 19.09 NA NA 11.87 12.64 3.01 090 

27516 .... ............ A ........ Treat thigh fx growth plate ................. 5.45 5.69 6.02 5.05 5.28 0.81 090 

27517 .... ............ A ........ Treat thigh fx growth plate ................. 8.98 NA NA 6.41 6.88 1.22 090 

27519 .... ............ A ........ Treat thigh fx growth plate ................. 15.80 NA NA 9.80 10.71 2.56 090 

27520 .... ............ A ........ Treat kneecap fracture ....................... 2.93 4.07 4.31 3.51 3.48 0.47 090 

27524 .... ............ A ........ Treat kneecap fracture ....................... 10.25 NA NA 6.94 7.59 1.75 090 

27530 .... ............ A ........ Treat knee fracture ............................. 3.97 4.80 5.06 4.24 4.33 0.65 090 

27532 .... ............ A ........ Treat knee fracture ............................. 7.43 6.38 6.88 5.62 6.05 1.26 090 

mstockstill on PROD1PC66 with PROPOSALS2

38257 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

27535 .... ............ A ........ Treat knee fracture ............................. 11.80 NA NA 8.20 9.17 2.01 090 

27536 .... ............ A ........ Treat knee fracture ............................. 17.19 NA NA 10.21 10.93 2.74 090 

27538 .... ............ A ........ Treat knee fracture(s) ......................... 4.95 5.49 5.82 4.87 5.04 0.84 090 

27540 .... ............ A ........ Treat knee fracture ............................. 13.45 NA NA 7.97 8.76 2.28 090 

27550 .... ............ A ........ Treat knee dislocation ........................ 5.84 5.20 5.63 4.50 4.73 0.76 090 

27552 .... ............ A ........ Treat knee dislocation ........................ 8.04 NA NA 6.08 6.53 1.36 090 

27556 .... ............ A ........ Treat knee dislocation ........................ 14.95 NA NA 9.27 10.48 2.51 090 

27557 .... ............ A ........ Treat knee dislocation ........................ 17.31 NA NA 10.50 11.83 2.98 090 

27558 .... ............ A ........ Treat knee dislocation ........................ 18.01 NA NA 10.37 11.76 3.09 090 

27560 .... ............ A ........ Treat kneecap dislocation .................. 3.88 4.21 4.48 3.68 3.39 0.40 090 

27562 .... ............ A ........ Treat kneecap dislocation .................. 5.86 NA NA 4.59 4.66 0.94 090 

27566 .... ............ A ........ Treat kneecap dislocation .................. 12.59 NA NA 7.89 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 12.21 13.54 3.38 090 

27590 .... ............ A ........ Amputate leg at thigh ......................... 13.35 NA NA 6.00 6.35 1.75 090 

27591 .... ............ A ........ Amputate leg at thigh ......................... 13.82 NA NA 7.35 8.01 2.03 090 

27592 .... ............ A ........ Amputate leg at thigh ......................... 10.86 NA NA 5.44 5.81 1.45 090 

27594 .... ............ A ........ Amputation follow-up surgery ............. 7.17 NA NA 4.71 4.95 1.02 090 

27596 .... ............ A ........ Amputation follow-up surgery ............. 11.15 NA NA 5.95 6.40 1.57 090 

27598 .... ............ A ........ Amputate lower leg at knee ............... 11.08 NA NA 6.18 6.63 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 3.78 4.17 0.86 090 

27601 .... ............ A ........ Decompression of lower leg ............... 5.94 NA NA 4.13 4.51 0.80 090 

27602 .... ............ A ........ Decompression of lower leg ............... 7.71 NA NA 4.27 4.72 1.10 090 

27603 .... ............ A ........ Drain lower leg lesion ......................... 5.12 6.97 7.24 3.88 4.03 0.74 090 

27604 .... ............ A ........ Drain lower leg bursa ......................... 4.51 6.40 6.25 3.39 3.68 0.69 090 

27605 .... ............ A ........ Incision of achilles tendon .................. 2.89 5.06 6.41 1.71 2.03 0.41 010 

27606 .... ............ A ........ Incision of achilles tendon .................. 4.15 NA NA 2.62 3.00 0.69 010 

27607 .... ............ A ........ Treat lower leg bone lesion ................ 8.51 NA NA 5.68 5.95 1.31 090 

27610 .... ............ A ........ Explore/treat ankle joint ...................... 9.01 NA NA 6.08 6.56 1.40 090 

27612 .... ............ A ........ Exploration of ankle joint .................... 8.01 NA NA 5.10 5.65 1.13 090 

27613 .... ............ A ........ Biopsy lower leg soft tissue ................ 2.19 3.87 3.55 1.76 1.78 0.20 010 

27614 .... ............ A ........ Biopsy lower leg soft tissue ................ 5.71 7.66 7.43 3.90 4.19 0.78 090 

27615 .... ............ A ........ Remove tumor, lower leg ................... 12.93 NA NA 7.93 8.69 1.84 090 

27618 .... ............ A ........ Remove lower leg lesion .................... 5.14 6.37 6.19 3.77 3.88 0.72 090 

27619 .... ............ A ........ Remove lower leg lesion .................... 8.47 9.91 9.74 5.24 5.61 1.25 090 

27620 .... ............ A ........ Explore/treat ankle joint ...................... 6.04 NA NA 4.54 5.01 0.97 090 

27625 .... ............ A ........ Remove ankle joint lining ................... 8.37 NA NA 5.45 5.98 1.28 090 

27626 .... ............ A ........ Remove ankle joint lining ................... 8.98 NA NA 5.73 6.37 1.48 090 

27630 .... ............ A ........ Removal of tendon lesion ................... 4.85 7.88 7.73 3.77 4.08 0.74 090 

27635 .... ............ A ........ Remove lower leg bone lesion ........... 7.91 NA NA 5.61 6.19 1.31 090 

27637 .... ............ A ........ Remove/graft leg bone lesion ............ 10.17 NA NA 6.96 7.67 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 8.13 9.24 1.89 090 

27641 .... ............ A ........ Partial removal of fibula ...................... 9.73 NA NA 6.71 7.54 1.46 090 

27645 .... ............ A ........ Extensive lower leg surgery ............... 14.78 NA NA 9.42 10.75 2.42 090 

27646 .... ............ A ........ Extensive lower leg surgery ............... 13.21 NA NA 8.25 9.68 2.06 090 

27647 .... ............ A ........ Extensive ankle/heel surgery ............. 12.85 NA NA 6.44 7.07 1.76 090 

27648 .... ............ A ........ Injection for ankle x-ray ...................... 0.96 2.85 3.15 0.34 0.33 0.08 000 

27650 .... ............ A ........ Repair achilles tendon ........................ 9.94 NA NA 6.13 6.86 1.59 090 

27652 .... ............ A ........ Repair/graft achilles tendon ................ 10.64 NA NA 6.37 7.22 1.72 090 

27654 .... ............ A ........ Repair of achilles tendon .................... 10.32 NA NA 5.93 6.55 1.58 090 

27656 .... ............ A ........ Repair leg fascia defect ...................... 4.62 7.88 8.23 3.56 3.69 0.69 090 

27658 .... ............ A ........ Repair of leg tendon, each ................. 5.03 NA NA 3.85 4.22 0.79 090 

27659 .... ............ A ........ Repair of leg tendon, each ................. 6.99 NA NA 4.62 5.18 1.09 090 

27664 .... ............ A ........ Repair of leg tendon, each ................. 4.64 NA NA 3.84 4.21 0.76 090 

27665 .... ............ A ........ Repair of leg tendon, each ................. 5.46 NA NA 4.28 4.66 0.89 090 

27675 .... ............ A ........ Repair lower leg tendons ................... 7.24 NA NA 4.61 5.20 1.11 090 

27676 .... ............ A ........ Repair lower leg tendons ................... 8.61 NA NA 5.68 6.23 1.37 090 

27680 .... ............ A ........ Release of lower leg tendon .............. 5.79 NA NA 4.12 4.66 0.93 090 

27681 .... ............ A ........ Release of lower leg tendons ............. 6.94 NA NA 5.07 5.44 1.15 090 

27685 .... ............ A ........ Revision of lower leg tendon .............. 6.57 8.62 7.99 4.50 5.01 0.97 090 

27686 .... ............ A ........ Revise lower leg tendons ................... 7.64 NA NA 5.25 5.90 1.24 090 

27687 .... ............ A ........ Revision of calf tendon ....................... 6.30 NA NA 4.42 4.89 1.00 090 

27690 .... ............ A ........ Revise lower leg tendon ..................... 8.96 NA NA 5.30 5.87 1.33 090 

27691 .... ............ A ........ Revise lower leg tendon ..................... 10.28 NA NA 6.63 7.22 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 4.83 5.38 1.05 090 

27696 .... ............ A ........ Repair of ankle ligaments ................... 8.46 NA NA 5.19 5.86 1.28 090 

27698 .... ............ A ........ Repair of ankle ligament .................... 9.49 NA NA 5.81 6.40 1.47 090 

27700 .... ............ A ........ Revision of ankle joint ........................ 9.54 NA NA 5.10 5.41 1.30 090 

27702 .... ............ A ........ Reconstruct ankle joint ....................... 14.28 NA NA 8.65 9.58 2.38 090 

mstockstill on PROD1PC66 with PROPOSALS2

38258 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

27703 .... ............ A ........ Reconstruction, ankle joint ................. 16.79 NA NA 9.78 10.53 2.77 090 

27704 .... ............ A ........ Removal of ankle implant ................... 7.69 NA NA 5.59 5.61 1.27 090 

27705 .... ............ A ........ Incision of tibia .................................... 10.74 NA NA 6.94 7.56 1.81 090 

27707 .... ............ A ........ Incision of fibula .................................. 4.67 NA NA 4.46 4.71 0.76 090 

27709 .... ............ A ........ Incision of tibia & fibula ...................... 17.32 NA NA 9.99 9.06 1.74 090 

27712 .... ............ A ........ Realignment of lower leg .................... 15.67 NA NA 9.63 10.12 2.48 090 

27715 .... ............ A ........ Revision of lower leg .......................... 15.36 NA NA 9.08 9.92 2.50 090 

27720 .... ............ A ........ Repair of tibia ..................................... 12.22 NA NA 7.92 8.67 2.05 090 

27722 .... ............ A ........ Repair/graft of tibia ............................. 12.31 NA NA 7.88 8.54 2.06 090 

27724 .... ............ A ........ Repair/graft of tibia ............................. 19.18 NA NA 10.31 11.35 3.17 090 

27725 .... ............ A ........ Repair of lower leg ............................. 17.15 NA NA 10.58 11.25 2.72 090 

27727 .... ............ A ........ Repair of lower leg ............................. 14.69 NA NA 9.07 9.64 2.44 090 

27730 .... ............ A ........ Repair of tibia epiphysis ..................... 7.59 NA NA 5.30 5.87 1.73 090 

27732 .... ............ A ........ Repair of fibula epiphysis ................... 5.37 NA NA 4.12 4.62 0.77 090 

27734 .... ............ A ........ Repair lower leg epiphyses ................ 8.72 NA NA 6.16 6.23 1.35 090 

27740 .... ............ A ........ Repair of leg epiphyses ...................... 9.49 NA NA 6.60 7.31 1.62 090 

27742 .... ............ A ........ Repair of leg epiphyses ...................... 10.49 NA NA 4.58 5.29 1.80 090 

27745 .... ............ A ........ Reinforce tibia ..................................... 10.37 NA NA 6.99 7.59 1.76 090 

27750 .... ............ A ........ Treatment of tibia fracture .................. 3.26 4.30 4.53 3.72 3.79 0.55 090 

27752 .... ............ A ........ Treatment of tibia fracture .................. 6.15 5.92 6.29 5.09 5.39 1.01 090 

27756 .... ............ A ........ Treatment of tibia fracture .................. 7.33 NA NA 5.75 6.11 1.17 090 

27758 .... ............ A ........ Treatment of tibia fracture .................. 12.40 NA NA 8.02 8.61 2.04 090 

27759 .... ............ A ........ Treatment of tibia fracture .................. 14.31 NA NA 8.68 9.51 2.39 090 

27760 .... ............ A ........ Treatment of ankle fracture ................ 3.09 4.25 4.47 3.65 3.63 0.48 090 

27762 .... ............ A ........ Treatment of ankle fracture ................ 5.33 5.44 5.91 4.63 4.97 0.85 090 

27766 .... ............ A ........ Treatment of ankle fracture ................ 8.73 NA NA 6.24 6.74 1.44 090 

27780 .... ............ A ........ Treatment of fibula fracture ................ 2.72 3.84 4.02 3.29 3.26 0.41 090 

27781 .... ............ A ........ Treatment of fibula fracture ................ 4.47 4.85 5.19 4.24 4.46 0.73 090 

27784 .... ............ A ........ Treatment of fibula fracture ................ 7.41 NA NA 5.56 6.03 1.23 090 

27786 .... ............ A ........ Treatment of ankle fracture ................ 2.91 4.02 4.25 3.41 3.38 0.46 090 

27788 .... ............ A ........ Treatment of ankle fracture ................ 4.52 4.94 5.30 4.21 4.44 0.74 090 

27792 .... ............ A ........ Treatment of ankle fracture ................ 7.91 NA NA 5.90 6.44 1.32 090 

27808 .... ............ A ........ Treatment of ankle fracture ................ 2.91 4.37 4.59 3.68 3.69 0.46 090 

27810 .... ............ A ........ Treatment of ankle fracture ................ 5.20 5.37 5.82 4.53 4.86 0.82 090 

27814 .... ............ A ........ Treatment of ankle fracture ................ 11.10 NA NA 7.23 7.91 1.86 090 

27816 .... ............ A ........ Treatment of ankle fracture ................ 2.96 3.96 4.18 3.31 3.37 0.43 090 

27818 .... ............ A ........ Treatment of ankle fracture ................ 5.57 5.38 5.89 4.42 4.81 0.82 090 

27822 .... ............ A ........ Treatment of ankle fracture ................ 12.12 NA NA 8.84 9.75 1.92 090 

27823 .... ............ A ........ Treatment of ankle fracture ................ 14.26 NA NA 9.40 10.46 2.26 090 

27824 .... ............ A ........ Treat lower leg fracture ...................... 3.20 3.63 3.86 3.44 3.52 0.45 090 

27825 .... ............ A ........ Treat lower leg fracture ...................... 6.60 5.76 6.20 4.75 5.08 1.02 090 

27826 .... ............ A ........ Treat lower leg fracture ...................... 8.97 NA NA 7.00 7.91 1.47 090 

27827 .... ............ A ........ Treat lower leg fracture ...................... 15.75 NA NA 10.75 11.77 2.44 090 

27828 .... ............ A ........ Treat lower leg fracture ...................... 18.19 NA NA 12.22 13.11 2.82 090 

27829 .... ............ A ........ Treat lower leg joint ............................ 5.68 NA NA 5.47 6.14 0.95 090 

27830 .... ............ A ........ Treat lower leg dislocation ................. 3.85 4.06 4.27 3.54 3.73 0.54 090 

27831 .... ............ A ........ Treat lower leg dislocation ................. 4.62 NA NA 4.04 4.25 0.73 090 

27832 .... ............ A ........ Treat lower leg dislocation ................. 6.67 NA NA 5.11 5.58 1.03 090 

27840 .... ............ A ........ Treat ankle dislocation ....................... 4.65 NA NA 3.62 3.69 0.46 090 

27842 .... ............ A ........ Treat ankle dislocation ....................... 6.34 NA NA 4.84 4.99 1.00 090 

27846 .... ............ A ........ Treat ankle dislocation ....................... 10.16 NA NA 6.75 7.36 1.71 090 

27848 .... ............ A ........ Treat ankle dislocation ....................... 11.56 NA NA 7.70 8.71 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 9.06 9.82 2.37 090 

27871 .... ............ A ........ Fusion of tibiofibular joint ................... 9.42 NA NA 6.52 7.05 1.59 090 

27880 .... ............ A ........ Amputation of lower leg ...................... 15.24 NA NA 6.63 6.90 1.76 090 

27881 .... ............ A ........ Amputation of lower leg ...................... 13.32 NA NA 7.36 8.12 1.99 090 

27882 .... ............ A ........ Amputation of lower leg ...................... 9.67 NA NA 5.47 5.98 1.29 090 

27884 .... ............ A ........ Amputation follow-up surgery ............. 8.64 NA NA 5.08 5.42 1.22 090 

27886 .... ............ A ........ Amputation follow-up surgery ............. 9.88 NA NA 5.63 6.09 1.40 090 

27888 .... ............ A ........ Amputation of foot at ankle ................ 10.23 NA NA 5.96 6.78 1.51 090 

27889 .... ............ A ........ Amputation of foot at ankle ................ 10.72 NA NA 5.41 5.93 1.46 090 

27892 .... ............ A ........ Decompression of leg ......................... 7.82 NA NA 5.10 5.31 1.10 090 

27893 .... ............ A ........ Decompression of leg ......................... 7.78 NA NA 5.10 5.29 1.10 090 

27894 .... ............ A ........ Decompression of leg ......................... 12.42 NA NA 7.33 7.56 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 3.89 3.46 1.56 1.77 0.33 010 

28002 .... ............ A ........ Treatment of foot infection ................. 5.78 6.52 5.80 3.49 3.66 0.61 010 

28003 .... ............ A ........ Treatment of foot infection ................. 8.95 7.62 6.97 4.47 4.88 1.12 090 

28005 .... ............ A ........ Treat foot bone lesion ........................ 9.30 NA NA 5.27 5.70 1.16 090 

28008 .... ............ A ........ Incision of foot fascia .......................... 4.50 6.03 5.32 2.93 3.09 0.57 090 

28010 .... ............ A ........ Incision of toe tendon ......................... 2.89 2.79 2.60 2.29 2.34 0.36 090 

mstockstill on PROD1PC66 with PROPOSALS2

38259 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

28011 .... ............ A ........ Incision of toe tendons ....................... 4.19 3.71 3.53 2.96 3.15 0.59 090 

28020 .... ............ A ........ Exploration of foot joint ....................... 5.06 7.22 6.67 3.52 3.86 0.72 090 

28022 .... ............ A ........ Exploration of foot joint ....................... 4.72 6.77 6.01 3.25 3.57 0.62 090 

28024 .... ............ A ........ Exploration of toe joint ........................ 4.43 6.40 5.86 3.05 3.52 0.58 090 

28035 .... ............ A ........ Decompression of tibia nerve ............. 5.14 7.13 6.56 3.48 3.83 0.70 090 

28043 .... ............ A ........ Excision of foot lesion ........................ 3.58 4.67 4.27 2.67 2.94 0.46 090 

28045 .... ............ A ........ Excision of foot lesion ........................ 4.77 6.86 6.16 3.17 3.41 0.63 090 

28046 .... ............ A ........ Resection of tumor, foot ..................... 10.55 10.19 9.53 5.67 6.11 1.36 090 

28050 .... ............ A ........ Biopsy of foot joint lining .................... 4.30 6.81 5.87 3.23 3.42 0.60 090 

28052 .... ............ A ........ Biopsy of foot joint lining .................... 3.98 6.16 5.59 2.81 3.15 0.53 090 

28054 .... ............ A ........ Biopsy of toe joint lining ..................... 3.49 6.10 5.43 2.73 3.00 0.46 090 

28055 .... ............ A ........ Neurectomy, foot ................................ 6.20 NA NA 3.34 3.55 0.74 090 

28060 .... ............ A ........ Partial removal, foot fascia ................. 5.29 6.90 6.23 3.45 3.69 0.70 090 

28062 .... ............ A ........ Removal of foot fascia ........................ 6.58 7.61 7.12 3.71 3.90 0.83 090 

28070 .... ............ A ........ Removal of foot joint lining ................. 5.15 7.21 6.22 3.47 3.65 0.73 090 

28072 .... ............ A ........ Removal of foot joint lining ................. 4.63 7.46 6.52 3.56 3.95 0.68 090 

28080 .... ............ A ........ Removal of foot lesion ........................ 4.65 7.49 6.34 4.09 3.92 0.47 090 

28086 .... ............ A ........ Excise foot tendon sheath .................. 4.83 7.75 7.88 3.77 4.24 0.76 090 

28088 .... ............ A ........ Excise foot tendon sheath .................. 3.90 6.89 6.34 3.15 3.53 0.61 090 

28090 .... ............ A ........ Removal of foot lesion ........................ 4.46 6.61 5.92 3.10 3.30 0.59 090 

28092 .... ............ A ........ Removal of toe lesions ....................... 3.69 6.32 5.81 2.92 3.24 0.49 090 

28100 .... ............ A ........ Removal of ankle/heel lesion ............. 5.72 7.96 8.01 3.94 4.35 0.82 090 

28102 .... ............ A ........ Remove/graft foot lesion .................... 7.80 NA NA 4.76 5.39 1.14 090 

28103 .... ............ A ........ Remove/graft foot lesion .................... 6.56 NA NA 3.94 4.32 0.91 090 

28104 .... ............ A ........ Removal of foot lesion ........................ 5.17 7.08 6.32 3.40 3.68 0.70 090 

28106 .... ............ A ........ Remove/graft foot lesion .................... 7.23 NA NA 4.12 4.34 0.97 090 

28107 .... ............ A ........ Remove/graft foot lesion .................... 5.62 7.52 7.09 3.57 3.92 0.74 090 

28108 .... ............ A ........ Removal of toe lesions ....................... 4.21 6.18 5.43 2.91 3.10 0.53 090 

28110 .... ............ A ........ Part removal of metatarsal ................. 4.13 6.77 6.03 2.99 3.13 0.54 090 

28111 .... ............ A ........ Part removal of metatarsal ................. 5.06 6.95 6.68 3.13 3.43 0.67 090 

28112 .... ............ A ........ Part removal of metatarsal ................. 4.54 7.03 6.46 3.17 3.40 0.61 090 

28113 .... ............ A ........ Part removal of metatarsal ................. 5.88 8.16 7.16 4.49 4.44 0.63 090 

28114 .... ............ A ........ Removal of metatarsal heads ............ 11.61 13.18 12.44 8.18 8.31 1.42 090 

28116 .... ............ A ........ Revision of foot ................................... 8.94 9.24 8.07 5.23 5.24 1.03 090 

28118 .... ............ A ........ Removal of heel bone ........................ 6.02 7.77 7.04 3.95 4.17 0.84 090 

28119 .... ............ A ........ Removal of heel spur ......................... 5.45 7.03 6.27 3.48 3.63 0.70 090 

28120 .... ............ A ........ Part removal of ankle/heel ................. 5.64 7.94 7.65 3.90 4.17 0.77 090 

28122 .... ............ A ........ Partial removal of foot bone ............... 7.56 8.27 7.60 4.67 5.00 0.98 090 

28124 .... ............ A ........ Partial removal of toe ......................... 4.88 6.59 5.84 3.36 3.53 0.60 090 

28126 .... ............ A ........ Partial removal of toe ......................... 3.56 5.81 5.04 2.59 2.81 0.45 090 

28130 .... ............ A ........ Removal of ankle bone ...................... 9.30 NA NA 6.06 6.37 1.26 090 

28140 .... ............ A ........ Removal of metatarsal ....................... 7.03 7.66 7.48 4.04 4.43 0.92 090 

28150 .... ............ A ........ Removal of toe ................................... 4.14 6.20 5.56 2.90 3.12 0.53 090 

28153 .... ............ A ........ Partial removal of toe ......................... 3.71 6.05 5.21 2.81 2.76 0.47 090 

28160 .... ............ A ........ Partial removal of toe ......................... 3.79 6.15 5.40 2.85 3.12 0.49 090 

28171 .... ............ A ........ Extensive foot surgery ........................ 9.85 NA NA 4.98 5.27 1.33 090 

28173 .... ............ A ........ Extensive foot surgery ........................ 9.05 8.55 8.13 4.51 4.89 1.12 090 

28175 .... ............ A ........ Extensive foot surgery ........................ 6.17 6.95 6.37 3.52 3.64 0.73 090 

28190 .... ............ A ........ Removal of foot foreign body ............. 1.98 3.92 3.67 1.31 1.40 0.22 010 

28192 .... ............ A ........ Removal of foot foreign body ............. 4.69 6.56 6.05 3.11 3.40 0.61 090 

28193 .... ............ A ........ Removal of foot foreign body ............. 5.79 7.17 6.42 3.55 3.76 0.73 090 

28200 .... ............ A ........ Repair of foot tendon .......................... 4.65 6.72 5.95 3.16 3.38 0.61 090 

28202 .... ............ A ........ Repair/graft of foot tendon ................. 6.96 7.53 7.46 3.81 4.20 0.91 090 

28208 .... ............ A ........ Repair of foot tendon .......................... 4.42 6.54 5.71 3.11 3.22 0.58 090 

28210 .... ............ A ........ Repair/graft of foot tendon ................. 6.41 7.42 6.85 3.82 3.95 0.81 090 

28220 .... ............ A ........ Release of foot tendon ....................... 4.58 6.24 5.49 2.99 3.23 0.57 090 

28222 .... ............ A ........ Release of foot tendons ..................... 5.67 6.74 6.03 3.25 3.71 0.69 090 

28225 .... ............ A ........ Release of foot tendon ....................... 3.70 5.86 5.11 2.64 2.79 0.46 090 

28226 .... ............ A ........ Release of foot tendons ..................... 4.58 6.74 5.81 3.19 3.50 0.58 090 

28230 .... ............ A ........ Incision of foot tendon(s) .................... 4.28 6.10 5.43 2.80 3.26 0.55 090 

28232 .... ............ A ........ Incision of toe tendon ......................... 3.43 5.77 5.18 2.60 2.97 0.44 090 

28234 .... ............ A ........ Incision of foot tendon ........................ 3.43 6.14 5.44 2.98 3.19 0.44 090 

28238 .... ............ A ........ Revision of foot tendon ...................... 7.85 8.21 7.76 4.28 4.63 1.06 090 

28240 .... ............ A ........ Release of big toe .............................. 4.40 6.19 5.46 2.87 3.20 0.58 090 

28250 .... ............ A ........ Revision of foot fascia ........................ 5.97 7.40 6.53 3.75 3.95 0.82 090 

28260 .... ............ A ........ Release of midfoot joint ...................... 8.08 8.28 7.37 4.53 4.80 1.14 090 

28261 .... ............ A ........ Revision of foot tendon ...................... 12.91 10.42 9.59 6.18 6.79 1.57 090 

28262 .... ............ A ........ Revision of foot and ankle .................. 17.01 15.42 14.52 9.71 10.34 2.60 090 

28264 .... ............ A ........ Release of midfoot joint ...................... 10.53 10.12 8.99 5.85 6.61 1.54 090 

28270 .... ............ A ........ Release of foot contracture ................ 4.82 6.75 5.86 3.36 3.57 0.62 090 

28272 .... ............ A ........ Release of toe joint, each .................. 3.84 5.67 4.96 2.57 2.73 0.46 090 

28280 .... ............ A ........ Fusion of toes ..................................... 5.24 7.14 6.73 3.47 4.00 0.73 090 

mstockstill on PROD1PC66 with PROPOSALS2

38260 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

28285 .... ............ A ........ Repair of hammertoe .......................... 4.65 6.54 5.74 3.26 3.37 0.59 090 

28286 .... ............ A ........ Repair of hammertoe .......................... 4.61 6.35 5.60 2.97 3.13 0.57 090 

28288 .... ............ A ........ Partial removal of foot bone ............... 5.81 8.42 7.22 4.60 4.77 0.65 090 

28289 .... ............ A ........ Repair hallux rigidus ........................... 8.11 9.25 8.66 5.24 5.53 1.02 090 

28290 .... ............ A ........ Correction of bunion ........................... 5.72 8.02 7.17 3.89 4.33 0.82 090 

28292 .... ............ A ........ Correction of bunion ........................... 8.72 10.08 8.83 6.00 5.81 0.91 090 

28293 .... ............ A ........ Correction of bunion ........................... 11.10 14.07 12.50 6.72 6.47 1.13 090 

28294 .... ............ A ........ Correction of bunion ........................... 8.63 9.21 8.32 4.64 4.68 1.09 090 

28296 .... ............ A ........ Correction of bunion ........................... 9.31 9.33 8.80 4.67 5.08 1.19 090 

28297 .... ............ A ........ Correction of bunion ........................... 9.31 10.29 9.66 5.25 5.78 1.32 090 

28298 .... ............ A ........ Correction of bunion ........................... 8.01 9.07 8.18 4.48 4.77 1.05 090 

28299 .... ............ A ........ Correction of bunion ........................... 11.39 10.29 9.59 5.58 5.87 1.37 090 

28300 .... ............ A ........ Incision of heel bone .......................... 9.61 NA NA 5.99 6.54 1.54 090 

28302 .... ............ A ........ Incision of ankle bone ........................ 9.62 NA NA 6.18 6.47 1.42 090 

28304 .... ............ A ........ Incision of midfoot bones ................... 9.29 9.38 8.70 4.99 5.39 1.27 090 

28305 .... ............ A ........ Incise/graft midfoot bones .................. 10.63 NA NA 5.68 6.21 1.27 090 

28306 .... ............ A ........ Incision of metatarsal ......................... 5.91 8.26 7.57 3.82 4.01 0.84 090 

28307 .... ............ A ........ Incision of metatarsal ......................... 6.39 9.12 10.14 4.27 4.82 0.90 090 

28308 .... ............ A ........ Incision of metatarsal ......................... 5.36 7.73 6.78 3.74 3.73 0.70 090 

28309 .... ............ A ........ Incision of metatarsals ........................ 13.96 NA NA 7.62 7.83 2.05 090 

28310 .... ............ A ........ Revision of big toe .............................. 5.48 7.35 6.58 3.33 3.46 0.70 090 

28312 .... ............ A ........ Revision of toe .................................... 4.60 7.19 6.35 3.16 3.41 0.63 090 

28313 .... ............ A ........ Repair deformity of toe ....................... 5.06 7.13 6.24 3.54 4.21 0.73 090 

28315 .... ............ A ........ Removal of sesamoid bone ................ 4.91 6.51 5.74 3.14 3.26 0.63 090 

28320 .... ............ A ........ Repair of foot bones ........................... 9.25 NA NA 5.63 6.20 1.43 090 

28322 .... ............ A ........ Repair of metatarsals ......................... 8.41 9.61 9.46 5.26 5.84 1.27 090 

28340 .... ............ A ........ Resect enlarged toe tissue ................. 7.04 7.90 7.21 3.98 4.14 0.84 090 

28341 .... ............ A ........ Resect enlarged toe ........................... 8.60 8.36 7.71 4.29 4.60 1.01 090 

28344 .... ............ A ........ Repair extra toe(s) .............................. 4.31 6.28 6.10 2.87 3.30 0.51 090 

28345 .... ............ A ........ Repair webbed toe(s) ......................... 5.98 7.45 6.88 3.70 4.23 0.80 090 

28360 .... ............ A ........ Reconstruct cleft foot .......................... 14.67 NA NA 6.31 8.40 2.29 090 

28400 .... ............ A ........ Treatment of heel fracture .................. 2.22 3.33 3.49 2.89 2.98 0.35 090 

28405 .... ............ A ........ Treatment of heel fracture .................. 4.63 4.36 4.63 3.62 4.15 0.73 090 

28406 .... ............ A ........ Treatment of heel fracture .................. 6.44 NA NA 5.52 6.19 1.11 090 

28415 .... ............ A ........ Treat heel fracture .............................. 17.54 NA NA 10.92 12.11 2.67 090 

28420 .... ............ A ........ Treat/graft heel fracture ...................... 17.07 NA NA 9.59 11.36 2.81 090 

28430 .... ............ A ........ Treatment of ankle fracture ................ 2.14 3.09 3.25 2.55 2.56 0.31 090 

28435 .... ............ A ........ Treatment of ankle fracture ................ 3.45 3.94 3.89 3.22 3.46 0.55 090 

28436 .... ............ A ........ Treatment of ankle fracture ................ 4.78 NA NA 4.65 5.34 0.81 090 

28445 .... ............ A ........ Treat ankle fracture ............................ 17.07 NA NA 9.72 10.39 2.59 090 

28450 .... ............ A ........ Treat midfoot fracture, each ............... 1.95 2.87 3.00 2.38 2.43 0.28 090 

28455 .... ............ A ........ Treat midfoot fracture, each ............... 3.15 3.69 3.56 3.06 3.24 0.44 090 

28456 .... ............ A ........ Treat midfoot fracture ......................... 2.75 NA NA 3.51 3.85 0.44 090 

28465 .... ............ A ........ Treat midfoot fracture, each ............... 7.13 NA NA 5.04 5.69 1.10 090 

28470 .... ............ A ........ Treat metatarsal fracture .................... 1.99 2.77 2.96 2.34 2.40 0.30 090 

28475 .... ............ A ........ Treat metatarsal fracture .................... 2.97 3.08 3.22 2.47 2.86 0.44 090 

28476 .... ............ A ........ Treat metatarsal fracture .................... 3.46 NA NA 4.27 4.64 0.54 090 

28485 .... ............ A ........ Treat metatarsal fracture .................... 5.77 NA NA 4.48 4.98 0.83 090 

28490 .... ............ A ........ Treat big toe fracture .......................... 1.12 2.05 2.04 1.64 1.65 0.14 090 

28495 .... ............ A ........ Treat big toe fracture .......................... 1.62 2.41 2.30 1.82 1.95 0.20 090 

28496 .... ............ A ........ Treat big toe fracture .......................... 2.39 7.31 7.76 2.95 3.06 0.36 090 

28505 .... ............ A ........ Treat big toe fracture .......................... 3.86 7.23 7.71 3.15 3.55 0.56 090 

28510 .... ............ A ........ Treatment of toe fracture .................... 1.12 1.65 1.60 1.58 1.56 0.14 090 

28515 .... ............ A ........ Treatment of toe fracture .................... 1.50 2.17 2.04 1.78 1.85 0.18 090 

28525 .... ............ A ........ Treat toe fracture ................................ 3.37 6.82 7.18 2.89 3.17 0.49 090 

28530 .... ............ A ........ Treat sesamoid bone fracture ............ 1.08 1.58 1.52 1.31 1.38 0.14 090 

28531 .... ............ A ........ Treat sesamoid bone fracture ............ 2.51 6.42 6.75 2.38 2.18 0.34 090 

28540 .... ............ A ........ Treat foot dislocation .......................... 2.10 2.68 2.56 2.25 2.34 0.26 090 

28545 .... ............ A ........ Treat foot dislocation .......................... 2.51 3.42 2.87 2.80 2.56 0.37 090 

28546 .... ............ A ........ Treat foot dislocation .......................... 3.28 7.91 7.37 3.58 3.97 0.52 090 

28555 .... ............ A ........ Repair foot dislocation ........................ 6.42 9.38 9.71 4.75 5.25 1.04 090 

28570 .... ............ A ........ Treat foot dislocation .......................... 1.70 2.43 2.46 1.87 2.12 0.23 090 

28575 .... ............ A ........ Treat foot dislocation .......................... 3.38 4.37 4.05 3.68 3.70 0.56 090 

28576 .... ............ A ........ Treat foot dislocation .......................... 4.48 NA NA 4.01 4.10 0.69 090 

28585 .... ............ A ........ Repair foot dislocation ........................ 8.17 9.70 8.55 5.10 5.51 1.25 090 

28600 .... ............ A ........ Treat foot dislocation .......................... 1.94 2.98 2.91 2.34 2.52 0.27 090 

28605 .... ............ A ........ Treat foot dislocation .......................... 2.78 3.90 3.49 3.29 3.18 0.40 090 

28606 .... ............ A ........ Treat foot dislocation .......................... 4.97 NA NA 4.10 4.43 0.82 090 

28615 .... ............ A ........ Repair foot dislocation ........................ 8.96 NA NA 6.87 7.48 1.30 090 

28630 .... ............ A ........ Treat toe dislocation ........................... 1.72 1.81 1.72 0.90 0.96 0.20 010 

28635 .... ............ A ........ Treat toe dislocation ........................... 1.93 2.21 2.13 1.30 1.42 0.26 010 

28636 .... ............ A ........ Treat toe dislocation ........................... 2.77 4.33 4.10 2.03 2.33 0.43 010 

mstockstill on PROD1PC66 with PROPOSALS2

38261 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

28645 .... ............ A ........ Repair toe dislocation ......................... 4.27 6.72 5.87 3.13 3.22 0.57 090 

28660 .... ............ A ........ Treat toe dislocation ........................... 1.25 1.28 1.27 0.77 0.78 0.13 010 

28665 .... ............ A ........ Treat toe dislocation ........................... 1.94 1.79 1.62 1.30 1.37 0.26 010 

28666 .... ............ A ........ Treat toe dislocation ........................... 2.66 NA NA 1.80 2.21 0.43 010 

28675 .... ............ A ........ Repair of toe dislocation ..................... 2.97 6.61 6.89 2.84 3.10 0.45 090 

28705 .... ............ A ........ Fusion of foot bones ........................... 20.12 NA NA 10.61 11.56 3.09 090 

28715 .... ............ A ........ Fusion of foot bones ........................... 14.40 NA NA 8.45 9.12 2.17 090 

28725 .... ............ A ........ Fusion of foot bones ........................... 11.97 NA NA 6.77 7.54 1.87 090 

28730 .... ............ A ........ Fusion of foot bones ........................... 12.21 NA NA 7.68 8.11 1.71 090 

28735 .... ............ A ........ Fusion of foot bones ........................... 12.03 NA NA 6.90 7.39 1.69 090 

28737 .... ............ A ........ Revision of foot bones ........................ 10.83 NA NA 5.99 6.43 1.47 090 

28740 .... ............ A ........ Fusion of foot bones ........................... 9.09 10.71 10.83 5.91 6.22 1.22 090 

28750 .... ............ A ........ Fusion of big toe joint ......................... 8.37 10.62 11.31 5.82 6.27 1.13 090 

28755 .... ............ A ........ Fusion of big toe joint ......................... 4.79 7.10 6.63 3.28 3.53 0.65 090 

28760 .... ............ A ........ Fusion of big toe joint ......................... 8.94 9.63 8.87 5.14 5.37 1.05 090 

28800 .... ............ A ........ Amputation of midfoot ........................ 8.65 NA NA 4.93 5.39 1.15 090 

28805 .... ............ A ........ Amputation thru metatarsal ................ 12.55 NA NA 5.83 5.77 1.18 090 

28810 .... ............ A ........ Amputation toe & metatarsal .............. 6.52 NA NA 4.01 4.26 0.86 090 

28820 .... ............ A ........ Amputation of toe ............................... 4.89 7.51 7.57 3.49 3.66 0.61 090 

28825 .... ............ A ........ Partial amputation of toe .................... 3.71 7.00 7.03 3.07 3.29 0.50 090 

28890 .... ............ A ........ High energy eswt, plantar f ................ 3.36 4.43 5.13 2.13 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 3.94 3.58 1.63 1.72 0.41 000 

29010 .... ............ A ........ Application of body cast ..................... 2.06 4.35 3.65 1.62 1.65 0.45 000 

29015 .... ............ A ........ Application of body cast ..................... 2.41 3.58 3.24 1.56 1.57 0.28 000 

29020 .... ............ A ........ Application of body cast ..................... 2.11 3.79 3.49 1.41 1.43 0.28 000 

29025 .... ............ A ........ Application of body cast ..................... 2.40 4.02 3.51 1.77 1.78 0.44 000 

29035 .... ............ A ........ Application of body cast ..................... 1.77 3.67 3.64 1.47 1.52 0.28 000 

29040 .... ............ A ........ Application of body cast ..................... 2.22 3.25 2.92 1.34 1.45 0.36 000 

29044 .... ............ A ........ Application of body cast ..................... 2.12 3.83 3.92 1.65 1.84 0.35 000 

29046 .... ............ A ........ Application of body cast ..................... 2.41 4.46 3.80 1.91 1.98 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 2.79 2.90 1.22 1.36 0.30 000 

29058 .... ............ A ........ Application of shoulder cast ............... 1.31 1.25 1.40 0.67 0.70 0.17 000 

29065 .... ............ A ........ Application of long arm cast ............... 0.87 1.27 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 1.25 1.27 0.68 0.66 0.14 000 

29086 .... ............ A ........ Apply finger cast ................................. 0.62 1.07 1.01 0.55 0.52 0.07 000 

29105 .... ............ A ........ Apply long arm splint .......................... 0.87 1.08 1.16 0.53 0.52 0.12 000 

29125 .... ............ A ........ Apply forearm splint ............................ 0.59 0.96 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 0.67 0.24 0.25 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 0.64 0.67 0.38 0.38 0.04 000 

29240 .... ............ A ........ Strapping of shoulder ......................... 0.71 0.68 0.77 0.40 0.38 0.06 000 

29260 .... ............ A ........ Strapping of elbow or wrist ................. 0.55 0.67 0.70 0.37 0.34 0.05 000 

29280 .... ............ A ........ Strapping of hand or finger ................ 0.51 0.66 0.73 0.37 0.34 0.03 000 

29305 .... ............ A ........ Application of hip cast ........................ 2.03 3.26 3.32 1.55 1.66 0.35 000 

29325 .... ............ A ........ Application of hip casts ...................... 2.32 3.32 3.49 1.59 1.80 0.40 000 

29345 .... ............ A ........ Application of long leg cast ................ 1.40 1.65 1.71 0.94 1.00 0.24 000 

29355 .... ............ A ........ Application of long leg cast ................ 1.53 1.61 1.66 0.93 1.03 0.26 000 

29358 .... ............ A ........ Apply long leg cast brace ................... 1.43 1.99 2.04 0.91 1.00 0.25 000 

29365 .... ............ A ........ Application of long leg cast ................ 1.18 1.57 1.62 0.85 0.90 0.20 000 

29405 .... ............ A ........ Apply short leg cast ............................ 0.86 1.18 1.21 0.65 0.68 0.14 000 

29425 .... ............ A ........ Apply short leg cast ............................ 1.01 1.20 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 0.63 0.66 0.26 0.27 0.08 000 

29445 .... ............ A ........ Apply rigid leg cast ............................. 1.78 1.54 1.69 0.88 0.93 0.27 000 

29450 .... ............ A ........ Application of leg cast ........................ 2.08 1.56 1.51 0.88 0.99 0.27 000 

29505 .... ............ A ........ Application, long leg splint .................. 0.69 1.06 1.12 0.45 0.45 0.08 000 

29515 .... ............ A ........ Application lower leg splint ................. 0.73 0.94 0.91 0.45 0.46 0.09 000 

29520 .... ............ A ........ Strapping of hip .................................. 0.54 0.65 0.76 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 0.53 0.48 0.30 0.31 0.06 000 

29550 .... ............ A ........ Strapping of toes ................................ 0.47 0.54 0.49 0.29 0.29 0.06 000 

29580 .... ............ A ........ Application of paste boot .................... 0.55 0.70 0.68 0.33 0.34 0.07 000 

29590 .... ............ A ........ Application of foot splint ..................... 0.76 0.58 0.55 0.25 0.28 0.09 000 

29700 .... ............ A ........ Removal/revision of cast .................... 0.57 0.94 0.92 0.25 0.27 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 1.30 1.44 0.55 0.64 0.20 000 

29715 .... ............ A ........ Removal/revision of cast .................... 0.94 1.21 1.18 0.44 0.41 0.09 000 

mstockstill on PROD1PC66 with PROPOSALS2

38262 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

29720 .... ............ A ........ Repair of body cast ............................ 0.68 1.16 1.16 0.35 0.37 0.12 000 

29730 .... ............ A ........ Windowing of cast .............................. 0.75 0.73 0.78 0.33 0.34 0.12 000 

29740 .... ............ A ........ Wedging of cast .................................. 1.12 1.03 1.10 0.47 0.48 0.18 000 

29750 .... ............ A ........ Wedging of clubfoot cast .................... 1.26 1.05 1.04 0.52 0.54 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 4.64 5.86 0.99 090 

29804 .... ............ A ........ Jaw arthroscopy/surgery .................... 8.71 NA NA 5.77 6.68 1.38 090 

29805 .... ............ A ........ Shoulder arthroscopy, dx ................... 5.94 NA NA 4.70 5.19 1.02 090 

29806 .... ............ A ........ Shoulder arthroscopy/surgery ............ 14.95 NA NA 9.37 10.28 2.50 090 

29807 .... ............ A ........ Shoulder arthroscopy/surgery ............ 14.48 NA NA 9.21 10.12 2.42 090 

29819 .... ............ A ........ Shoulder arthroscopy/surgery ............ 7.68 NA NA 5.62 6.21 1.32 090 

29820 .... ............ A ........ Shoulder arthroscopy/surgery ............ 7.12 NA NA 5.18 5.71 1.22 090 

29821 .... ............ A ........ Shoulder arthroscopy/surgery ............ 7.78 NA NA 5.65 6.24 1.33 090 

29822 .... ............ A ........ Shoulder arthroscopy/surgery ............ 7.49 NA NA 5.57 6.14 1.28 090 

29823 .... ............ A ........ Shoulder arthroscopy/surgery ............ 8.24 NA NA 6.04 6.64 1.41 090 

29824 .... ............ A ........ Shoulder arthroscopy/surgery ............ 8.82 NA NA 6.53 7.04 1.42 090 

29825 .... ............ A ........ Shoulder arthroscopy/surgery ............ 7.68 NA NA 5.63 6.20 1.32 090 

29826 .... ............ A ........ Shoulder arthroscopy/surgery ............ 9.05 NA NA 6.18 6.87 1.55 090 

29827 .... ............ A ........ Arthroscop rotator cuff repr ................ 15.44 NA NA 9.33 10.45 2.67 090 

29830 .... ............ A ........ Elbow arthroscopy .............................. 5.80 NA NA 4.48 4.92 0.99 090 

29834 .... ............ A ........ Elbow arthroscopy/surgery ................. 6.33 NA NA 4.85 5.35 1.08 090 

29835 .... ............ A ........ Elbow arthroscopy/surgery ................. 6.53 NA NA 4.96 5.43 1.13 090 

29836 .... ............ A ........ Elbow arthroscopy/surgery ................. 7.61 NA NA 5.58 6.19 1.22 090 

29837 .... ............ A ........ Elbow arthroscopy/surgery ................. 6.92 NA NA 5.06 5.61 1.19 090 

29838 .... ............ A ........ Elbow arthroscopy/surgery ................. 7.77 NA NA 5.65 6.28 1.30 090 

29840 .... ............ A ........ Wrist arthroscopy ................................ 5.59 NA NA 4.60 4.97 0.84 090 

29843 .... ............ A ........ Wrist arthroscopy/surgery ................... 6.06 NA NA 4.78 5.23 0.92 090 

29844 .... ............ A ........ Wrist arthroscopy/surgery ................... 6.42 NA NA 4.86 5.36 1.04 090 

29845 .... ............ A ........ Wrist arthroscopy/surgery ................... 7.58 NA NA 5.58 6.02 0.99 090 

29846 .... ............ A ........ Wrist arthroscopy/surgery ................... 6.80 NA NA 5.09 5.58 1.07 090 

29847 .... ............ A ........ Wrist arthroscopy/surgery ................... 7.13 NA NA 5.24 5.71 1.08 090 

29848 .... ............ A ........ Wrist endoscopy/surgery .................... 6.24 NA NA 5.25 5.44 0.86 090 

29850 .... ............ A ........ Knee arthroscopy/surgery .................. 8.18 NA NA 4.71 4.97 1.25 090 

29851 .... ............ A ........ Knee arthroscopy/surgery .................. 13.08 NA NA 8.23 9.02 2.35 090 

29855 .... ............ A ........ Tibial arthroscopy/surgery .................. 10.60 NA NA 7.28 8.04 1.85 090 

29856 .... ............ A ........ Tibial arthroscopy/surgery .................. 14.12 NA NA 8.71 9.70 2.40 090 

29860 .... ............ A ........ Hip arthroscopy, dx ............................ 8.85 NA NA 6.25 6.60 1.36 090 

29861 .... ............ A ........ Hip arthroscopy/surgery ..................... 9.95 NA NA 6.39 6.91 1.59 090 

29862 .... ............ A ........ Hip arthroscopy/surgery ..................... 10.97 NA NA 7.58 8.08 1.62 090 

29863 .... ............ A ........ Hip arthroscopy/surgery ..................... 10.97 NA NA 7.51 8.02 1.42 090 

29866 .... ............ A ........ Autgrft implnt, knee w/scope .............. 14.48 NA NA 9.48 10.43 2.40 090 

29867 .... ............ A ........ Allgrft implnt, knee w/scope ............... 18.18 NA NA 11.16 12.21 2.79 090 

29868 .... ............ A ........ Meniscal trnspl, knee w/scpe ............. 24.89 NA NA 13.83 15.34 4.36 090 

29870 .... ............ A ........ Knee arthroscopy, dx ......................... 5.11 NA NA 4.17 4.54 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 5.58 6.08 1.04 090 

29874 .... ............ A ........ Knee arthroscopy/surgery .................. 7.10 NA NA 5.08 5.59 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 6.19 6.62 1.37 090 

29877 .... ............ A ........ Knee arthroscopy/surgery .................. 8.15 NA NA 5.98 6.37 1.28 090 

29879 .... ............ A ........ Knee arthroscopy/surgery .................. 8.84 NA NA 6.23 6.68 1.39 090 

29880 .... ............ A ........ Knee arthroscopy/surgery .................. 9.30 NA NA 6.43 6.90 1.47 090 

29881 .... ............ A ........ Knee arthroscopy/surgery .................. 8.56 NA NA 6.14 6.56 1.34 090 

29882 .... ............ A ........ Knee arthroscopy/surgery .................. 9.45 NA NA 6.46 6.86 1.50 090 

29883 .... ............ A ........ Knee arthroscopy/surgery .................. 11.61 NA NA 7.59 8.34 1.93 090 

29884 .... ............ A ........ Knee arthroscopy/surgery .................. 8.13 NA NA 5.96 6.34 1.27 090 

29885 .... ............ A ........ Knee arthroscopy/surgery .................. 10.03 NA NA 7.03 7.51 1.58 090 

29886 .... ............ A ........ Knee arthroscopy/surgery .................. 8.34 NA NA 6.03 6.45 1.30 090 

29887 .... ............ A ........ Knee arthroscopy/surgery .................. 9.98 NA NA 6.96 7.46 1.57 090 

29888 .... ............ A ........ Knee arthroscopy/surgery .................. 14.14 NA NA 8.28 9.26 2.42 090 

29889 .... ............ A ........ Knee arthroscopy/surgery .................. 17.15 NA NA 10.63 11.56 2.79 090 

29891 .... ............ A ........ Ankle arthroscopy/surgery .................. 9.47 NA NA 6.62 7.08 1.39 090 

29892 .... ............ A ........ Ankle arthroscopy/surgery .................. 10.07 NA NA 6.35 7.09 1.41 090 

29893 .... ............ A ........ Scope, plantar fasciotomy .................. 6.08 8.59 7.49 4.53 4.30 0.63 090 

29894 .... ............ A ........ Ankle arthroscopy/surgery .................. 7.26 NA NA 4.68 5.09 1.15 090 

29895 .... ............ A ........ Ankle arthroscopy/surgery .................. 7.04 NA NA 4.47 4.99 1.11 090 

29897 .... ............ A ........ Ankle arthroscopy/surgery .................. 7.23 NA NA 4.79 5.37 1.17 090 

29898 .... ............ A ........ Ankle arthroscopy/surgery .................. 8.38 NA NA 5.19 5.72 1.28 090 

29899 .... ............ A ........ Ankle arthroscopy/surgery .................. 15.21 NA NA 9.21 9.90 2.41 090 

29900 .... ............ A ........ Mcp joint arthroscopy, dx ................... 5.74 NA NA 4.67 5.29 0.94 090 

29901 .... ............ A ........ Mcp joint arthroscopy, surg ................ 6.45 NA NA 5.05 5.74 1.06 090 

29902 .... ............ A ........ Mcp joint arthroscopy, surg ................ 7.02 NA NA 4.72 5.46 1.12 090 

mstockstill on PROD1PC66 with PROPOSALS2

38263 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

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 3.98 3.98 1.34 1.35 0.12 010 

30020 .... ............ A ........ Drainage of nose lesion ..................... 1.45 4.15 3.66 1.39 1.41 0.12 010 

30100 .... ............ A ........ Intranasal biopsy ................................ 0.94 2.57 2.24 0.75 0.78 0.07 000 

30110 .... ............ A ........ Removal of nose polyp(s) .................. 1.65 3.88 3.52 1.45 1.49 0.14 010 

30115 .... ............ A ........ Removal of nose polyp(s) .................. 4.38 NA NA 5.97 5.79 0.41 090 

30117 .... ............ A ........ Removal of intranasal lesion .............. 3.20 18.04 15.41 4.90 4.71 0.26 090 

30118 .... ............ A ........ Removal of intranasal lesion .............. 9.81 NA NA 8.55 8.76 0.78 090 

30120 .... ............ A ........ Revision of nose ................................. 5.31 7.06 6.75 5.09 5.52 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 7.80 0.63 090 

30130 .... ............ A ........ Excise inferior turbinate ...................... 3.41 NA NA 5.62 5.55 0.31 090 

30140 .... ............ A ........ Resect inferior turbinate ..................... 3.48 NA NA 7.07 6.55 0.35 090 

30150 .... ............ A ........ Partial removal of nose ...................... 9.44 NA NA 9.03 9.96 0.93 090 

30160 .... ............ A ........ Removal of nose ................................ 9.88 NA NA 8.88 9.43 0.88 090 

30200 .... ............ A ........ Injection treatment of nose ................. 0.78 2.01 1.80 0.67 0.70 0.06 000 

30210 .... ............ A ........ Nasal sinus therapy ............................ 1.10 2.50 2.27 1.27 1.28 0.09 010 

30220 .... ............ A ........ Insert nasal septal button ................... 1.56 5.78 4.95 1.43 1.46 0.12 010 

30300 .... ............ A ........ Remove nasal foreign body ............... 1.06 4.27 4.43 1.86 1.87 0.08 010 

30310 .... ............ A ........ Remove nasal foreign body ............... 1.98 NA NA 2.90 2.97 0.16 010 

30320 .... ............ A ........ Remove nasal foreign body ............... 4.56 NA NA 6.33 6.63 0.39 090 

30400 .... ............ R ........ Reconstruction of nose ....................... 10.58 NA NA 13.86 14.67 1.04 090 

30410 .... ............ R ........ Reconstruction of nose ....................... 13.72 NA NA 15.27 16.68 1.42 090 

30420 .... ............ R ........ Reconstruction of nose ....................... 16.62 NA NA 15.79 16.70 1.46 090 

30430 .... ............ R ........ Revision of nose ................................. 7.96 NA NA 13.20 14.55 0.77 090 

30435 .... ............ R ........ Revision of nose ................................. 12.45 NA NA 15.34 17.27 1.22 090 

30450 .... ............ R ........ Revision of nose ................................. 19.38 NA NA 16.88 19.30 1.97 090 

30460 .... ............ A ........ Revision of nose ................................. 10.24 NA NA 7.49 8.68 1.03 090 

30462 .... ............ A ........ Revision of nose ................................. 20.12 NA NA 14.68 17.44 2.54 090 

30465 .... ............ A ........ Repair nasal stenosis ......................... 12.20 NA NA 11.07 11.41 1.06 090 

30520 .... ............ A ........ Repair of nasal septum ...................... 6.85 NA NA 8.03 7.24 0.46 090 

30540 .... ............ A ........ Repair nasal defect ............................ 7.81 NA NA 8.53 8.66 0.67 090 

30545 .... ............ A ........ Repair nasal defect ............................ 11.50 NA NA 11.08 11.33 1.71 090 

30560 .... ............ A ........ Release of nasal adhesions ............... 1.28 5.25 4.96 2.02 2.05 0.10 010 

30580 .... ............ A ........ Repair upper jaw fistula ...................... 6.76 8.17 7.98 4.73 5.26 0.89 090 

30600 .... ............ A ........ Repair mouth/nose fistula ................... 6.07 7.67 7.57 4.20 4.59 0.70 090 

30620 .... ............ A ........ Intranasal reconstruction .................... 6.04 NA NA 8.64 8.65 0.57 090 

30630 .... ............ A ........ Repair nasal septum defect ............... 7.18 NA NA 7.72 7.74 0.61 090 

30801 .... ............ A ........ Ablate inf turbinate, superf ................. 1.11 4.27 4.16 2.11 1.99 0.09 010 

30802 .... ............ A ........ Cauterization, inner nose ................... 2.05 4.95 4.72 2.51 2.40 0.16 010 

30901 .... ............ A ........ Control of nosebleed .......................... 1.21 1.27 1.30 0.31 0.31 0.11 000 

30903 .... ............ A ........ Control of nosebleed .......................... 1.54 3.26 2.95 0.43 0.46 0.13 000 

30905 .... ............ A ........ Control of nosebleed .......................... 1.97 3.91 3.68 0.51 0.63 0.17 000 

30906 .... ............ A ........ Repeat control of nosebleed .............. 2.45 4.27 4.03 0.77 0.97 0.20 000 

30915 .... ............ A ........ Ligation, nasal sinus artery ................ 7.36 NA NA 6.46 6.48 0.58 090 

30920 .... ............ A ........ Ligation, upper jaw artery ................... 11.03 NA NA 8.97 8.85 0.80 090 

30930 .... ............ A ........ Ther fx, nasal inf turbinate ................. 1.28 NA NA 1.64 1.61 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 3.19 2.98 1.33 1.35 0.09 010 

31002 .... ............ A ........ Irrigation, sphenoid sinus ................... 1.93 NA NA 2.67 2.93 0.15 010 

31020 .... ............ A ........ Exploration, maxillary sinus ................ 2.99 8.56 8.47 5.52 5.29 0.29 090 

31030 .... ............ A ........ Exploration, maxillary sinus ................ 5.95 10.38 10.84 6.44 6.49 0.60 090 

31032 .... ............ A ........ Explore sinus, remove polyps ............ 6.61 NA NA 7.00 7.04 0.59 090 

31040 .... ............ A ........ Exploration behind upper jaw ............. 9.66 NA NA 7.38 8.59 0.87 090 

31050 .... ............ A ........ Exploration, sphenoid sinus ............... 5.31 NA NA 6.50 6.37 0.49 090 

31051 .... ............ A ........ Sphenoid sinus surgery ...................... 7.16 NA NA 8.31 8.18 0.62 090 

31070 .... ............ A ........ Exploration of frontal sinus ................. 4.32 NA NA 6.17 5.98 0.38 090 

31075 .... ............ A ........ Exploration of frontal sinus ................. 9.40 NA NA 9.29 9.40 0.75 090 

31080 .... ............ A ........ Removal of frontal sinus ..................... 12.54 NA NA 10.75 12.10 1.23 090 

31081 .... ............ A ........ Removal of frontal sinus ..................... 13.99 NA NA 15.48 14.63 2.47 090 

31084 .... ............ A ........ Removal of frontal sinus ..................... 14.75 NA NA 12.88 13.04 1.19 090 

31085 .... ............ A ........ Removal of frontal sinus ..................... 15.44 NA NA 14.48 13.98 1.73 090 

31086 .... ............ A ........ Removal of frontal sinus ..................... 14.16 NA NA 12.78 12.87 1.07 090 

31087 .... ............ A ........ Removal of frontal sinus ..................... 14.39 NA NA 11.66 11.96 1.44 090 

31090 .... ............ A ........ Exploration of sinuses ........................ 10.88 NA NA 13.38 12.80 0.94 090 

31200 .... ............ A ........ Removal of ethmoid sinus .................. 5.03 NA NA 7.44 8.33 0.29 090 

31201 .... ............ A ........ Removal of ethmoid sinus .................. 8.49 NA NA 8.99 8.97 0.82 090 

31205 .... ............ A ........ Removal of ethmoid sinus .................. 10.47 NA NA 9.55 10.72 0.67 090 

31225 .... ............ A ........ Removal of upper jaw ........................ 26.44 NA NA 17.94 17.65 1.59 090 

31230 .... ............ A ........ Removal of upper jaw ........................ 30.56 NA NA 19.56 19.08 1.78 090 

31231 .... ............ A ........ Nasal endoscopy, dx .......................... 1.10 3.57 3.44 0.77 0.82 0.09 000 

31233 .... ............ A ........ Nasal/sinus endoscopy, dx ................. 2.18 4.25 4.22 1.13 1.29 0.20 000 

mstockstill on PROD1PC66 with PROPOSALS2

38264 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

31235 .... ............ A ........ Nasal/sinus endoscopy, dx ................. 2.64 4.63 4.72 1.27 1.48 0.26 000 

31237 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 2.98 4.89 4.98 1.40 1.61 0.28 000 

31238 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 3.26 4.81 4.96 1.49 1.76 0.27 000 

31239 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 9.23 NA NA 6.46 7.21 0.62 010 

31240 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 2.61 NA NA 1.27 1.48 0.24 000 

31254 .... ............ A ........ Revision of ethmoid sinus .................. 4.64 NA NA 1.95 2.36 0.45 000 

31255 .... ............ A ........ Removal of ethmoid sinus .................. 6.95 NA NA 2.72 3.37 0.73 000 

31256 .... ............ A ........ Exploration maxillary sinus ................. 3.29 NA NA 1.50 1.78 0.33 000 

31267 .... ............ A ........ Endoscopy, maxillary sinus ................ 5.45 NA NA 2.22 2.71 0.55 000 

31276 .... ............ A ........ Sinus endoscopy, surgical .................. 8.84 NA NA 3.35 4.17 0.92 000 

31287 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 3.91 NA NA 1.71 2.05 0.39 000 

31288 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 4.57 NA NA 1.93 2.34 0.46 000 

31290 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 18.50 NA NA 9.11 10.43 1.40 010 

31291 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 19.45 NA NA 9.60 10.90 1.69 010 

31292 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 15.79 NA NA 8.11 9.24 1.21 010 

31293 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 17.36 NA NA 8.74 9.94 1.28 010 

31294 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 20.20 NA NA 9.74 11.17 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 14.58 14.61 1.17 090 

31320 .... ............ A ........ Diagnostic incision, larynx .................. 5.62 NA NA 10.11 10.06 0.46 090 

31360 .... ............ A ........ Removal of larynx ............................... 29.57 NA NA 20.13 18.12 1.38 090 

31365 .... ............ A ........ Removal of larynx ............................... 38.47 NA NA 23.08 21.36 1.98 090 

31367 .... ............ A ........ Partial removal of larynx ..................... 30.23 NA NA 22.55 21.88 1.79 090 

31368 .... ............ A ........ Partial removal of larynx ..................... 33.85 NA NA 24.64 24.70 2.21 090 

31370 .... ............ A ........ Partial removal of larynx ..................... 27.23 NA NA 22.16 21.91 1.75 090 

31375 .... ............ A ........ Partial removal of larynx ..................... 25.73 NA NA 21.16 20.49 1.63 090 

31380 .... ............ A ........ Partial removal of larynx ..................... 25.23 NA NA 20.80 20.43 1.71 090 

31382 .... ............ A ........ Partial removal of larynx ..................... 28.23 NA NA 22.72 21.83 1.68 090 

31390 .... ............ A ........ Removal of larynx & pharynx ............. 42.17 NA NA 26.07 24.82 2.24 090 

31395 .... ............ A ........ Reconstruct larynx & pharynx ............ 43.46 NA NA 28.60 28.01 2.49 090 

31400 .... ............ A ........ Revision of larynx ............................... 11.48 NA NA 12.47 12.96 0.83 090 

31420 .... ............ A ........ Removal of epiglottis .......................... 11.32 NA NA 8.59 8.96 0.83 090 

31500 .... ............ A ........ Insert emergency airway .................... 2.33 NA NA 0.42 0.49 0.17 000 

31502 .... ............ A ........ Change of windpipe airway ................ 0.65 NA NA 0.21 0.24 0.05 000 

31505 .... ............ A ........ Diagnostic laryngoscopy ..................... 0.61 1.42 1.42 0.59 0.60 0.05 000 

31510 .... ............ A ........ Laryngoscopy with biopsy .................. 1.92 3.21 3.22 1.01 1.12 0.16 000 

31511 .... ............ A ........ Remove foreign body, larynx ............. 2.16 2.92 2.99 1.03 1.03 0.19 000 

31512 .... ............ A ........ Removal of larynx lesion .................... 2.07 2.95 3.04 1.06 1.19 0.18 000 

31513 .... ............ A ........ Injection into vocal cord ...................... 2.10 NA NA 1.09 1.26 0.17 000 

31515 .... ............ A ........ Laryngoscopy for aspiration ............... 1.80 3.17 3.34 0.88 0.97 0.14 000 

31520 .... ............ A ........ Dx laryngoscopy, newborn ................. 2.56 NA NA 1.22 1.37 0.20 000 

31525 .... ............ A ........ Dx laryngoscopy excl nb .................... 2.63 3.44 3.51 1.24 1.43 0.21 000 

31526 .... ............ A ........ Dx laryngoscopy w/oper scope .......... 2.57 NA NA 1.26 1.47 0.21 000 

31527 .... ............ A ........ Laryngoscopy for treatment ................ 3.27 NA NA 1.39 1.62 0.26 000 

31528 .... ............ A ........ Laryngoscopy and dilation .................. 2.37 NA NA 1.10 1.26 0.19 000 

31529 .... ............ A ........ Laryngoscopy and dilation .................. 2.68 NA NA 1.26 1.46 0.22 000 

31530 .... ............ A ........ Laryngoscopy w/fb removal ................ 3.38 NA NA 1.46 1.68 0.29 000 

31531 .... ............ A ........ Laryngoscopy w/fb & op scope .......... 3.58 NA NA 1.60 1.91 0.29 000 

31535 .... ............ A ........ Laryngoscopy w/biopsy ...................... 3.16 NA NA 1.45 1.70 0.26 000 

31536 .... ............ A ........ Laryngoscopy w/bx & op scope ......... 3.55 NA NA 1.59 1.89 0.29 000 

31540 .... ............ A ........ Laryngoscopy w/exc of tumor ............ 4.12 NA NA 1.77 2.12 0.33 000 

31541 .... ............ A ........ Larynscop w/tumr exc + scope .......... 4.52 NA NA 1.91 2.31 0.37 000 

31545 .... ............ A ........ Remove vc lesion w/scope ................. 6.30 NA NA 2.54 2.96 0.37 000 

31546 .... ............ A ........ Remove vc lesion scope/graft ............ 9.73 NA NA 3.47 4.27 0.78 000 

31560 .... ............ A ........ Laryngoscop w/arytenoidectom .......... 5.45 NA NA 2.17 2.62 0.43 000 

31561 .... ............ A ........ Larynscop, remve cart + scop ............ 5.99 NA NA 2.35 2.82 0.49 000 

31570 .... ............ A ........ Laryngoscope w/vc inj ........................ 3.86 4.25 4.91 1.66 1.99 0.31 000 

31571 .... ............ A ........ Laryngoscop w/vc inj + scope ............ 4.26 NA NA 1.83 2.18 0.35 000 

31575 .... ............ A ........ Diagnostic laryngoscopy ..................... 1.10 1.69 1.78 0.76 0.81 0.09 000 

31576 .... ............ A ........ Laryngoscopy with biopsy .................. 1.97 3.50 3.55 1.05 1.16 0.14 000 

31577 .... ............ A ........ Remove foreign body, larynx ............. 2.47 3.36 3.54 1.17 1.34 0.21 000 

31578 .... ............ A ........ Removal of larynx lesion .................... 2.84 3.98 4.08 1.35 1.41 0.23 000 

31579 .... ............ A ........ Diagnostic laryngoscopy ..................... 2.26 2.86 3.29 1.15 1.30 0.18 000 

31580 .... ............ A ........ Revision of larynx ............................... 14.46 NA NA 13.81 14.81 1.00 090 

31582 .... ............ A ........ Revision of larynx ............................... 22.87 NA NA 22.55 23.84 1.76 090 

31584 .... ............ A ........ Treat larynx fracture ........................... 20.35 NA NA 15.29 16.56 1.72 090 

31587 .... ............ A ........ Revision of larynx ............................... 15.12 NA NA 8.67 8.86 0.97 090 

31588 .... ............ A ........ Revision of larynx ............................... 14.62 NA NA 12.51 12.88 1.06 090 

31590 .... ............ A ........ Reinnervate larynx .............................. 7.63 NA NA 12.73 14.02 0.84 090 

31595 .... ............ A ........ Larynx nerve surgery .......................... 8.75 NA NA 9.62 9.97 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 2.30 2.73 0.80 000 

mstockstill on PROD1PC66 with PROPOSALS2

38265 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

31601 .... ............ A ........ Incision of windpipe ............................ 4.44 NA NA 1.76 2.06 0.40 000 

31603 .... ............ A ........ Incision of windpipe ............................ 4.14 NA NA 1.20 1.45 0.44 000 

31605 .... ............ A ........ Incision of windpipe ............................ 3.57 NA NA 0.82 1.01 0.40 000 

31610 .... ............ A ........ Incision of windpipe ............................ 9.29 NA NA 7.72 7.90 0.79 090 

31611 .... ............ A ........ Surgery/speech prosthesis ................. 5.92 NA NA 7.06 6.97 0.46 090 

31612 .... ............ A ........ Puncture/clear windpipe ..................... 0.91 1.08 1.09 0.26 0.31 0.08 000 

31613 .... ............ A ........ Repair windpipe opening .................... 4.63 NA NA 6.11 6.00 0.42 090 

31614 .... ............ A ........ Repair windpipe opening .................... 8.47 NA NA 9.56 9.03 0.58 090 

31615 .... ............ A ........ Visualization of windpipe .................... 2.09 2.37 2.46 1.05 1.11 0.16 000 

31620 .... ............ A ........ Endobronchial us add-on ................... 1.40 5.96 5.81 0.33 0.44 0.11 ZZZ 

31622 .... ............ A ........ Dx bronchoscope/wash ...................... 2.78 5.19 5.43 0.90 0.98 0.18 000 

31623 .... ............ A ........ Dx bronchoscope/brush ...................... 2.88 5.92 6.19 0.90 0.98 0.13 000 

31624 .... ............ A ........ Dx bronchoscope/lavage .................... 2.88 5.29 5.54 0.90 0.98 0.13 000 

31625 .... ............ A ........ Bronchoscopy w/biopsy(s) .................. 3.36 5.43 5.63 1.02 1.12 0.18 000 

31628 .... ............ A ........ Bronchoscopy/lung bx, each .............. 3.80 6.90 6.98 1.11 1.21 0.18 000 

31629 .... ............ A ........ Bronchoscopy/needle bx, each .......... 4.09 11.90 13.10 1.18 1.29 0.16 000 

31630 .... ............ A ........ Bronchoscopy dilate/fx repr ................ 3.81 NA NA 1.27 1.50 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, addœl ............. 1.03 0.85 0.84 0.24 0.28 0.18 ZZZ 

31633 .... ............ A ........ Bronchoscopy/needle bx addœl .......... 1.32 0.98 0.95 0.31 0.36 0.16 ZZZ 

31635 .... ............ A ........ Bronchoscopy w/fb removal ............... 3.67 5.16 5.64 1.14 1.29 0.24 000 

31636 .... ............ A ........ Bronchoscopy, bronch stents ............. 4.30 NA NA 1.35 1.56 0.31 000 

31637 .... ............ A ........ Bronchoscopy, stent add-on ............... 1.58 NA NA 0.41 0.49 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 1.54 1.81 0.46 000 

31641 .... ............ A ........ Bronchoscopy, treat blockage ............ 5.02 NA NA 1.50 1.69 0.35 000 

31643 .... ............ A ........ Diag bronchoscope/catheter ............... 3.49 NA NA 1.04 1.14 0.20 000 

31645 .... ............ A ........ Bronchoscopy, clear airways .............. 3.16 4.69 4.93 0.97 1.05 0.16 000 

31646 .... ............ A ........ Bronchoscopy, reclear airway ............ 2.72 4.38 4.63 0.85 0.93 0.14 000 

31656 .... ............ A ........ Bronchoscopy, inj for x-ray ................. 2.17 5.69 6.42 0.69 0.76 0.15 000 

31715 .... ............ A ........ Injection for bronchus x-ray ................ 1.11 NA NA 0.25 0.30 0.07 000 

31717 .... ............ A ........ Bronchial brush biopsy ....................... 2.12 5.78 7.03 0.72 0.77 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 0.50 0.14 000 

31730 .... ............ A ........ Intro, windpipe wire/tube .................... 2.85 25.45 13.80 0.75 0.88 0.21 000 

31750 .... ............ A ........ Repair of windpipe .............................. 15.19 NA NA 17.43 17.29 1.05 090 

31755 .... ............ A ........ Repair of windpipe .............................. 17.19 NA NA 23.90 23.95 1.29 090 

31760 .... ............ A ........ Repair of windpipe .............................. 23.36 NA NA 9.75 10.23 2.95 090 

31766 .... ............ A ........ Reconstruction of windpipe ................ 31.58 NA NA 11.72 12.64 4.53 090 

31770 .... ............ A ........ Repair/graft of bronchus ..................... 23.48 NA NA 8.55 9.44 2.84 090 

31775 .... ............ A ........ Reconstruct bronchus ......................... 24.51 NA NA 9.46 10.53 3.02 090 

31780 .... ............ A ........ Reconstruct windpipe ......................... 19.70 NA NA 8.84 9.83 1.65 090 

31781 .... ............ A ........ Reconstruct windpipe ......................... 24.77 NA NA 9.67 10.83 2.25 090 

31785 .... ............ A ........ Remove windpipe lesion .................... 18.29 NA NA 7.75 8.61 1.59 090 

31786 .... ............ A ........ Remove windpipe lesion .................... 25.34 NA NA 9.65 11.40 3.30 090 

31800 .... ............ A ........ Repair of windpipe injury .................... 8.10 NA NA 8.64 8.89 0.79 090 

31805 .... ............ A ........ Repair of windpipe injury .................... 13.34 NA NA 6.21 6.73 1.83 090 

31820 .... ............ A ........ Closure of windpipe lesion ................. 4.58 5.83 5.68 3.27 3.42 0.38 090 

31825 .... ............ A ........ Repair of windpipe defect ................... 6.98 7.43 7.45 4.49 4.86 0.53 090 

31830 .... ............ A ........ Revise windpipe scar ......................... 4.54 5.91 5.79 3.55 3.74 0.44 090 

31899 .... ............ C ........ Airways surgical procedure ................ 0.00 0.00 1.44 0.00 0.45 0.00 YYY 

32000 .... ............ A ........ Drainage of chest ............................... 1.54 2.39 2.70 0.47 0.46 0.08 000 

32002 .... ............ A ........ Treatment of collapsed lung ............... 2.19 2.86 3.01 1.04 1.03 0.12 000 

32005 .... ............ A ........ Treat lung lining chemically ................ 2.19 5.01 5.74 0.59 0.64 0.23 000 

32019 .... ............ A ........ Insert pleural catheter ......................... 4.17 15.00 17.51 1.52 1.57 0.42 000 

32020 .... ............ A ........ Insertion of chest tube ........................ 3.29 NA NA 0.97 1.16 0.43 000 

32035 .... ............ A ........ Exploration of chest ............................ 11.20 NA NA 6.04 5.95 1.26 090 

32036 .... ............ A ........ Exploration of chest ............................ 12.21 NA NA 6.29 6.38 1.43 090 

32095 .... ............ A ........ Biopsy through chest wall .................. 10.06 NA NA 5.08 5.24 1.22 090 

32100 .... ............ A ........ Exploration/biopsy of chest ................ 16.08 NA NA 6.99 7.42 2.24 090 

32110 .... ............ A ........ Explore/repair chest ............................ 25.15 NA NA 9.86 10.32 3.22 090 

32120 .... ............ A ........ Re-exploration of chest ...................... 14.27 NA NA 6.76 6.93 1.63 090 

32124 .... ............ A ........ Explore chest free adhesions ............. 15.33 NA NA 6.95 7.10 1.90 090 

32140 .... ............ A ........ Removal of lung lesion(s) ................... 16.54 NA NA 7.37 7.54 1.97 090 

32141 .... ............ A ........ Remove/treat lung lesions .................. 27.10 NA NA 10.18 8.89 2.01 090 

32150 .... ............ A ........ Removal of lung lesion(s) ................... 16.70 NA NA 7.49 7.55 2.01 090 

32151 .... ............ A ........ Remove lung foreign body ................. 16.82 NA NA 7.86 8.08 2.04 090 

32160 .... ............ A ........ Open chest heart massage ................ 13.02 NA NA 5.83 5.55 1.31 090 

32200 .... ............ A ........ Drain, open, lung lesion ..................... 18.48 NA NA 8.76 8.69 2.14 090 

32201 .... ............ A ........ Drain, percut, lung lesion ................... 3.99 19.70 20.04 1.45 1.32 0.24 000 

32215 .... ............ A ........ Treat chest lining ................................ 12.93 NA NA 6.20 6.58 1.69 090 

32220 .... ............ A ........ Release of lung .................................. 26.41 NA NA 11.88 12.45 3.57 090 

mstockstill on PROD1PC66 with PROPOSALS2

38266 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

32225 .... ............ A ........ Partial release of lung ........................ 16.63 NA NA 7.43 7.56 2.07 090 

32310 .... ............ A ........ Removal of chest lining ...................... 15.16 NA NA 6.93 7.16 2.00 090 

32320 .... ............ A ........ Free/remove chest lining .................... 27.04 NA NA 11.44 11.82 3.52 090 

32400 .... ............ A ........ Needle biopsy chest lining ................. 1.76 2.14 2.11 0.57 0.54 0.10 000 

32402 .... ............ A ........ Open biopsy chest lining .................... 8.89 NA NA 4.68 4.91 1.07 090 

32405 .... ............ A ........ Biopsy, lung or mediastinum .............. 1.93 0.70 0.66 0.70 0.64 0.11 000 

32420 .... ............ A ........ Puncture/clear lung ............................. 2.18 NA NA 0.72 0.68 0.12 000 

32440 .... ............ A ........ Removal of lung ................................. 27.17 NA NA 10.91 11.93 3.69 090 

32442 .... ............ A ........ Sleeve pneumonectomy ..................... 56.37 NA NA 18.84 16.75 3.85 090 

32445 .... ............ A ........ Removal of lung ................................. 63.60 NA NA 22.86 18.49 3.72 090 

32480 .... ............ A ........ Partial removal of lung ....................... 25.71 NA NA 10.19 11.15 3.50 090 

32482 .... ............ A ........ Bilobectomy ........................................ 27.28 NA NA 11.08 12.01 3.67 090 

32484 .... ............ A ........ Segmentectomy .................................. 25.30 NA NA 9.58 10.49 3.04 090 

32486 .... ............ A ........ Sleeve lobectomy ............................... 42.80 NA NA 14.66 14.04 3.52 090 

32488 .... ............ A ........ Completion pneumonectomy .............. 42.83 NA NA 15.59 14.70 3.81 090 

32491 .... ............ R ........ Lung volume reduction ....................... 25.09 NA NA 10.44 11.57 2.99 090 

32500 .... ............ A ........ Partial removal of lung ....................... 24.48 NA NA 10.26 11.33 3.26 090 

32501 .... ............ A ........ Repair bronchus add-on ..................... 4.68 NA NA 1.35 1.45 0.65 ZZZ 

32503 .... ............ A ........ Resect apical lung tumor .................... 31.61 NA NA 12.10 13.61 4.38 090 

32504 .... ............ A ........ Resect apical lung tum/chest ............. 36.41 NA NA 13.49 15.12 5.09 090 

32540 .... ............ A ........ Removal of lung lesion ....................... 30.22 NA NA 11.49 10.68 2.08 090 

32601 .... ............ A ........ Thoracoscopy, diagnostic ................... 5.45 NA NA 2.07 2.22 0.80 000 

32602 .... ............ A ........ Thoracoscopy, diagnostic ................... 5.95 NA NA 2.23 2.38 0.87 000 

32603 .... ............ A ........ Thoracoscopy, diagnostic ................... 7.80 NA NA 2.75 2.93 1.14 000 

32604 .... ............ A ........ Thoracoscopy, diagnostic ................... 8.77 NA NA 3.05 3.25 1.25 000 

32605 .... ............ A ........ Thoracoscopy, diagnostic ................... 6.92 NA NA 2.58 2.73 1.00 000 

32606 .... ............ A ........ Thoracoscopy, diagnostic ................... 8.39 NA NA 2.97 3.16 1.22 000 

32650 .... ............ A ........ Thoracoscopy, surgical ....................... 10.77 NA NA 5.23 6.00 1.58 090 

32651 .... ............ A ........ Thoracoscopy, surgical ....................... 18.70 NA NA 7.69 7.47 1.87 090 

32652 .... ............ A ........ Thoracoscopy, surgical ....................... 29.00 NA NA 11.14 10.65 2.73 090 

32653 .... ............ A ........ Thoracoscopy, surgical ....................... 18.09 NA NA 7.45 7.22 1.89 090 

32654 .... ............ A ........ Thoracoscopy, surgical ....................... 20.44 NA NA 7.96 7.75 1.63 090 

32655 .... ............ A ........ Thoracoscopy, surgical ....................... 16.09 NA NA 6.87 7.08 1.90 090 

32656 .... ............ A ........ Thoracoscopy, surgical ....................... 13.18 NA NA 5.96 6.96 1.90 090 

32657 .... ............ A ........ Thoracoscopy, surgical ....................... 12.85 NA NA 5.96 6.84 2.00 090 

32658 .... ............ A ........ Thoracoscopy, surgical ....................... 11.65 NA NA 5.48 6.44 1.70 090 

32659 .... ............ A ........ Thoracoscopy, surgical ....................... 11.86 NA NA 5.78 6.64 1.62 090 

32660 .... ............ A ........ Thoracoscopy, surgical ....................... 17.69 NA NA 7.58 8.51 2.09 090 

32661 .... ............ A ........ Thoracoscopy, surgical ....................... 13.27 NA NA 6.04 6.94 1.93 090 

32662 .... ............ A ........ Thoracoscopy, surgical ....................... 14.91 NA NA 6.64 7.74 2.18 090 

32663 .... ............ A ........ Thoracoscopy, surgical ....................... 24.56 NA NA 9.41 10.10 2.73 090 

32664 .... ............ A ........ Thoracoscopy, surgical ....................... 14.22 NA NA 5.62 6.75 2.33 090 

32665 .... ............ A ........ Thoracoscopy, surgical ....................... 21.45 NA NA 8.54 8.35 2.16 090 

32800 .... ............ A ........ Repair lung hernia .............................. 15.59 NA NA 6.86 7.17 1.99 090 

32810 .... ............ A ........ Close chest after drainage ................. 14.83 NA NA 6.98 7.27 1.94 090 

32815 .... ............ A ........ Close bronchial fistula ........................ 49.79 NA NA 18.63 14.86 3.28 090 

32820 .... ............ A ........ Reconstruct injured chest ................... 22.33 NA NA 10.56 11.57 2.53 090 

32851 .... ............ A ........ Lung transplant, single ....................... 40.94 NA NA 20.18 24.04 5.58 090 

32852 .... ............ A ........ Lung transplant with bypass ............... 44.65 NA NA 22.54 28.05 6.02 090 

32853 .... ............ A ........ Lung transplant, double ...................... 50.11 NA NA 22.79 27.36 7.07 090 

32854 .... ............ A ........ Lung transplant with bypass ............... 53.88 NA NA 25.79 30.38 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 9.62 9.78 2.94 090 

32905 .... ............ A ........ Revise & repair chest wall .................. 23.17 NA NA 9.54 9.85 3.16 090 

32906 .... ............ A ........ Revise & repair chest wall .................. 29.18 NA NA 11.04 11.60 3.98 090 

32940 .... ............ A ........ Revision of lung .................................. 21.22 NA NA 8.50 9.01 2.89 090 

32960 .... ............ A ........ Therapeutic pneumothorax ................. 1.84 1.61 1.66 0.69 0.62 0.16 000 

32997 .... ............ A ........ Total lung lavage ................................ 7.31 NA NA 1.85 1.88 0.55 000 

32998 .... ............ A ........ Perq rf ablate tx, pul tumor ................ 5.68 69.54 68.94 2.00 1.85 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 1.00 0.90 0.14 000 

33011 .... ............ A ........ Repeat drainage of heart sac ............. 2.24 NA NA 1.09 0.96 0.15 000 

33015 .... ............ A ........ Incision of heart sac ........................... 8.44 NA NA 5.04 5.00 0.65 090 

33020 .... ............ A ........ Incision of heart sac ........................... 14.87 NA NA 6.36 6.59 1.80 090 

33025 .... ............ A ........ Incision of heart sac ........................... 13.65 NA NA 5.83 6.11 1.81 090 

33030 .... ............ A ........ Partial removal of heart sac ............... 22.27 NA NA 9.11 9.34 2.84 090 

33031 .... ............ A ........ Partial removal of heart sac ............... 25.30 NA NA 9.58 9.87 3.14 090 

33050 .... ............ A ........ Removal of heart sac lesion ............... 16.85 NA NA 7.37 7.64 2.15 090 

33120 .... ............ A ........ Removal of heart lesion ..................... 27.33 NA NA 10.56 11.10 3.70 090 

33130 .... ............ A ........ Removal of heart lesion ..................... 24.05 NA NA 9.39 9.76 3.01 090 

33140 .... ............ A ........ Heart revascularize (tmr) .................... 28.26 NA NA 10.32 10.65 2.86 090 

mstockstill on PROD1PC66 with PROPOSALS2

38267 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

33141 .... ............ A ........ Heart tmr w/other procedure .............. 2.54 NA NA 0.78 1.19 0.69 ZZZ 

33202 .... ............ A ........ Insert epicard eltrd, open ................... 13.15 NA NA 6.03 6.16 1.71 090 

33203 .... ............ A ........ Insert epicard eltrd, endo ................... 13.92 NA NA 6.09 6.22 1.39 090 

33206 .... ............ A ........ Insertion of heart pacemaker ............. 7.31 NA NA 4.96 4.75 0.52 090 

33207 .... ............ A ........ Insertion of heart pacemaker ............. 8.00 NA NA 5.06 4.99 0.59 090 

33208 .... ............ A ........ Insertion of heart pacemaker ............. 8.72 NA NA 5.47 5.12 0.56 090 

33210 .... ............ A ........ Insertion of heart electrode ................ 3.30 NA NA 1.60 1.45 0.18 000 

33211 .... ............ A ........ Insertion of heart electrode ................ 3.39 NA NA 1.54 1.45 0.21 000 

33212 .... ............ A ........ Insertion of pulse generator ............... 5.51 NA NA 3.59 3.50 0.43 090 

33213 .... ............ A ........ Insertion of pulse generator ............... 6.36 NA NA 4.07 3.94 0.45 090 

33214 .... ............ A ........ Upgrade of pacemaker system .......... 7.78 NA NA 5.19 5.08 0.58 090 

33215 .... ............ A ........ Reposition pacing-defib lead .............. 4.89 NA NA 3.36 3.30 0.37 090 

33216 .... ............ A ........ Insert lead pace-defib, one ................. 5.81 NA NA 4.38 4.33 0.36 090 

33217 .... ............ A ........ Insert lead pace-defib, dual ................ 5.78 NA NA 4.29 4.30 0.39 090 

33218 .... ............ A ........ Repair lead pace-defib, one ............... 5.97 NA NA 4.66 4.51 0.37 090 

33220 .... ............ A ........ Repair lead pace-defib, dual .............. 6.05 NA NA 4.62 4.50 0.37 090 

33222 .... ............ A ........ Revise pocket, pacemaker ................. 5.01 NA NA 4.18 4.27 0.42 090 

33223 .... ............ A ........ Revise pocket, pacing-defib ............... 6.49 NA NA 4.71 4.70 0.45 090 

33224 .... ............ A ........ Insert pacing lead & connect .............. 9.04 NA NA 4.73 4.43 0.54 000 

33225 .... ............ A ........ L ventric pacing lead add-on .............. 8.33 NA NA 4.18 3.77 0.45 ZZZ 

33226 .... ............ A ........ Reposition l ventric lead ..................... 8.68 NA NA 4.57 4.26 0.59 000 

33233 .... ............ A ........ Removal of pacemaker system .......... 3.33 NA NA 3.16 3.25 0.22 090 

33234 .... ............ A ........ Removal of pacemaker system .......... 7.85 NA NA 5.30 5.15 0.56 090 

33235 .... ............ A ........ Removal pacemaker electrode ........... 9.93 NA NA 7.01 6.98 0.73 090 

33236 .... ............ A ........ Remove electrode/thoracotomy .......... 12.64 NA NA 6.36 6.95 1.69 090 

33237 .... ............ A ........ Remove electrode/thoracotomy .......... 13.75 NA NA 7.80 7.77 1.59 090 

33238 .... ............ A ........ Remove electrode/thoracotomy .......... 15.28 NA NA 7.98 8.15 2.03 090 

33240 .... ............ A ........ Insert pulse generator ........................ 7.61 NA NA 5.06 4.88 0.41 090 

33241 .... ............ A ........ Remove pulse generator .................... 3.26 NA NA 2.89 2.96 0.18 090 

33243 .... ............ A ........ Remove eltrd/thoracotomy ................. 23.42 NA NA 10.84 11.18 2.10 090 

33244 .... ............ A ........ Remove eltrd, transven ...................... 13.84 NA NA 9.12 9.09 0.99 090 

33249 .... ............ A ........ Eltrd/insert pace-defib ......................... 15.02 NA NA 9.78 9.19 0.77 090 

33250 .... ............ A ........ Ablate heart dysrhythm focus ............. 25.78 NA NA 10.80 10.80 3.19 090 

33251 .... ............ A ........ Ablate heart dysrhythm focus ............. 28.80 NA NA 10.97 11.34 3.60 090 

33254 .... ............ A ........ Ablate atria, lmtd ................................ 23.58 NA NA 9.76 9.88 3.35 090 

33255 .... ............ A ........ Ablate atria w/o bypass, ext ............... 28.91 NA NA 11.36 11.50 3.94 090 

33256 .... ............ A ........ Ablate atria w/bypass, exten .............. 34.77 NA NA 13.11 13.28 4.95 090 

33261 .... ............ A ........ Ablate heart dysrhythm focus ............. 28.80 NA NA 11.63 11.64 3.46 090 

33265 .... ............ A ........ Ablate atria w/bypass, endo ............... 23.58 NA NA 9.76 9.88 3.35 090 

33266 .... ............ A ........ Ablate atria w/o bypass endo ............. 32.91 NA NA 12.55 12.72 4.80 090 

33282 .... ............ A ........ Implant pat-active ht record ................ 4.70 NA NA 4.08 4.09 0.23 090 

33284 .... ............ A ........ Remove pat-active ht record .............. 3.04 NA NA 3.26 3.42 0.14 090 

33300 .... ............ A ........ Repair of heart wound ........................ 44.89 NA NA 15.08 12.25 2.66 090 

33305 .... ............ A ........ Repair of heart wound ........................ 76.85 NA NA 25.16 17.89 3.13 090 

33310 .... ............ A ........ Exploratory heart surgery ................... 20.22 NA NA 8.36 9.05 2.59 090 

33315 .... ............ A ........ Exploratory heart surgery ................... 26.05 NA NA 10.35 10.63 3.28 090 

33320 .... ............ A ........ Repair major blood vessel(s) ............. 18.46 NA NA 7.93 8.20 2.08 090 

33321 .... ............ A ........ Repair major vessel ............................ 20.71 NA NA 8.38 9.40 2.91 090 

33322 .... ............ A ........ Repair major blood vessel(s) ............. 24.30 NA NA 9.55 10.00 2.86 090 

33330 .... ............ A ........ Insert major vessel graft ..................... 25.17 NA NA 9.49 9.92 2.82 090 

33332 .... ............ A ........ Insert major vessel graft ..................... 24.46 NA NA 9.47 10.01 3.03 090 

33335 .... ............ A ........ Insert major vessel graft ..................... 33.79 NA NA 12.50 12.99 4.28 090 

33400 .... ............ A ........ Repair of aortic valve ......................... 41.37 NA NA 14.60 15.23 4.11 090 

33401 .... ............ A ........ Valvuloplasty, open ............................ 24.41 NA NA 10.28 11.81 3.57 090 

33403 .... ............ A ........ Valvuloplasty, w/cp bypass ................ 25.39 NA NA 12.17 12.96 3.55 090 

33404 .... ............ A ........ Prepare heart-aorta conduit ............... 31.25 NA NA 12.02 13.31 4.33 090 

33405 .... ............ A ........ Replacement of aortic valve ............... 41.19 NA NA 15.12 16.76 5.33 090 

33406 .... ............ A ........ Replacement of aortic valve ............... 52.55 NA NA 18.40 18.82 5.45 090 

33410 .... ............ A ........ Replacement of aortic valve ............... 46.28 NA NA 16.57 16.63 4.69 090 

33411 .... ............ A ........ Replacement of aortic valve ............... 61.94 NA NA 21.16 20.01 5.48 090 

33412 .... ............ A ........ Replacement of aortic valve ............... 43.77 NA NA 16.27 18.37 6.39 090 

33413 .... ............ A ........ Replacement of aortic valve ............... 59.74 NA NA 23.31 21.60 6.53 090 

33414 .... ............ A ........ Repair of aortic valve ......................... 39.29 NA NA 14.29 14.36 4.57 090 

33415 .... ............ A ........ Revision, subvalvular tissue ............... 37.19 NA NA 13.15 12.56 4.14 090 

33416 .... ............ A ........ Revise ventricle muscle ...................... 36.43 NA NA 13.26 13.43 4.57 090 

33417 .... ............ A ........ Repair of aortic valve ......................... 29.17 NA NA 11.69 12.72 4.10 090 

33420 .... ............ A ........ Revision of mitral valve ...................... 25.67 NA NA 9.47 9.44 1.82 090 

33422 .... ............ A ........ Revision of mitral valve ...................... 29.61 NA NA 11.36 12.69 3.94 090 

33425 .... ............ A ........ Repair of mitral valve ......................... 49.83 NA NA 17.63 15.38 4.07 090 

33426 .... ............ A ........ Repair of mitral valve ......................... 43.15 NA NA 15.75 16.49 5.03 090 

33427 .... ............ A ........ Repair of mitral valve ......................... 44.70 NA NA 15.72 17.59 6.09 090 

33430 .... ............ A ........ Replacement of mitral valve ............... 50.75 NA NA 18.57 18.00 5.10 090 

mstockstill on PROD1PC66 with PROPOSALS2

38268 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

33460 .... ............ A ........ Revision of tricuspid valve .................. 44.62 NA NA 14.77 13.16 3.45 090 

33463 .... ............ A ........ Valvuloplasty, tricuspid ....................... 56.95 NA NA 19.74 16.33 3.87 090 

33464 .... ............ A ........ Valvuloplasty, tricuspid ....................... 44.49 NA NA 15.85 14.75 4.15 090 

33465 .... ............ A ........ Replace tricuspid valve ...................... 50.59 NA NA 17.67 15.33 4.39 090 

33468 .... ............ A ........ Revision of tricuspid valve .................. 32.82 NA NA 14.95 14.37 4.07 090 

33470 .... ............ A ........ Revision of pulmonary valve .............. 21.32 NA NA 7.93 9.44 1.03 090 

33471 .... ............ A ........ Valvotomy, pulmonary valve .............. 22.83 NA NA 11.33 9.94 3.39 090 

33472 .... ............ A ........ Revision of pulmonary valve .............. 22.90 NA NA 8.80 10.07 3.55 090 

33474 .... ............ A ........ Revision of pulmonary valve .............. 39.27 NA NA 13.25 12.73 3.22 090 

33475 .... ............ A ........ Replacement, pulmonary valve .......... 42.27 NA NA 15.11 15.34 4.93 090 

33476 .... ............ A ........ Revision of heart chamber ................. 26.41 NA NA 10.39 11.35 2.42 090 

33478 .... ............ A ........ Revision of heart chamber ................. 27.38 NA NA 11.02 12.03 3.89 090 

33496 .... ............ A ........ Repair, prosth valve clot ..................... 29.71 NA NA 11.12 11.99 4.13 090 

33500 .... ............ A ........ Repair heart vessel fistula .................. 27.82 NA NA 11.00 11.24 3.87 090 

33501 .... ............ A ........ Repair heart vessel fistula .................. 19.43 NA NA 8.17 8.24 1.91 090 

33502 .... ............ A ........ Coronary artery correction .................. 21.69 NA NA 9.31 10.18 3.00 090 

33503 .... ............ A ........ Coronary artery graft .......................... 22.29 NA NA 11.18 10.37 1.78 090 

33504 .... ............ A ........ Coronary artery graft .......................... 25.30 NA NA 10.57 11.12 3.36 090 

33505 .... ............ A ........ Repair artery w/tunnel ........................ 38.35 NA NA 14.84 13.45 2.19 090 

33506 .... ............ A ........ Repair artery, translocation ................ 37.80 NA NA 12.76 14.13 4.66 090 

33507 .... ............ A ........ Repair art, intramural .......................... 31.35 NA NA 11.10 12.48 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 12.91 14.67 4.41 090 

33511 .... ............ A ........ CABG, vein, two ................................. 38.34 NA NA 14.16 15.67 4.56 090 

33512 .... ............ A ........ CABG, vein, three .............................. 43.87 NA NA 15.94 16.82 4.67 090 

33513 .... ............ A ........ CABG, vein, four ................................ 45.26 NA NA 16.36 17.15 4.88 090 

33514 .... ............ A ........ CABG, vein, five ................................. 47.97 NA NA 17.32 17.74 4.77 090 

33516 .... ............ A ........ Cabg, vein, six or more ...................... 49.65 NA NA 17.93 18.47 5.13 090 

33517 .... ............ A ........ CABG, artery-vein, single ................... 3.61 NA NA 1.08 0.97 0.39 ZZZ 

33518 .... ............ A ........ CABG, artery-vein, two ....................... 7.93 NA NA 2.37 1.98 0.73 ZZZ 

33519 .... ............ A ........ CABG, artery-vein, three .................... 10.49 NA NA 3.15 2.74 1.04 ZZZ 

33521 .... ............ A ........ CABG, artery-vein, four ...................... 12.59 NA NA 3.78 3.44 1.37 ZZZ 

33522 .... ............ A ........ CABG, artery-vein, five ....................... 14.14 NA NA 4.25 4.04 1.78 ZZZ 

33523 .... ............ A ........ Cabg, art-vein, six or more ................. 16.08 NA NA 4.80 4.69 2.13 ZZZ 

33530 .... ............ A ........ Coronary artery, bypass/reop ............. 10.13 NA NA 2.96 2.46 0.88 ZZZ 

33533 .... ............ A ........ CABG, arterial, single ......................... 33.64 NA NA 12.56 14.55 4.56 090 

33534 .... ............ A ........ CABG, arterial, two ............................. 39.77 NA NA 14.74 16.27 4.70 090 

33535 .... ............ A ........ CABG, arterial, three .......................... 44.64 NA NA 16.28 17.26 5.03 090 

33536 .... ............ A ........ Cabg, arterial, four or more ................ 48.32 NA NA 17.31 17.84 5.44 090 

33542 .... ............ A ........ Removal of heart lesion ..................... 48.08 NA NA 16.91 15.05 4.38 090 

33545 .... ............ A ........ Repair of heart damage ..................... 56.93 NA NA 20.10 17.93 5.21 090 

33548 .... ............ A ........ Restore/remodel, ventricle .................. 53.96 NA NA 19.36 19.44 5.53 090 

33572 .... ............ A ........ Open coronary endarterectomy .......... 4.44 NA NA 1.32 1.39 0.65 ZZZ 

33600 .... ............ A ........ Closure of valve .................................. 30.15 NA NA 12.08 12.36 4.42 090 

33602 .... ............ A ........ Closure of valve .................................. 29.18 NA NA 11.26 12.24 3.82 090 

33606 .... ............ A ........ Anastomosis/artery-aorta .................... 31.37 NA NA 11.94 12.83 4.41 090 

33608 .... ............ A ........ Repair anomaly w/conduit .................. 31.72 NA NA 12.80 13.55 4.74 090 

33610 .... ............ A ........ Repair by enlargement ....................... 31.24 NA NA 13.56 13.20 4.56 090 

33611 .... ............ A ........ Repair double ventricle ....................... 35.49 NA NA 12.41 13.30 4.37 090 

33612 .... ............ A ........ Repair double ventricle ....................... 36.49 NA NA 14.19 14.46 5.30 090 

33615 .... ............ A ........ Repair, modified fontan ...................... 35.76 NA NA 13.70 13.23 4.32 090 

33617 .... ............ A ........ Repair single ventricle ........................ 38.96 NA NA 14.02 15.41 5.66 090 

33619 .... ............ A ........ Repair single ventricle ........................ 48.60 NA NA 18.07 19.46 6.46 090 

33641 .... ............ A ........ Repair heart septum defect ................ 29.50 NA NA 10.89 10.25 3.23 090 

33645 .... ............ A ........ Revision of heart veins ....................... 27.98 NA NA 10.71 11.28 3.79 090 

33647 .... ............ A ........ Repair heart septum defects .............. 29.37 NA NA 12.61 13.14 3.32 090 

33660 .... ............ A ........ Repair of heart defects ....................... 31.75 NA NA 11.76 12.57 4.49 090 

33665 .... ............ A ........ Repair of heart defects ....................... 34.77 NA NA 12.23 13.06 4.00 090 

33670 .... ............ A ........ Repair of heart chambers ................... 36.58 NA NA 15.34 13.74 4.65 090 

33675 .... ............ A ........ Close mult vsd .................................... 35.87 NA NA 15.47 17.04 4.95 090 

33676 .... ............ A ........ Close mult vsd w/resection ................ 36.87 NA NA 15.78 17.37 5.44 090 

33677 .... ............ A ........ Cl mult vsd w/rem pul band ............... 38.37 NA NA 16.34 17.99 5.68 090 

33681 .... ............ A ........ Repair heart septum defect ................ 32.16 NA NA 12.88 13.84 4.45 090 

33684 .... ............ A ........ Repair heart septum defect ................ 34.29 NA NA 13.45 14.57 3.39 090 

33688 .... ............ A ........ Repair heart septum defect ................ 34.67 NA NA 11.68 10.70 4.73 090 

33690 .... ............ A ........ Reinforce pulmonary artery ................ 20.20 NA NA 8.64 9.39 1.97 090 

33692 .... ............ A ........ Repair of heart defects ....................... 31.38 NA NA 18.79 14.76 4.58 090 

33694 .... ............ A ........ Repair of heart defects ....................... 35.49 NA NA 10.04 12.13 5.28 090 

33697 .... ............ A ........ Repair of heart defects ....................... 37.49 NA NA 16.62 16.63 4.09 090 

33702 .... ............ A ........ Repair of heart defects ....................... 27.11 NA NA 10.54 11.71 3.68 090 

33710 .... ............ A ........ Repair of heart defects ....................... 30.28 NA NA 11.28 12.68 4.43 090 

33720 .... ............ A ........ Repair of heart defect ......................... 27.13 NA NA 10.68 11.55 3.84 090 

mstockstill on PROD1PC66 with PROPOSALS2

38269 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

33722 .... ............ A ........ Repair of heart defect ......................... 29.05 NA NA 10.66 11.92 1.30 090 

33724 .... ............ A ........ Repair venous anomaly ...................... 27.55 NA NA 10.37 10.50 4.00 090 

33726 .... ............ A ........ Repair pul venous stenosis ................ 37.04 NA NA 13.22 13.38 5.03 090 

33730 .... ............ A ........ Repair heart-vein defect(s) ................. 36.01 NA NA 12.82 13.55 5.03 090 

33732 .... ............ A ........ Repair heart-vein defect ..................... 28.80 NA NA 12.55 13.34 3.68 090 

33735 .... ............ A ........ Revision of heart chamber ................. 22.04 NA NA 10.86 9.67 1.92 090 

33736 .... ............ A ........ Revision of heart chamber ................. 24.16 NA NA 11.91 11.68 3.09 090 

33737 .... ............ A ........ Revision of heart chamber ................. 22.34 NA NA 9.14 9.77 3.25 090 

33750 .... ............ A ........ Major vessel shunt ............................. 22.06 NA NA 9.61 10.21 1.16 090 

33755 .... ............ A ........ Major vessel shunt ............................. 22.44 NA NA 7.77 8.29 3.26 090 

33762 .... ............ A ........ Major vessel shunt ............................. 22.44 NA NA 8.72 9.17 3.14 090 

33764 .... ............ A ........ Major vessel shunt & graft ................. 22.44 NA NA 8.94 9.63 3.01 090 

33766 .... ............ A ........ Major vessel shunt ............................. 23.41 NA NA 8.46 10.08 3.70 090 

33767 .... ............ A ........ Major vessel shunt ............................. 25.14 NA NA 8.52 10.27 3.82 090 

33768 .... ............ A ........ Cavopulmonary shunting .................... 8.00 NA NA 1.84 2.31 1.19 ZZZ 

33770 .... ............ A ........ Repair great vessels defect ................ 39.02 NA NA 11.91 13.07 5.74 090 

33771 .... ............ A ........ Repair great vessels defect ................ 40.58 NA NA 13.14 12.33 5.68 090 

33774 .... ............ A ........ Repair great vessels defect ................ 31.54 NA NA 12.22 13.47 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 10.22 13.53 5.09 090 

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 14.99 15.98 6.20 090 

33779 .... ............ A ........ Repair great vessels defect ................ 43.15 NA NA 12.50 13.75 2.92 090 

33780 .... ............ A ........ Repair great vessels defect ................ 43.85 NA NA 13.14 15.87 3.68 090 

33781 .... ............ A ........ Repair great vessels defect ................ 43.16 NA NA 11.13 12.74 5.97 090 

33786 .... ............ A ........ Repair arterial trunk ............................ 41.74 NA NA 14.15 14.98 5.71 090 

33788 .... ............ A ........ Revision of pulmonary artery ............. 27.26 NA NA 8.23 10.34 4.03 090 

33800 .... ............ A ........ Aortic suspension ............................... 17.23 NA NA 6.84 7.55 2.46 090 

33802 .... ............ A ........ Repair vessel defect ........................... 18.24 NA NA 7.96 8.52 2.27 090 

33803 .... ............ A ........ Repair vessel defect ........................... 20.18 NA NA 6.38 8.33 3.20 090 

33813 .... ............ A ........ Repair septal defect ........................... 21.23 NA NA 8.82 9.89 3.13 090 

33814 .... ............ A ........ Repair septal defect ........................... 26.41 NA NA 10.41 11.53 3.85 090 

33820 .... ............ A ........ Revise major vessel ........................... 16.61 NA NA 6.98 7.91 2.35 090 

33822 .... ............ A ........ Revise major vessel ........................... 17.63 NA NA 5.92 7.44 2.68 090 

33824 .... ............ A ........ Revise major vessel ........................... 20.10 NA NA 8.47 9.24 2.89 090 

33840 .... ............ A ........ Remove aorta constriction .................. 21.21 NA NA 9.36 9.76 2.16 090 

33845 .... ............ A ........ Remove aorta constriction .................. 22.77 NA NA 9.39 10.40 3.22 090 

33851 .... ............ A ........ Remove aorta constriction .................. 21.85 NA NA 8.88 9.82 3.18 090 

33852 .... ............ A ........ Repair septal defect ........................... 24.28 NA NA 14.27 12.08 2.16 090 

33853 .... ............ A ........ Repair septal defect ........................... 32.35 NA NA 12.28 13.67 4.48 090 

33860 .... ............ A ........ Ascending aortic graft ......................... 59.33 NA NA 20.24 18.40 5.76 090 

33861 .... ............ A ........ Ascending aortic graft ......................... 43.94 NA NA 15.73 16.78 6.37 090 

33863 .... ............ A ........ Ascending aortic graft ......................... 58.71 NA NA 19.64 19.22 6.59 090 

33870 .... ............ A ........ Transverse aortic arch graft ............... 45.93 NA NA 16.30 17.40 6.62 090 

33875 .... ............ A ........ Thoracic aortic graft ............................ 35.68 NA NA 12.91 13.54 4.89 090 

33877 .... ............ A ........ Thoracoabdominal graft ...................... 68.85 NA NA 21.04 18.79 5.94 090 

33880 .... ............ A ........ Endovasc taa repr incl subcl .............. 34.48 NA NA 10.90 12.12 2.75 090 

33881 .... ............ A ........ Endovasc taa repr w/o subcl .............. 29.48 NA NA 9.65 10.74 2.33 090 

33883 .... ............ A ........ Insert endovasc prosth, taa ................ 20.99 NA NA 7.21 8.15 2.11 090 

33884 .... ............ A ........ Endovasc prosth, taa, add-on ............ 8.20 NA NA 2.09 2.32 0.86 ZZZ 

33886 .... ............ A ........ Endovasc prosth, delayed .................. 17.99 NA NA 6.29 7.24 1.80 090 

33889 .... ............ A ........ Artery transpose/endovas taa ............ 15.92 NA NA 3.97 4.60 2.18 000 

33891 .... ............ A ........ Car-car bp grft/endovas taa ............... 20.00 NA NA 5.80 6.47 2.73 000 

33910 .... ............ A ........ Remove lung artery emboli ................ 29.59 NA NA 11.34 11.37 3.70 090 

33915 .... ............ A ........ Remove lung artery emboli ................ 24.83 NA NA 9.16 9.44 1.44 090 

33916 .... ............ A ........ Surgery of great vessel ...................... 28.30 NA NA 10.90 11.11 3.67 090 

33917 .... ............ A ........ Repair pulmonary artery ..................... 25.14 NA NA 10.04 11.17 3.70 090 

33920 .... ............ A ........ Repair pulmonary atresia ................... 32.58 NA NA 9.46 11.95 4.38 090 

33922 .... ............ A ........ Transect pulmonary artery ................. 24.09 NA NA 10.19 10.76 3.10 090 

33924 .... ............ A ........ Remove pulmonary shunt .................. 5.49 NA NA 1.61 1.82 0.82 ZZZ 

33925 .... ............ A ........ Rpr pul art unifocal w/o cpb ............... 31.25 NA NA 15.94 14.34 4.61 090 

33926 .... ............ A ........ Repr pul art, unifocal w/cpb ............... 44.68 NA NA 14.86 16.18 6.22 090 

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 22.99 25.92 9.06 090 

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 30.44 25.97 6.26 090 

33960 .... ............ A ........ External circulation assist ................... 19.33 NA NA 5.42 5.20 2.67 000 

33961 .... ............ A ........ External circulation assist ................... 10.91 NA NA 2.97 3.29 0.88 ZZZ 

33967 .... ............ A ........ Insert ia percut device ........................ 4.84 NA NA 2.32 2.11 0.35 000 

33968 .... ............ A ........ Remove aortic assist device .............. 0.64 NA NA 0.25 0.24 0.07 000 

33970 .... ............ A ........ Aortic circulation assist ....................... 6.74 NA NA 2.49 2.40 0.82 000 

33971 .... ............ A ........ Aortic circulation assist ....................... 11.91 NA NA 5.92 5.99 1.25 090 

mstockstill on PROD1PC66 with PROPOSALS2

38270 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

33973 .... ............ A ........ Insert balloon device .......................... 9.75 NA NA 3.85 3.59 1.26 000 

33974 .... ............ A ........ Remove intra-aortic balloon ............... 14.93 NA NA 7.59 7.77 1.74 090 

33975 .... ............ A ........ Implant ventricular device ................... 20.97 NA NA 6.33 6.36 3.07 XXX 

33976 .... ............ A ........ Implant ventricular device ................... 22.97 NA NA 7.59 7.62 3.26 XXX 

33977 .... ............ A ........ Remove ventricular device ................. 20.07 NA NA 9.40 10.23 2.81 090 

33978 .... ............ A ........ Remove ventricular device ................. 22.51 NA NA 10.41 11.09 3.31 090 

33979 .... ............ A ........ Insert intracorporeal device ................ 45.93 NA NA 13.34 14.31 6.97 XXX 

33980 .... ............ A ........ Remove intracorporeal device ............ 64.86 NA NA 23.15 24.50 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 6.35 6.58 1.85 090 

34051 .... ............ A ........ Removal of artery clot ........................ 16.91 NA NA 7.39 7.50 2.21 090 

34101 .... ............ A ........ Removal of artery clot ........................ 10.85 NA NA 4.29 4.84 1.41 090 

34111 .... ............ A ........ Removal of arm artery clot ................. 10.85 NA NA 4.27 4.84 1.40 090 

34151 .... ............ A ........ Removal of artery clot ........................ 26.41 NA NA 8.66 9.55 3.56 090 

34201 .... ............ A ........ Removal of artery clot ........................ 19.38 NA NA 6.53 6.01 1.45 090 

34203 .... ............ A ........ Removal of leg artery clot .................. 17.73 NA NA 6.36 7.24 2.36 090 

34401 .... ............ A ........ Removal of vein clot ........................... 26.41 NA NA 9.28 10.02 3.10 090 

34421 .... ............ A ........ Removal of vein clot ........................... 13.29 NA NA 5.17 5.74 1.55 090 

34451 .... ............ A ........ Removal of vein clot ........................... 28.41 NA NA 9.39 10.46 3.84 090 

34471 .... ............ A ........ Removal of vein clot ........................... 21.00 NA NA 7.81 6.53 1.18 090 

34490 .... ............ A ........ Removal of vein clot ........................... 10.83 NA NA 4.34 4.90 1.41 090 

34501 .... ............ A ........ Repair valve, femoral vein .................. 16.74 NA NA 6.41 7.54 2.35 090 

34502 .... ............ A ........ Reconstruct vena cava ....................... 27.86 NA NA 10.51 11.44 3.63 090 

34510 .... ............ A ........ Transposition of vein valve ................. 19.80 NA NA 7.55 8.43 2.33 090 

34520 .... ............ A ........ Cross-over vein graft .......................... 19.05 NA NA 7.00 8.10 2.29 090 

34530 .... ............ A ........ Leg vein fusion ................................... 17.77 NA NA 6.75 7.87 1.74 090 

34800 .... ............ A ........ Endovas aaa repr w/sm tube ............. 21.46 NA NA 7.23 8.22 2.46 090 

34802 .... ............ A ........ Endovas aaa repr w/2-p part .............. 23.71 NA NA 8.14 8.97 2.33 090 

34803 .... ............ A ........ Endovas aaa repr w/3-p part .............. 24.74 NA NA 8.00 9.12 2.01 090 

34804 .... ............ A ........ Endovas aaa repr w/1–p part ............. 23.71 NA NA 8.04 8.93 2.30 090 

34805 .... ............ A ........ Endovas aaa repr w/long tube ........... 22.59 NA NA 7.25 8.44 2.01 090 

34808 .... ............ A ........ Endovas iliac a device addon ............ 4.12 NA NA 1.05 1.22 0.59 ZZZ 

34812 .... ............ A ........ Xpose for endoprosth, femorl ............. 6.74 NA NA 1.67 1.96 1.18 000 

34813 .... ............ A ........ Femoral endovas graft add-on ........... 4.79 NA NA 1.16 1.37 0.67 ZZZ 

34820 .... ............ A ........ Xpose for endoprosth, iliac ................. 9.74 NA NA 2.46 2.85 1.50 000 

34825 .... ............ A ........ Endovasc extend prosth, init .............. 12.72 NA NA 5.12 5.63 1.28 090 

34826 .... ............ A ........ Endovasc exten prosth, add-l ............. 4.12 NA NA 1.13 1.25 0.44 ZZZ 

34830 .... ............ A ........ Open aortic tube prosth repr .............. 35.10 NA NA 10.35 12.09 4.55 090 

34831 .... ............ A ........ Open aortoiliac prosth repr ................. 37.85 NA NA 11.29 11.64 4.89 090 

34832 .... ............ A ........ Open aortofemor prosth repr .............. 37.85 NA NA 11.78 13.17 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 1.55 1.88 0.76 000 

34900 .... ............ A ........ Endovasc iliac repr w/graft ................. 16.77 NA NA 6.04 6.84 2.00 090 

35001 .... ............ A ........ Repair defect of artery ........................ 20.70 NA NA 7.69 8.61 2.81 090 

35002 .... ............ A ........ Repair artery rupture, neck ................ 22.12 NA NA 7.44 8.63 3.00 090 

35005 .... ............ A ........ Repair defect of artery ........................ 19.18 NA NA 8.58 8.54 1.77 090 

35011 .... ............ A ........ Repair defect of artery ........................ 18.50 NA NA 6.29 7.16 2.55 090 

35013 .... ............ A ........ Repair artery rupture, arm .................. 23.10 NA NA 7.73 8.74 3.10 090 

35021 .... ............ A ........ Repair defect of artery ........................ 22.09 NA NA 8.44 8.97 2.87 090 

35022 .... ............ A ........ Repair artery rupture, chest ............... 25.62 NA NA 10.45 9.98 3.17 090 

35045 .... ............ A ........ Repair defect of arm artery ................ 17.94 NA NA 6.26 6.93 2.45 090 

35081 .... ............ A ........ Repair defect of artery ........................ 33.37 NA NA 10.70 11.14 4.01 090 

35082 .... ............ A ........ Repair artery rupture, aorta ................ 41.93 NA NA 12.78 14.09 5.44 090 

35091 .... ............ A ........ Repair defect of artery ........................ 35.35 NA NA 10.00 11.85 5.14 090 

35092 .... ............ A ........ Repair artery rupture, aorta ................ 50.81 NA NA 14.51 16.16 6.40 090 

35102 .... ............ A ........ Repair defect of artery ........................ 36.37 NA NA 11.29 11.88 4.48 090 

35103 .... ............ A ........ Repair artery rupture, groin ................ 43.49 NA NA 12.64 14.34 5.76 090 

35111 .... ............ A ........ Repair defect of artery ........................ 26.17 NA NA 8.50 9.49 3.47 090 

35112 .... ............ A ........ Repair artery rupture,spleen ............... 32.44 NA NA 10.07 11.08 4.08 090 

35121 .... ............ A ........ Repair defect of artery ........................ 31.41 NA NA 9.96 11.25 4.30 090 

35122 .... ............ A ........ Repair artery rupture, belly ................. 37.76 NA NA 11.57 12.77 4.75 090 

35131 .... ............ A ........ Repair defect of artery ........................ 26.29 NA NA 8.63 9.73 3.80 090 

35132 .... ............ A ........ Repair artery rupture, groin ................ 32.44 NA NA 10.30 11.33 4.30 090 

35141 .... ............ A ........ Repair defect of artery ........................ 20.83 NA NA 6.92 7.95 2.90 090 

35142 .... ............ A ........ Repair artery rupture, thigh ................ 25.03 NA NA 8.23 9.32 3.36 090 

35151 .... ............ A ........ Repair defect of artery ........................ 23.61 NA NA 7.63 8.85 3.24 090 

35152 .... ............ A ........ Repair artery rupture, knee ................ 27.53 NA NA 9.09 10.22 3.61 090 

35180 .... ............ A ........ Repair blood vessel lesion ................. 15.01 NA NA 6.28 6.52 1.00 090 

35182 .... ............ A ........ Repair blood vessel lesion ................. 31.58 NA NA 10.85 11.97 4.36 090 

35184 .... ............ A ........ Repair blood vessel lesion ................. 18.72 NA NA 6.48 7.46 2.53 090 

35188 .... ............ A ........ Repair blood vessel lesion ................. 15.05 NA NA 6.19 6.92 2.16 090 

35189 .... ............ A ........ Repair blood vessel lesion ................. 29.85 NA NA 10.56 11.18 4.01 090 

mstockstill on PROD1PC66 with PROPOSALS2

38271 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

35190 .... ............ A ........ Repair blood vessel lesion ................. 13.33 NA NA 5.22 5.86 1.80 090 

35201 .... ............ A ........ Repair blood vessel lesion ................. 16.84 NA NA 6.31 7.17 2.34 090 

35206 .... ............ A ........ Repair blood vessel lesion ................. 13.76 NA NA 5.29 5.94 1.87 090 

35207 .... ............ A ........ Repair blood vessel lesion ................. 10.85 NA NA 6.62 7.00 1.48 090 

35211 .... ............ A ........ Repair blood vessel lesion ................. 24.50 NA NA 9.70 10.22 3.20 090 

35216 .... ............ A ........ Repair blood vessel lesion ................. 36.47 NA NA 13.56 11.32 2.65 090 

35221 .... ............ A ........ Repair blood vessel lesion ................. 26.54 NA NA 8.35 9.17 3.37 090 

35226 .... ............ A ........ Repair blood vessel lesion ................. 15.22 NA NA 5.77 6.62 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 7.12 2.43 090 

35241 .... ............ A ........ Repair blood vessel lesion ................. 25.50 NA NA 10.02 10.55 3.53 090 

35246 .... ............ A ........ Repair blood vessel lesion ................. 28.15 NA NA 10.14 11.09 3.86 090 

35251 .... ............ A ........ Repair blood vessel lesion ................. 31.83 NA NA 9.45 10.68 4.13 090 

35256 .... ............ A ........ Repair blood vessel lesion ................. 18.98 NA NA 6.36 7.40 2.63 090 

35261 .... ............ A ........ Repair blood vessel lesion ................. 18.88 NA NA 6.94 7.52 2.61 090 

35266 .... ............ A ........ Repair blood vessel lesion ................. 15.75 NA NA 5.46 6.27 2.10 090 

35271 .... ............ A ........ Repair blood vessel lesion ................. 24.50 NA NA 9.67 10.09 3.16 090 

35276 .... ............ A ........ Repair blood vessel lesion ................. 25.72 NA NA 9.76 10.45 3.49 090 

35281 .... ............ A ........ Repair blood vessel lesion ................. 29.93 NA NA 9.27 10.57 3.97 090 

35286 .... ............ A ........ Repair blood vessel lesion ................. 17.06 NA NA 6.30 7.20 2.35 090 

35301 .... ............ A ........ Rechanneling of artery ....................... 19.53 NA NA 6.68 7.59 2.68 090 

35302 .... ............ A ........ Rechanneling of artery ....................... 21.27 NA NA 6.90 7.06 2.98 090 

35303 .... ............ A ........ Rechanneling of artery ....................... 23.52 NA NA 7.45 7.63 3.26 090 

35304 .... ............ A ........ Rechanneling of artery ....................... 24.52 NA NA 7.70 7.88 3.41 090 

35305 .... ............ A ........ Rechanneling of artery ....................... 23.52 NA NA 7.45 7.63 3.26 090 

35306 .... ............ A ........ Rechanneling of artery ....................... 9.25 NA NA 2.28 2.35 1.34 ZZZ 

35311 .... ............ A ........ Rechanneling of artery ....................... 28.52 NA NA 9.63 10.69 3.42 090 

35321 .... ............ A ........ Rechanneling of artery ....................... 16.51 NA NA 5.77 6.61 2.25 090 

35331 .... ............ A ........ Rechanneling of artery ....................... 27.61 NA NA 8.81 10.05 3.83 090 

35341 .... ............ A ........ Rechanneling of artery ....................... 26.10 NA NA 8.23 9.60 3.78 090 

35351 .... ............ A ........ Rechanneling of artery ....................... 24.53 NA NA 7.65 8.67 3.35 090 

35355 .... ............ A ........ Rechanneling of artery ....................... 19.78 NA NA 6.35 7.24 2.67 090 

35361 .... ............ A ........ Rechanneling of artery ....................... 30.11 NA NA 9.60 10.67 4.15 090 

35363 .... ............ A ........ Rechanneling of artery ....................... 32.22 NA NA 10.45 11.53 4.33 090 

35371 .... ............ A ........ Rechanneling of artery ....................... 15.23 NA NA 5.32 6.16 2.14 090 

35372 .... ............ A ........ Rechanneling of artery ....................... 18.50 NA NA 6.12 7.11 2.63 090 

35390 .... ............ A ........ Reoperation, carotid add-on ............... 3.19 NA NA 0.82 0.95 0.46 ZZZ 

35400 .... ............ A ........ Angioscopy ......................................... 3.00 NA NA 0.72 0.92 0.43 ZZZ 

35450 .... ............ A ........ Repair arterial blockage ..................... 10.05 NA NA 2.96 3.30 1.25 000 

35452 .... ............ A ........ Repair arterial blockage ..................... 6.90 NA NA 2.06 2.34 0.94 000 

35454 .... ............ A ........ Repair arterial blockage ..................... 6.03 NA NA 1.76 2.05 0.87 000 

35456 .... ............ A ........ Repair arterial blockage ..................... 7.34 NA NA 2.12 2.47 1.04 000 

35458 .... ............ A ........ Repair arterial blockage ..................... 9.48 NA NA 2.80 3.15 1.26 000 

35459 .... ............ A ........ Repair arterial blockage ..................... 8.62 NA NA 2.63 2.88 1.21 000 

35460 .... ............ A ........ Repair venous blockage ..................... 6.03 NA NA 1.75 2.02 0.83 000 

35470 .... ............ A ........ Repair arterial blockage ..................... 8.62 59.93 74.50 3.39 3.38 0.69 000 

35471 .... ............ A ........ Repair arterial blockage ..................... 10.05 64.34 82.51 4.56 4.27 0.67 000 

35472 .... ............ A ........ Repair arterial blockage ..................... 6.90 46.58 55.56 2.77 2.76 0.58 000 

35473 .... ............ A ........ Repair arterial blockage ..................... 6.03 45.57 52.79 2.46 2.44 0.51 000 

35474 .... ............ A ........ Repair arterial blockage ..................... 7.35 59.20 73.53 2.93 2.91 0.57 000 

35475 .... ............ R ........ Repair arterial blockage ..................... 9.48 48.02 51.97 3.38 3.45 0.62 000 

35476 .... ............ A ........ Repair venous blockage ..................... 6.03 36.79 40.56 2.25 2.26 0.34 000 

35480 .... ............ A ........ Atherectomy, open ............................. 11.06 NA NA 3.98 4.01 1.28 000 

35481 .... ............ A ........ Atherectomy, open ............................. 7.60 NA NA 2.58 2.71 1.13 000 

35482 .... ............ A ........ Atherectomy, open ............................. 6.64 NA NA 2.01 2.30 0.89 000 

35483 .... ............ A ........ Atherectomy, open ............................. 8.09 NA NA 2.55 2.82 1.15 000 

35484 .... ............ A ........ Atherectomy, open ............................. 10.42 NA NA 2.90 3.36 1.27 000 

35485 .... ............ A ........ Atherectomy, open ............................. 9.48 NA NA 2.86 3.22 1.35 000 

35490 .... ............ A ........ Atherectomy, percutaneous ................ 11.06 NA NA 5.04 5.09 0.71 000 

35491 .... ............ A ........ Atherectomy, percutaneous ................ 7.60 NA NA 3.74 3.55 0.74 000 

35492 .... ............ A ........ Atherectomy, percutaneous ................ 6.64 NA NA 3.40 3.33 0.43 000 

35493 .... ............ A ........ Atherectomy, percutaneous ................ 8.09 NA NA 3.87 3.88 0.56 000 

35494 .... ............ A ........ Atherectomy, percutaneous ................ 10.42 NA NA 5.01 4.76 0.59 000 

35495 .... ............ A ........ Atherectomy, percutaneous ................ 9.48 NA NA 4.35 4.42 0.69 000 

35500 .... ............ A ........ Harvest vein for bypass ...................... 6.44 NA NA 1.60 1.83 0.93 ZZZ 

35501 .... ............ A ........ Artery bypass graft ............................. 28.99 NA NA 11.04 9.83 4.10 090 

35506 .... ............ A ........ Artery bypass graft ............................. 25.23 NA NA 8.34 8.92 2.87 090 

35508 .... ............ A ........ Artery bypass graft ............................. 25.99 NA NA 8.77 9.16 2.78 090 

35509 .... ............ A ........ Artery bypass graft ............................. 27.99 NA NA 10.74 9.74 3.92 090 

35510 .... ............ A ........ Artery bypass graft ............................. 24.29 NA NA 7.68 8.94 2.12 090 

35511 .... ............ A ........ Artery bypass graft ............................. 22.12 NA NA 7.58 8.41 2.91 090 

35512 .... ............ A ........ Artery bypass graft ............................. 23.79 NA NA 7.47 8.74 2.12 090 

mstockstill on PROD1PC66 with PROPOSALS2

38272 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

35515 .... ............ A ........ Artery bypass graft ............................. 25.99 NA NA 9.09 9.07 2.78 090 

35516 .... ............ A ........ Artery bypass graft ............................. 24.11 NA NA 7.46 7.18 2.34 090 

35518 .... ............ A ........ Artery bypass graft ............................. 22.57 NA NA 7.36 8.19 3.03 090 

35521 .... ............ A ........ Artery bypass graft ............................. 24.00 NA NA 7.96 8.92 3.13 090 

35522 .... ............ A ........ Artery bypass graft ............................. 23.05 NA NA 7.40 8.59 2.12 090 

35525 .... ............ A ........ Artery bypass graft ............................. 21.59 NA NA 7.03 8.22 2.12 090 

35526 .... ............ A ........ Artery bypass graft ............................. 31.47 NA NA 13.81 13.92 3.63 090 

35531 .... ............ A ........ Artery bypass graft ............................. 38.98 NA NA 11.47 13.04 5.18 090 

35533 .... ............ A ........ Artery bypass graft ............................. 29.79 NA NA 9.50 10.69 3.85 090 

35536 .... ............ A ........ Artery bypass graft ............................. 33.60 NA NA 9.50 11.39 4.62 090 

35537 .... ............ A ........ Artery bypass graft ............................. 41.75 NA NA 13.08 13.17 5.72 090 

35538 .... ............ A ........ Artery bypass graft ............................. 46.82 NA NA 14.44 14.55 6.39 090 

35539 .... ............ A ........ Artery bypass graft ............................. 43.98 NA NA 13.48 13.65 6.02 090 

35540 .... ............ A ........ Artery bypass graft ............................. 49.20 NA NA 14.82 15.01 6.76 090 

35548 .... ............ A ........ Artery bypass graft ............................. 22.57 NA NA 7.73 8.60 2.98 090 

35549 .... ............ A ........ Artery bypass graft ............................. 24.34 NA NA 8.74 9.63 3.30 090 

35551 .... ............ A ........ Artery bypass graft ............................. 27.72 NA NA 9.39 10.52 3.75 090 

35556 .... ............ A ........ Artery bypass graft ............................. 26.62 NA NA 8.63 9.22 3.10 090 

35558 .... ............ A ........ Artery bypass graft ............................. 23.00 NA NA 7.85 8.73 3.00 090 

35560 .... ............ A ........ Artery bypass graft ............................. 33.90 NA NA 10.63 11.99 4.75 090 

35563 .... ............ A ........ Artery bypass graft ............................. 25.99 NA NA 8.84 9.63 3.52 090 

35565 .... ............ A ........ Artery bypass graft ............................. 25.00 NA NA 8.15 9.19 3.30 090 

35566 .... ............ A ........ Artery bypass graft ............................. 32.22 NA NA 9.84 10.66 3.83 090 

35571 .... ............ A ........ Artery bypass graft ............................. 25.39 NA NA 8.08 9.51 3.43 090 

35572 .... ............ A ........ Harvest femoropopliteal vein .............. 6.81 NA NA 1.92 2.07 0.99 ZZZ 

35583 .... ............ A ........ Vein bypass graft ................................ 27.62 NA NA 8.64 9.45 3.17 090 

35585 .... ............ A ........ Vein bypass graft ................................ 32.22 NA NA 10.10 11.19 4.02 090 

35587 .... ............ A ........ Vein bypass graft ................................ 26.08 NA NA 8.48 9.99 3.52 090 

35600 .... ............ A ........ Harvest artery for cabg ....................... 4.94 NA NA 1.53 1.58 0.73 ZZZ 

35601 .... ............ A ........ Artery bypass graft ............................. 26.99 NA NA 10.38 9.52 3.72 090 

35606 .... ............ A ........ Artery bypass graft ............................. 22.36 NA NA 7.30 8.21 2.70 090 

35612 .... ............ A ........ Artery bypass graft ............................. 16.71 NA NA 6.29 7.10 2.09 090 

35616 .... ............ A ........ Artery bypass graft ............................. 21.74 NA NA 7.09 7.60 2.20 090 

35621 .... ............ A ........ Artery bypass graft ............................. 20.95 NA NA 6.77 7.76 2.92 090 

35623 .... ............ A ........ Bypass graft, not vein ......................... 25.79 NA NA 8.43 9.49 3.46 090 

35626 .... ............ A ........ Artery bypass graft ............................. 29.06 NA NA 10.20 11.09 4.08 090 

35631 .... ............ A ........ Artery bypass graft ............................. 35.90 NA NA 10.54 12.26 4.96 090 

35636 .... ............ A ........ Artery bypass graft ............................. 31.62 NA NA 9.72 11.03 4.10 090 

35637 .... ............ A ........ Artery bypass graft ............................. 32.92 NA NA 10.65 10.83 4.44 090 

35638 .... ............ A ........ Artery bypass graft ............................. 33.47 NA NA 10.79 10.97 4.52 090 

35642 .... ............ A ........ Artery bypass graft ............................. 18.85 NA NA 6.20 7.69 2.28 090 

35645 .... ............ A ........ Artery bypass graft ............................. 18.34 NA NA 7.86 7.97 2.50 090 

35646 .... ............ A ........ Artery bypass graft ............................. 32.84 NA NA 10.44 11.82 4.44 090 

35647 .... ............ A ........ Artery bypass graft ............................. 29.62 NA NA 9.65 10.73 3.99 090 

35650 .... ............ A ........ Artery bypass graft ............................. 20.08 NA NA 6.90 7.61 2.72 090 

35651 .... ............ A ........ Artery bypass graft ............................. 25.97 NA NA 8.75 9.74 3.36 090 

35654 .... ............ A ........ Artery bypass graft ............................. 26.17 NA NA 8.34 9.53 3.53 090 

35656 .... ............ A ........ Artery bypass graft ............................. 20.39 NA NA 6.83 7.75 2.80 090 

35661 .... ............ A ........ Artery bypass graft ............................. 20.22 NA NA 7.03 8.02 2.72 090 

35663 .... ............ A ........ Artery bypass graft ............................. 23.80 NA NA 7.92 8.97 3.11 090 

35665 .... ............ A ........ Artery bypass graft ............................. 22.22 NA NA 7.35 8.44 3.01 090 

35666 .... ............ A ........ Artery bypass graft ............................. 23.53 NA NA 8.48 9.60 3.16 090 

35671 .... ............ A ........ Artery bypass graft ............................. 20.64 NA NA 7.61 8.54 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 1.70 2.05 1.03 ZZZ 

35683 .... ............ A ........ Composite bypass graft ...................... 8.49 NA NA 1.96 2.41 1.20 ZZZ 

35685 .... ............ A ........ Bypass graft patency/patch ................ 4.04 NA NA 0.96 1.16 0.58 ZZZ 

35686 .... ............ A ........ Bypass graft/av fist patency ............... 3.34 NA NA 0.84 0.99 0.47 ZZZ 

35691 .... ............ A ........ Arterial transposition ........................... 18.32 NA NA 5.88 7.21 2.59 090 

35693 .... ............ A ........ Arterial transposition ........................... 15.64 NA NA 6.10 6.90 2.22 090 

35694 .... ............ A ........ Arterial transposition ........................... 19.19 NA NA 6.32 7.50 2.70 090 

35695 .... ............ A ........ Arterial transposition ........................... 19.97 NA NA 6.70 7.61 2.74 090 

35697 .... ............ A ........ Reimplant artery each ........................ 3.00 NA NA 0.74 0.89 0.41 ZZZ 

35700 .... ............ A ........ Reoperation, bypass graft .................. 3.08 NA NA 0.77 0.90 0.44 ZZZ 

35701 .... ............ A ........ Exploration, carotid artery .................. 9.11 NA NA 4.31 4.72 1.12 090 

35721 .... ............ A ........ Exploration, femoral artery ................. 7.66 NA NA 3.79 4.10 1.03 090 

35741 .... ............ A ........ Exploration popliteal artery ................. 8.61 NA NA 3.86 4.28 1.12 090 

35761 .... ............ A ........ Exploration of artery/vein .................... 5.84 NA NA 3.42 3.73 0.75 090 

35800 .... ............ A ........ Explore neck vessels .......................... 7.99 NA NA 3.94 4.30 0.95 090 

35820 .... ............ A ........ Explore chest vessels ......................... 36.81 NA NA 12.92 10.11 1.95 090 

35840 .... ............ A ........ Explore abdominal vessels ................. 10.87 NA NA 4.79 5.05 1.34 090 

35860 .... ............ A ........ Explore limb vessels ........................... 6.72 NA NA 3.36 3.71 0.78 090 

mstockstill on PROD1PC66 with PROPOSALS2

38273 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

35870 .... ............ A ........ Repair vessel graft defect .................. 24.39 NA NA 7.90 8.88 3.01 090 

35875 .... ............ A ........ Removal of clot in graft ...................... 10.64 NA NA 4.27 4.74 1.41 090 

35876 .... ............ A ........ Removal of clot in graft ...................... 17.74 NA NA 5.94 6.75 2.40 090 

35879 .... ............ A ........ Revise graft w/vein ............................. 17.28 NA NA 5.96 6.85 2.28 090 

35881 .... ............ A ........ Revise graft w/vein ............................. 19.22 NA NA 6.45 7.60 2.56 090 

35883 .... ............ A ........ Revise graft w/nonauto graft .............. 23.07 NA NA 8.45 8.79 3.19 090 

35884 .... ............ A ........ Revise graft w/vein ............................. 24.57 NA NA 8.89 9.25 3.41 090 

35901 .... ............ A ........ Excision, graft, neck ........................... 8.26 NA NA 4.23 4.78 1.15 090 

35903 .... ............ A ........ Excision, graft, extremity .................... 9.44 NA NA 4.58 5.39 1.30 090 

35905 .... ............ A ........ Excision, graft, thorax ......................... 33.39 NA NA 10.65 11.93 4.44 090 

35907 .... ............ A ........ Excision, graft, abdomen .................... 37.14 NA NA 10.89 12.59 4.92 090 

36000 .... ............ A ........ Place needle in vein ........................... 0.18 0.45 0.51 0.06 0.05 0.01 XXX 

36002 .... ............ A ........ Pseudoaneurysm injection trt ............. 1.96 2.23 2.53 0.86 0.90 0.17 000 

36005 .... ............ A ........ Injection ext venography .................... 0.95 8.31 7.97 0.38 0.34 0.05 000 

36010 .... ............ A ........ Place catheter in vein ......................... 2.43 10.97 15.10 0.79 0.78 0.20 XXX 

36011 .... ............ A ........ Place catheter in vein ......................... 3.14 19.38 23.54 1.01 1.02 0.27 XXX 

36012 .... ............ A ........ Place catheter in vein ......................... 3.51 20.00 19.39 1.28 1.21 0.23 XXX 

36013 .... ............ A ........ Place catheter in artery ...................... 2.52 18.38 19.98 0.91 0.81 0.25 XXX 

36014 .... ............ A ........ Place catheter in artery ...................... 3.02 18.75 19.33 1.12 1.05 0.19 XXX 

36015 .... ............ A ........ Place catheter in artery ...................... 3.51 18.34 20.87 1.05 1.10 0.21 XXX 

36100 .... ............ A ........ Establish access to artery .................. 3.02 10.95 11.54 1.18 1.15 0.26 XXX 

36120 .... ............ A ........ Establish access to artery .................. 2.01 9.11 9.90 0.60 0.62 0.14 XXX 

36140 .... ............ A ........ Establish access to artery .................. 2.01 10.28 11.53 0.70 0.67 0.16 XXX 

36145 .... ............ A ........ Artery to vein shunt ............................ 2.01 10.19 11.31 0.66 0.65 0.11 XXX 

36160 .... ............ A ........ Establish access to aorta ................... 2.52 11.30 12.43 1.04 0.89 0.26 XXX 

36200 .... ............ A ........ Place catheter in aorta ....................... 3.02 13.45 14.95 1.01 1.00 0.24 XXX 

36215 .... ............ A ........ Place catheter in artery ...................... 4.67 25.46 26.21 1.87 1.72 0.27 XXX 

36216 .... ............ A ........ Place catheter in artery ...................... 5.27 27.57 28.24 2.07 1.90 0.31 XXX 

36217 .... ............ A ........ Place catheter in artery ...................... 6.29 45.25 50.18 2.43 2.26 0.44 XXX 

36218 .... ............ A ........ Place catheter in artery ...................... 1.01 3.72 4.39 0.39 0.36 0.07 ZZZ 

36245 .... ............ A ........ Place catheter in artery ...................... 4.67 28.07 30.14 2.06 1.87 0.31 XXX 

36246 .... ............ A ........ Place catheter in artery ...................... 5.27 26.94 28.43 1.97 1.88 0.38 XXX 

36247 .... ............ A ........ Place catheter in artery ...................... 6.29 44.33 46.92 2.33 2.22 0.47 XXX 

36248 .... ............ A ........ Place catheter in artery ...................... 1.01 3.12 3.58 0.38 0.36 0.07 ZZZ 

36260 .... ............ A ........ Insertion of infusion pump .................. 9.82 NA NA 4.63 4.79 1.29 090 

36261 .... ............ A ........ Revision of infusion pump .................. 5.55 NA NA 3.04 3.37 0.70 090 

36262 .... ............ A ........ Removal of infusion pump .................. 4.05 NA NA 2.69 2.72 0.54 090 

36299 .... ............ C ........ Vessel injection procedure ................. 0.00 0.00 6.30 0.00 6.30 0.00 YYY 

36400 .... ............ A ........ Bl draw < 3 yrs fem/jugular ................ 0.38 0.28 0.29 0.09 0.10 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 0.24 0.27 0.04 0.05 0.01 XXX 

36410 .... ............ A ........ Non-routine bl draw > 3 yrs ............... 0.18 0.31 0.30 0.05 0.05 0.01 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 0.20 0.21 0.06 XXX 

36430 .... ............ A ........ Blood transfusion service ................... 0.00 0.93 0.97 0.00 0.51 0.06 XXX 

36440 .... ............ A ........ Bl push transfuse, 2 yr or < ............... 1.03 NA NA 0.25 0.30 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 0.67 0.86 0.15 XXX 

36460 .... ............ A ........ Transfusion service, fetal ................... 6.58 NA NA 1.84 2.01 0.79 XXX 

36470 .... ............ A ........ Injection therapy of vein ..................... 1.09 2.38 2.54 0.64 0.69 0.12 010 

36471 .... ............ A ........ Injection therapy of veins ................... 1.60 2.54 2.81 0.79 0.88 0.19 010 

36475 .... ............ A ........ Endovenous rf, 1st vein ...................... 6.72 35.43 43.52 1.88 2.22 0.37 000 

36476 .... ............ A ........ Endovenous rf, vein add-on ............... 3.38 6.09 6.96 0.83 1.00 0.18 ZZZ 

36478 .... ............ A ........ Endovenous laser, 1st vein ................ 6.72 26.65 36.69 2.05 2.29 0.37 000 

36479 .... ............ A ........ Endovenous laser vein addon ............ 3.38 6.29 7.16 0.95 1.05 0.18 ZZZ 

36481 .... ............ A ........ Insertion of catheter, vein ................... 6.98 NA NA 2.35 2.42 0.55 000 

36500 .... ............ A ........ Insertion of catheter, vein ................... 3.51 NA NA 1.26 1.30 0.20 000 

36510 .... ............ A ........ Insertion of catheter, vein ................... 1.09 1.05 2.48 0.29 0.46 0.10 000 

36511 .... ............ A ........ Apheresis wbc .................................... 1.74 NA NA 0.58 0.65 0.08 000 

36512 .... ............ A ........ Apheresis rbc ...................................... 1.74 NA NA 0.61 0.68 0.08 000 

36513 .... ............ A ........ Apheresis platelets ............................. 1.74 NA NA 0.55 0.64 0.17 000 

36514 .... ............ A ........ Apheresis plasma ............................... 1.74 10.41 13.69 0.54 0.63 0.08 000 

36515 .... ............ A ........ Apheresis, adsorp/reinfuse ................. 1.74 45.00 55.61 0.48 0.58 0.08 000 

36516 .... ............ A ........ Apheresis, selective ............................ 1.22 48.74 66.49 0.39 0.44 0.08 000 

36522 .... ............ A ........ Photopheresis ..................................... 1.67 37.04 34.36 0.94 0.94 0.13 000 

36550 .... ............ A ........ Declot vascular device ....................... 0.00 0.32 0.35 0.06 0.23 0.37 XXX 

36555 .... ............ A ........ Insert non-tunnel cv cath .................... 2.68 3.77 4.82 0.59 0.70 0.11 000 

36556 .... ............ A ........ Insert non-tunnel cv cath .................... 2.50 2.83 4.23 0.56 0.65 0.19 000 

36557 .... ............ A ........ Insert tunneled cv cath ....................... 5.11 14.84 17.90 2.26 2.45 0.57 010 

36558 .... ............ A ........ Insert tunneled cv cath ....................... 4.81 14.71 17.82 2.36 2.43 0.57 010 

36560 .... ............ A ........ Insert tunneled cv cath ....................... 6.26 21.07 25.32 2.69 2.83 0.57 010 

36561 .... ............ A ........ Insert tunneled cv cath ....................... 6.01 22.02 25.76 2.64 2.78 0.57 010 

mstockstill on PROD1PC66 with PROPOSALS2

38274 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

36563 .... ............ A ........ Insert tunneled cv cath ....................... 6.21 22.86 24.79 2.59 2.79 0.84 010 

36565 .... ............ A ........ Insert tunneled cv cath ....................... 6.01 17.33 21.04 2.47 2.71 0.57 010 

36566 .... ............ A ........ Insert tunneled cv cath ....................... 6.51 110.45 68.26 2.59 2.86 0.57 010 

36568 .... ............ A ........ Insert picc cath ................................... 1.92 5.81 6.62 0.60 0.58 0.11 000 

36569 .... ............ A ........ Insert picc cath ................................... 1.82 4.44 5.85 0.67 0.60 0.19 000 

36570 .... ............ A ........ Insert picvad cath ............................... 5.33 20.99 27.31 2.10 2.44 0.57 010 

36571 .... ............ A ........ Insert picvad cath ............................... 5.31 24.25 28.75 2.44 2.56 0.57 010 

36575 .... ............ A ........ Repair tunneled cv cath ..................... 0.67 3.27 3.65 0.23 0.24 0.20 000 

36576 .... ............ A ........ Repair tunneled cv cath ..................... 3.21 5.86 6.37 1.56 1.69 0.19 010 

36578 .... ............ A ........ Replace tunneled cv cath ................... 3.51 9.10 10.05 2.00 2.12 0.19 010 

36580 .... ............ A ........ Replace cvad cath .............................. 1.31 3.93 5.42 0.43 0.42 0.19 000 

36581 .... ............ A ........ Replace tunneled cv cath ................... 3.45 15.37 17.34 1.74 1.80 0.19 010 

36582 .... ............ A ........ Replace tunneled cv cath ................... 5.21 21.33 23.45 2.46 2.62 0.19 010 

36583 .... ............ A ........ Replace tunneled cv cath ................... 5.26 21.33 23.46 2.49 2.65 0.19 010 

36584 .... ............ A ........ Replace picc cath ............................... 1.20 3.94 5.42 0.62 0.57 0.19 000 

36585 .... ............ A ........ Replace picvad cath ........................... 4.81 22.31 24.96 2.44 2.54 0.19 010 

36589 .... ............ A ........ Removal tunneled cv cath .................. 2.27 1.85 2.04 1.23 1.30 0.24 010 

36590 .... ............ A ........ Removal tunneled cv cath .................. 3.32 3.60 3.48 1.60 1.65 0.44 010 

36595 .... ............ A ........ Mech remov tunneled cv cath ............ 3.59 10.76 13.92 1.39 1.39 0.21 000 

36596 .... ............ A ........ Mech remov tunneled cv cath ............ 0.75 2.56 3.11 0.43 0.46 0.05 000 

36597 .... ............ A ........ Reposition venous catheter ................ 1.21 2.03 2.20 0.46 0.44 0.07 000 

36598 .... ............ T ......... Inj w/fluor, eval cv device ................... 0.74 2.19 2.41 0.27 1.45 0.05 000 

36600 .... ............ A ........ Withdrawal of arterial blood ................ 0.32 0.49 0.49 0.07 0.08 0.02 XXX 

36620 .... ............ A ........ Insertion catheter, artery .................... 1.15 NA NA 0.15 0.20 0.07 000 

36625 .... ............ A ........ Insertion catheter, artery .................... 2.11 NA NA 0.51 0.52 0.26 000 

36640 .... ............ A ........ Insertion catheter, artery .................... 2.10 NA NA 0.91 0.98 0.21 000 

36660 .... ............ A ........ Insertion catheter, artery .................... 1.40 NA NA 0.40 0.39 0.14 000 

36680 .... ............ A ........ Insert needle, bone cavity .................. 1.20 NA NA 0.28 0.39 0.11 000 

36800 .... ............ A ........ Insertion of cannula ............................ 2.43 NA NA 1.52 1.67 0.25 000 

36810 .... ............ A ........ Insertion of cannula ............................ 3.96 NA NA 1.32 1.51 0.45 000 

36815 .... ............ A ........ Insertion of cannula ............................ 2.62 NA NA 1.04 1.11 0.35 000 

36818 .... ............ A ........ Av fuse, uppr arm, cephalic ............... 11.81 NA NA 4.48 5.31 1.90 090 

36819 .... ............ A ........ Av fuse, uppr arm, basilic ................... 14.39 NA NA 5.11 5.76 1.96 090 

36820 .... ............ A ........ Av fusion/forearm vein ........................ 14.39 NA NA 5.24 5.82 1.95 090 

36821 .... ............ A ........ Av fusion direct any site ..................... 9.15 NA NA 3.93 4.30 1.23 090 

36822 .... ............ A ........ Insertion of cannula(s) ........................ 5.51 NA NA 3.73 4.06 0.79 090 

36823 .... ............ A ........ Insertion of cannula(s) ........................ 22.82 NA NA 8.63 9.03 2.89 090 

36825 .... ............ A ........ Artery-vein autograft ........................... 10.00 NA NA 4.21 4.65 1.35 090 

36830 .... ............ A ........ Artery-vein nonautograft ..................... 12.00 NA NA 4.12 4.69 1.66 090 

36831 .... ............ A ........ Open thrombect av fistula .................. 8.01 NA NA 3.18 3.57 1.09 090 

36832 .... ............ A ........ Av fistula revision, open ..................... 10.50 NA NA 3.74 4.25 1.44 090 

36833 .... ............ A ........ Av fistula revision ............................... 11.95 NA NA 4.11 4.68 1.65 090 

36834 .... ............ A ........ Repair A–V aneurysm ........................ 11.11 NA NA 4.20 4.52 1.37 090 

36835 .... ............ A ........ Artery to vein shunt ............................ 7.43 NA NA 3.73 4.05 0.98 090 

36838 .... ............ A ........ Dist revas ligation, hemo .................... 21.59 NA NA 7.03 8.22 3.02 090 

36860 .... ............ A ........ External cannula declotting ................ 2.01 3.33 2.55 0.63 0.66 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 40.42 46.50 2.77 2.92 0.29 090 

37140 .... ............ A ........ Revision of circulation ........................ 25.12 NA NA 8.95 9.70 2.02 090 

37145 .... ............ A ........ Revision of circulation ........................ 26.13 NA NA 10.29 10.37 3.26 090 

37160 .... ............ A ........ Revision of circulation ........................ 23.13 NA NA 7.87 8.60 2.82 090 

37180 .... ............ A ........ Revision of circulation ........................ 26.13 NA NA 9.32 9.75 3.35 090 

37181 .... ............ A ........ Splice spleen/kidney veins ................. 28.26 NA NA 8.83 10.00 3.41 090 

37182 .... ............ A ........ Insert hepatic shunt (tips) ................... 16.97 NA NA 6.41 6.02 1.00 000 

37183 .... ............ A ........ Remove hepatic shunt (tips) .............. 7.99 NA NA 3.12 2.97 0.47 000 

37184 .... ............ A ........ Prim art mech thrombectomy ............. 8.66 49.36 60.20 3.24 3.22 0.55 000 

37185 .... ............ A ........ Prim art m-thrombect add-on ............. 3.28 16.17 19.40 1.12 1.09 0.21 ZZZ 

37186 .... ............ A ........ Sec art m-thrombect add-on .............. 4.92 34.32 41.56 1.78 1.66 0.32 ZZZ 

37187 .... ............ A ........ Venous mech thrombectomy .............. 8.03 47.81 58.74 3.02 3.01 0.51 000 

37188 .... ............ A ........ Venous m-thrombectomy add-on ....... 5.71 41.84 51.67 2.20 2.23 0.37 000 

37195 .... ............ C ........ Thrombolytic therapy, stroke .............. 0.00 0.00 4.03 0.00 4.03 0.00 XXX 

37200 .... ............ A ........ Transcatheter biopsy .......................... 4.55 NA NA 1.67 1.53 0.27 000 

37201 .... ............ A ........ Transcatheter therapy infuse .............. 4.99 NA NA 2.33 2.40 0.33 000 

37202 .... ............ A ........ Transcatheter therapy infuse .............. 5.67 NA NA 3.28 3.18 0.43 000 

37203 .... ............ A ........ Transcatheter retrieval ........................ 5.02 29.76 31.17 2.08 2.01 0.29 000 

37204 .... ............ A ........ Transcatheter occlusion ..................... 18.11 NA NA 6.29 5.93 1.48 000 

37205 .... ............ A ........ Transcath iv stent, percut ................... 8.27 73.69 27.08 3.20 3.58 0.60 000 

37206 .... ............ A ........ Transcath iv stent/perc addl ............... 4.12 62.08 21.67 1.55 1.49 0.31 ZZZ 

37207 .... ............ A ........ Transcath iv stent, open ..................... 8.27 NA NA 2.38 2.78 1.17 000 

37208 .... ............ A ........ Transcath iv stent/open addl .............. 4.12 NA NA 1.01 1.20 0.59 ZZZ 

37209 .... ............ A ........ Change iv cath at thromb tx ............... 2.27 NA NA 0.78 0.74 0.15 000 

37210 .... ............ A ........ Embolization uterine fibroid ................ 10.60 82.44 80.73 3.71 3.32 0.60 000 

mstockstill on PROD1PC66 with PROPOSALS2

38275 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

37215 .... ............ R ........ Transcath stent, cca w/eps ................ 19.58 NA NA 9.70 9.46 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 0.75 0.76 0.21 ZZZ 

37251 .... ............ A ........ Iv us each add vessel add-on ............ 1.60 NA NA 0.49 0.52 0.19 ZZZ 

37500 .... ............ A ........ Endoscopy ligate perf veins ............... 11.54 NA NA 5.34 6.11 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 5.15 5.38 1.33 090 

37600 .... ............ A ........ Ligation of neck artery ........................ 12.34 NA NA 4.92 5.76 1.41 090 

37605 .... ............ A ........ Ligation of neck artery ........................ 14.20 NA NA 5.48 6.21 1.99 090 

37606 .... ............ A ........ Ligation of neck artery ........................ 8.72 NA NA 4.85 4.71 1.23 090 

37607 .... ............ A ........ Ligation of a-v fistula .......................... 6.19 NA NA 3.01 3.30 0.85 090 

37609 .... ............ A ........ Temporal artery procedure ................. 3.02 4.17 4.34 1.82 1.89 0.36 010 

37615 .... ............ A ........ Ligation of neck artery ........................ 7.72 NA NA 4.10 4.09 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 7.91 8.54 2.98 090 

37618 .... ............ A ........ Ligation of extremity artery ................. 5.95 NA NA 3.35 3.48 0.67 090 

37620 .... ............ A ........ Revision of major vein ........................ 11.49 NA NA 5.45 5.50 0.91 090 

37650 .... ............ A ........ Revision of major vein ........................ 8.41 NA NA 3.99 4.37 1.01 090 

37660 .... ............ A ........ Revision of major vein ........................ 22.20 NA NA 7.63 8.40 2.49 090 

37700 .... ............ A ........ Revise leg vein ................................... 3.76 NA NA 2.37 2.59 0.53 090 

37718 .... ............ A ........ Ligate/strip short leg vein ................... 7.05 NA NA 3.46 3.77 0.14 090 

37722 .... ............ A ........ Ligate/strip long leg vein .................... 8.08 NA NA 3.67 4.06 0.86 090 

37735 .... ............ A ........ Removal of leg veins/lesion ............... 10.81 NA NA 4.67 5.08 1.48 090 

37760 .... ............ A ........ Ligation, leg veins, open .................... 10.69 NA NA 4.47 4.92 1.44 090 

37765 .... ............ A ........ Phleb veins—extrem—to 20 ............... 7.63 NA NA 3.57 4.10 0.48 090 

37766 .... ............ A ........ Phleb veins—extrem 20+ ................... 9.58 NA NA 4.12 4.71 0.48 090 

37780 .... ............ A ........ Revision of leg vein ............................ 3.87 NA NA 2.37 2.63 0.53 090 

37785 .... ............ A ........ Ligate/divide/excise vein ..................... 3.87 4.87 5.04 2.56 2.65 0.54 090 

37788 .... ............ A ........ Revascularization, penis ..................... 23.21 NA NA 12.19 10.63 2.26 090 

37790 .... ............ A ........ Penile venous occlusion ..................... 8.37 NA NA 5.16 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 6.83 6.51 1.92 090 

38101 .... ............ A ........ Removal of spleen, partial .................. 19.47 NA NA 6.93 6.79 2.05 090 

38102 .... ............ A ........ Removal of spleen, total ..................... 4.79 NA NA 1.23 1.44 0.63 ZZZ 

38115 .... ............ A ........ Repair of ruptured spleen ................... 21.80 NA NA 7.43 7.06 2.09 090 

38120 .... ............ A ........ Laparoscopy, splenectomy ................. 16.97 NA NA 6.91 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 1.11 0.98 0.14 000 

38204 .... ............ B ........ Bl donor search management ............ 2.00 0.46 0.76 0.46 0.76 0.06 XXX 

38205 .... ............ R ........ Harvest allogenic stem cells ............... 1.50 NA NA 0.54 0.61 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 0.41 0.40 0.41 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 0.72 0.71 0.72 0.03 XXX 

38211 .... ............ I .......... Tumor cell deplete of harvst ............... 1.42 0.65 0.65 0.65 0.65 0.02 XXX 

38212 .... ............ I .......... Rbc depletion of harvest .................... 0.94 0.43 0.43 0.43 0.43 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 0.37 0.37 0.37 0.37 0.01 XXX 

38215 .... ............ I .......... Harvest stem cell concentrte .............. 0.94 0.43 0.43 0.43 0.43 0.02 XXX 

38220 .... ............ A ........ Bone marrow aspiration ..................... 1.08 2.66 3.19 0.45 0.48 0.05 XXX 

38221 .... ............ A ........ Bone marrow biopsy ........................... 1.37 2.77 3.35 0.58 0.61 0.07 XXX 

38230 .... ............ R ........ Bone marrow collection ...................... 4.80 NA NA 3.14 3.13 0.48 010 

38240 .... ............ R ........ Bone marrow/stem transplant ............ 2.24 NA NA 0.95 0.99 0.11 XXX 

38241 .... ............ R ........ Bone marrow/stem transplant ............ 2.24 NA NA 0.95 1.00 0.11 XXX 

38242 .... ............ A ........ Lymphocyte infuse transplant ............. 1.71 NA NA 0.69 0.74 0.08 000 

38300 .... ............ A ........ Drainage, lymph node lesion .............. 2.28 4.18 4.14 2.02 1.99 0.25 010 

38305 .... ............ A ........ Drainage, lymph node lesion .............. 6.55 NA NA 4.19 4.18 0.88 090 

38308 .... ............ A ........ Incision of lymph channels ................. 6.73 NA NA 3.53 3.64 0.85 090 

38380 .... ............ A ........ Thoracic duct procedure ..................... 8.34 NA NA 5.04 5.31 0.74 090 

38381 .... ............ A ........ Thoracic duct procedure ..................... 13.32 NA NA 6.07 6.48 1.85 090 

38382 .... ............ A ........ Thoracic duct procedure ..................... 10.51 NA NA 5.43 5.60 1.37 090 

38500 .... ............ A ........ Biopsy/removal, lymph nodes ............ 3.76 3.72 3.71 2.02 2.05 0.49 010 

38505 .... ............ A ........ Needle biopsy, lymph nodes .............. 1.14 2.10 2.06 0.74 0.75 0.09 000 

38510 .... ............ A ........ Biopsy/removal, lymph nodes ............ 6.69 5.36 5.43 3.09 3.27 0.72 010 

38520 .... ............ A ........ Biopsy/removal, lymph nodes ............ 6.95 NA NA 3.74 3.89 0.84 090 

38525 .... ............ A ........ Biopsy/removal, lymph nodes ............ 6.35 NA NA 3.45 3.37 0.80 090 

38530 .... ............ A ........ Biopsy/removal, lymph nodes ............ 8.26 NA NA 4.09 4.24 1.12 090 

38542 .... ............ A ........ Explore deep node(s), neck ............... 6.08 NA NA 3.97 4.19 0.60 090 

38550 .... ............ A ........ Removal, neck/armpit lesion .............. 6.99 NA NA 4.25 4.08 0.88 090 

38555 .... ............ A ........ Removal, neck/armpit lesion .............. 15.42 NA NA 7.45 7.96 1.76 090 

38562 .... ............ A ........ Removal, pelvic lymph nodes ............ 10.92 NA NA 5.77 5.77 1.20 090 

mstockstill on PROD1PC66 with PROPOSALS2

38276 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

38564 .... ............ A ........ Removal, abdomen lymph nodes ....... 11.29 NA NA 5.21 5.23 1.32 090 

38570 .... ............ A ........ Laparoscopy, lymph node biop .......... 9.28 NA NA 4.06 4.01 1.13 010 

38571 .... ............ A ........ Laparoscopy, lymphadenectomy ........ 14.70 NA NA 6.90 6.28 1.15 010 

38572 .... ............ A ........ Laparoscopy, lymphadenectomy ........ 16.86 NA NA 5.99 6.57 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 6.54 6.30 0.72 090 

38720 .... ............ A ........ Removal of lymph nodes, neck .......... 21.72 NA NA 10.23 9.65 1.20 090 

38724 .... ............ A ........ Removal of lymph nodes, neck .......... 23.72 NA NA 11.00 10.25 1.28 090 

38740 .... ............ A ........ Remove armpit lymph nodes ............. 10.57 NA NA 4.98 4.97 1.32 090 

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 1.43 1.52 0.72 ZZZ 

38747 .... ............ A ........ Remove abdominal lymph nodes ....... 4.88 NA NA 1.27 1.47 0.64 ZZZ 

38760 .... ............ A ........ Remove groin lymph nodes ............... 13.49 NA NA 5.91 6.03 1.72 090 

38765 .... ............ A ........ Remove groin lymph nodes ............... 21.78 NA NA 8.38 8.64 2.48 090 

38770 .... ............ A ........ Remove pelvis lymph nodes .............. 13.98 NA NA 6.77 6.29 1.40 090 

38780 .... ............ A ........ Remove abdomen lymph nodes ........ 17.56 NA NA 8.03 8.12 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 3.18 3.26 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 4.26 4.47 0.89 090 

39010 .... ............ A ........ Exploration of chest ............................ 13.11 NA NA 5.99 6.79 1.76 090 

39200 .... ............ A ........ Removal chest lesion ......................... 15.04 NA NA 6.20 6.87 2.03 090 

39220 .... ............ A ........ Removal chest lesion ......................... 19.47 NA NA 8.00 8.69 2.46 090 

39400 .... ............ A ........ Visualization of chest .......................... 8.00 NA NA 4.14 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 6.15 1.78 090 

39502 .... ............ A ........ Repair paraesophageal hernia ........... 17.09 NA NA 6.57 6.86 2.17 090 

39503 .... ............ A ........ Repair of diaphragm hernia ................ 108.67 NA NA 26.87 30.78 10.98 090 

39520 .... ............ A ........ Repair of diaphragm hernia ................ 16.63 NA NA 6.79 7.44 2.24 090 

39530 .... ............ A ........ Repair of diaphragm hernia ................ 16.22 NA NA 6.22 6.71 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 5.73 5.96 1.80 090 

39541 .... ............ A ........ Repair of diaphragm hernia ................ 15.67 NA NA 6.05 6.34 1.93 090 

39545 .... ............ A ........ Revision of diaphragm ........................ 14.58 NA NA 6.87 7.26 1.84 090 

39560 .... ............ A ........ Resect diaphragm, simple .................. 12.97 NA NA 5.52 5.91 1.59 090 

39561 .... ............ A ........ Resect diaphragm, complex ............... 19.75 NA NA 9.30 9.33 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 2.09 1.86 0.59 0.60 0.05 000 

40500 .... ............ A ........ Partial excision of lip .......................... 4.35 7.88 7.37 4.36 4.33 0.38 090 

40510 .... ............ A ........ Partial excision of lip .......................... 4.74 6.73 6.64 3.63 3.80 0.49 090 

40520 .... ............ A ........ Partial excision of lip .......................... 4.71 6.98 7.25 3.82 3.96 0.52 090 

40525 .... ............ A ........ Reconstruct lip with flap ..................... 7.61 NA NA 5.35 5.82 0.85 090 

40527 .... ............ A ........ Reconstruct lip with flap ..................... 9.20 NA NA 6.16 6.73 0.97 090 

40530 .... ............ A ........ Partial removal of lip ........................... 5.45 7.57 7.66 4.27 4.40 0.55 090 

40650 .... ............ A ........ Repair lip ............................................ 3.69 5.93 6.36 3.15 3.22 0.38 090 

40652 .... ............ A ........ Repair lip ............................................ 4.32 7.23 7.46 4.11 4.18 0.52 090 

40654 .... ............ A ........ Repair lip ............................................ 5.37 8.06 8.34 4.68 4.81 0.60 090 

40700 .... ............ A ........ Repair cleft lip/nasal ........................... 13.97 NA NA 8.71 8.99 0.95 090 

40701 .... ............ A ........ Repair cleft lip/nasal ........................... 17.03 NA NA 7.83 10.18 1.65 090 

40702 .... ............ A ........ Repair cleft lip/nasal ........................... 14.09 NA NA 5.83 7.29 1.23 090 

40720 .... ............ A ........ Repair cleft lip/nasal ........................... 14.54 NA NA 9.55 9.66 1.80 090 

40761 .... ............ A ........ Repair cleft lip/nasal ........................... 15.69 NA NA 9.32 9.75 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 3.83 3.40 1.88 1.83 0.13 010 

40801 .... ............ A ........ Drainage of mouth lesion ................... 2.57 4.88 4.45 2.59 2.66 0.31 010 

40804 .... ............ A ........ Removal, foreign body, mouth ........... 1.26 3.77 3.56 1.83 1.83 0.11 010 

40805 .... ............ A ........ Removal, foreign body, mouth ........... 2.73 5.12 4.79 2.66 2.73 0.32 010 

40806 .... ............ A ........ Incision of lip fold ................................ 0.31 2.41 2.12 0.51 0.50 0.04 000 

40808 .... ............ A ........ Biopsy of mouth lesion ....................... 0.98 3.59 3.11 1.62 1.55 0.10 010 

40810 .... ............ A ........ Excision of mouth lesion .................... 1.33 3.67 3.26 1.72 1.68 0.13 010 

40812 .... ............ A ........ Excise/repair mouth lesion ................. 2.33 4.54 4.13 2.29 2.34 0.28 010 

40814 .... ............ A ........ Excise/repair mouth lesion ................. 3.45 5.69 5.30 3.70 3.79 0.41 090 

40816 .... ............ A ........ Excision of mouth lesion .................... 3.70 5.90 5.52 3.78 3.88 0.40 090 

40818 .... ............ A ........ Excise oral mucosa for graft .............. 2.72 5.81 5.48 3.74 3.85 0.21 090 

40819 .... ............ A ........ Excise lip or cheek fold ...................... 2.45 4.93 4.50 3.11 3.10 0.29 090 

40820 .... ............ A ........ Treatment of mouth lesion ................. 1.30 5.28 4.58 2.93 2.67 0.11 010 

40830 .... ............ A ........ Repair mouth laceration ..................... 1.78 4.01 3.88 1.99 2.04 0.19 010 

40831 .... ............ A ........ Repair mouth laceration ..................... 2.50 5.21 4.96 2.69 2.88 0.30 010 

40840 .... ............ R ........ Reconstruction of mouth .................... 9.03 10.03 9.91 5.63 6.30 1.08 090 

40842 .... ............ R ........ Reconstruction of mouth .................... 9.03 10.35 10.11 5.81 6.23 1.08 090 

40843 .... ............ R ........ Reconstruction of mouth .................... 12.62 11.36 11.73 5.81 6.86 1.39 090 

mstockstill on PROD1PC66 with PROPOSALS2

38277 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

40844 .... ............ R ........ Reconstruction of mouth .................... 16.57 15.45 15.51 9.34 10.37 2.00 090 

40845 .... ............ R ........ Reconstruction of mouth .................... 19.13 16.03 16.44 10.26 11.65 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 2.42 1.33 1.37 0.12 010 

41005 .... ............ A ........ Drainage of mouth lesion ................... 1.28 4.30 3.80 1.77 1.74 0.12 010 

41006 .... ............ A ........ Drainage of mouth lesion ................... 3.28 5.46 5.10 2.85 3.00 0.35 090 

41007 .... ............ A ........ Drainage of mouth lesion ................... 3.14 5.34 5.24 2.73 2.88 0.31 090 

41008 .... ............ A ........ Drainage of mouth lesion ................... 3.40 5.52 5.09 2.87 3.03 0.42 090 

41009 .... ............ A ........ Drainage of mouth lesion ................... 3.63 5.85 5.40 3.17 3.37 0.47 090 

41010 .... ............ A ........ Incision of tongue fold ........................ 1.08 3.86 3.56 1.56 1.55 0.07 010 

41015 .... ............ A ........ Drainage of mouth lesion ................... 4.00 6.30 5.84 4.00 4.06 0.46 090 

41016 .... ............ A ........ Drainage of mouth lesion ................... 4.11 6.23 5.91 4.08 4.15 0.53 090 

41017 .... ............ A ........ Drainage of mouth lesion ................... 4.11 6.38 6.00 4.14 4.21 0.53 090 

41018 .... ............ A ........ Drainage of mouth lesion ................... 5.14 6.77 6.42 4.51 4.52 0.68 090 

41100 .... ............ A ........ Biopsy of tongue ................................. 1.39 2.68 2.53 1.18 1.29 0.15 010 

41105 .... ............ A ........ Biopsy of tongue ................................. 1.44 2.67 2.47 1.20 1.25 0.13 010 

41108 .... ............ A ........ Biopsy of floor of mouth ..................... 1.07 2.51 2.27 1.08 1.10 0.10 010 

41110 .... ............ A ........ Excision of tongue lesion ................... 1.53 3.64 3.28 1.64 1.63 0.13 010 

41112 .... ............ A ........ Excision of tongue lesion ................... 2.77 5.25 4.84 3.24 3.22 0.28 090 

41113 .... ............ A ........ Excision of tongue lesion ................... 3.23 5.52 5.11 3.40 3.43 0.34 090 

41114 .... ............ A ........ Excision of tongue lesion ................... 8.71 NA NA 6.33 6.71 0.83 090 

41115 .... ............ A ........ Excision of tongue fold ....................... 1.76 4.19 3.75 1.73 1.80 0.18 010 

41116 .... ............ A ........ Excision of mouth lesion .................... 2.47 5.54 4.91 2.80 2.78 0.23 090 

41120 .... ............ A ........ Partial removal of tongue ................... 10.91 NA NA 14.29 14.64 0.79 090 

41130 .... ............ A ........ Partial removal of tongue ................... 15.51 NA NA 15.88 15.83 0.93 090 

41135 .... ............ A ........ Tongue and neck surgery .................. 29.83 NA NA 21.89 22.26 1.89 090 

41140 .... ............ A ........ Removal of tongue ............................. 28.81 NA NA 23.58 24.79 2.27 090 

41145 .... ............ A ........ Tongue removal, neck surgery ........... 37.59 NA NA 28.85 29.32 2.55 090 

41150 .... ............ A ........ Tongue, mouth, jaw surgery ............... 29.52 NA NA 23.06 23.60 1.95 090 

41153 .... ............ A ........ Tongue, mouth, neck surgery ............ 33.28 NA NA 23.98 24.19 2.01 090 

41155 .... ............ A ........ Tongue, jaw, & neck surgery ............. 43.96 NA NA 27.67 26.88 2.34 090 

41250 .... ............ A ........ Repair tongue laceration .................... 1.93 3.83 3.28 1.60 1.39 0.18 010 

41251 .... ............ A ........ Repair tongue laceration .................... 2.29 3.47 3.32 1.77 1.64 0.22 010 

41252 .... ............ A ........ Repair tongue laceration .................... 2.99 4.57 4.20 2.13 2.16 0.29 010 

41500 .... ............ A ........ Fixation of tongue ............................... 3.74 NA NA 7.49 7.31 0.30 090 

41510 .... ............ A ........ Tongue to lip surgery ......................... 3.45 NA NA 6.42 7.28 0.20 090 

41520 .... ............ A ........ Reconstruction, tongue fold ................ 2.77 5.77 5.19 3.25 3.43 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 4.77 3.68 2.11 1.70 0.12 010 

41805 .... ............ A ........ Removal foreign body, gum ............... 1.28 4.61 3.66 2.69 2.46 0.13 010 

41806 .... ............ A ........ Removal foreign body,jawbone .......... 2.73 5.82 4.71 3.35 3.20 0.37 010 

41822 .... ............ R ........ Excision of gum lesion ....................... 2.35 4.80 4.32 1.86 1.85 0.31 010 

41823 .... ............ R ........ Excision of gum lesion ....................... 3.63 6.41 6.00 3.71 3.87 0.47 090 

41825 .... ............ A ........ Excision of gum lesion ....................... 1.35 3.68 3.36 1.47 1.85 0.15 010 

41826 .... ............ A ........ Excision of gum lesion ....................... 2.35 5.09 3.76 2.58 2.35 0.30 010 

41827 .... ............ A ........ Excision of gum lesion ....................... 3.72 6.63 6.07 3.39 3.52 0.35 090 

41828 .... ............ R ........ Excision of gum lesion ....................... 3.11 4.10 3.95 1.66 2.31 0.44 010 

41830 .... ............ R ........ Removal of gum tissue ....................... 3.38 5.98 5.48 3.13 3.38 0.44 010 

41872 .... ............ R ........ Repair gum ......................................... 2.90 6.02 5.50 3.30 3.38 0.30 090 

41874 .... ............ R ........ Repair tooth socket ............................ 3.13 5.67 5.27 2.73 2.96 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 2.47 2.50 1.20 1.22 0.12 010 

42100 .... ............ A ........ Biopsy roof of mouth .......................... 1.33 2.27 2.16 1.26 1.31 0.13 010 

42104 .... ............ A ........ Excision lesion, mouth roof ................ 1.66 3.56 3.03 1.67 1.60 0.16 010 

42106 .... ............ A ........ Excision lesion, mouth roof ................ 2.12 4.45 3.83 2.08 2.26 0.25 010 

42107 .... ............ A ........ Excision lesion, mouth roof ................ 4.48 6.53 6.09 3.70 3.81 0.44 090 

42120 .... ............ A ........ Remove palate/lesion ......................... 11.70 NA NA 12.27 11.90 0.52 090 

42140 .... ............ A ........ Excision of uvula ................................ 1.65 4.55 4.08 2.11 2.08 0.13 090 

42145 .... ............ A ........ Repair palate, pharynx/uvula .............. 9.63 NA NA 7.50 7.39 0.65 090 

42160 .... ............ A ........ Treatment mouth roof lesion .............. 1.82 3.77 3.99 1.69 1.98 0.17 010 

42180 .... ............ A ........ Repair palate ...................................... 2.52 3.36 3.19 1.86 1.97 0.21 010 

42182 .... ............ A ........ Repair palate ...................................... 3.84 3.99 3.94 2.41 2.72 0.40 010 

42200 .... ............ A ........ Reconstruct cleft palate ...................... 12.41 NA NA 8.64 9.36 1.27 090 

42205 .... ............ A ........ Reconstruct cleft palate ...................... 13.57 NA NA 7.37 8.76 1.58 090 

42210 .... ............ A ........ Reconstruct cleft palate ...................... 14.91 NA NA 10.29 10.80 2.17 090 

42215 .... ............ A ........ Reconstruct cleft palate ...................... 8.88 NA NA 7.43 8.24 1.31 090 

42220 .... ............ A ........ Reconstruct cleft palate ...................... 7.07 NA NA 7.20 6.93 0.73 090 

42225 .... ............ A ........ Reconstruct cleft palate ...................... 9.66 NA NA 12.28 14.65 0.86 090 

42226 .... ............ A ........ Lengthening of palate ......................... 10.24 NA NA 11.88 13.22 1.01 090 

42227 .... ............ A ........ Lengthening of palate ......................... 9.81 NA NA 11.19 13.13 0.98 090 

42235 .... ............ A ........ Repair palate ...................................... 7.92 NA NA 10.31 11.09 0.72 090 

42260 .... ............ A ........ Repair nose to lip fistula ..................... 10.10 9.75 9.96 6.08 6.55 1.26 090 

mstockstill on PROD1PC66 with PROPOSALS2

38278 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

42280 .... ............ A ........ Preparation, palate mold .................... 1.56 2.23 2.10 0.84 0.99 0.19 010 

42281 .... ............ A ........ Insertion, palate prosthesis ................ 1.95 3.02 2.79 1.69 1.76 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 3.12 2.94 1.74 1.75 0.16 010 

42305 .... ............ A ........ Drainage of salivary gland .................. 6.23 NA NA 4.00 4.31 0.51 090 

42310 .... ............ A ........ Drainage of salivary gland .................. 1.58 2.28 2.25 1.39 1.46 0.13 010 

42320 .... ............ A ........ Drainage of salivary gland .................. 2.37 3.73 3.47 1.88 1.97 0.21 010 

42330 .... ............ A ........ Removal of salivary stone .................. 2.23 3.40 3.24 1.74 1.77 0.19 010 

42335 .... ............ A ........ Removal of salivary stone .................. 3.35 5.75 5.28 2.85 2.97 0.29 090 

42340 .... ............ A ........ Removal of salivary stone .................. 4.64 6.69 6.30 3.49 3.67 0.42 090 

42400 .... ............ A ........ Biopsy of salivary gland ..................... 0.78 1.99 1.80 0.65 0.68 0.06 000 

42405 .... ............ A ........ Biopsy of salivary gland ..................... 3.31 3.96 3.95 2.16 2.28 0.28 010 

42408 .... ............ A ........ Excision of salivary cyst ..................... 4.58 6.41 6.11 3.28 3.41 0.45 090 

42409 .... ............ A ........ Drainage of salivary cyst .................... 2.85 5.30 4.87 2.54 2.63 0.27 090 

42410 .... ............ A ........ Excise parotid gland/lesion ................. 9.46 NA NA 5.38 5.73 0.91 090 

42415 .... ............ A ........ Excise parotid gland/lesion ................. 17.99 NA NA 8.68 9.63 1.43 090 

42420 .... ............ A ........ Excise parotid gland/lesion ................. 20.87 NA NA 9.64 10.85 1.65 090 

42425 .... ............ A ........ Excise parotid gland/lesion ................. 13.31 NA NA 6.87 7.62 1.05 090 

42426 .... ............ A ........ Excise parotid gland/lesion ................. 22.54 NA NA 10.09 11.36 1.81 090 

42440 .... ............ A ........ Excise submaxillary gland .................. 7.05 NA NA 3.88 4.28 0.59 090 

42450 .... ............ A ........ Excise sublingual gland ...................... 4.66 6.37 6.06 4.03 4.08 0.42 090 

42500 .... ............ A ........ Repair salivary duct ............................ 4.34 6.11 5.85 3.87 3.99 0.41 090 

42505 .... ............ A ........ Repair salivary duct ............................ 6.23 7.27 7.12 4.73 4.99 0.55 090 

42507 .... ............ A ........ Parotid duct diversion ......................... 6.16 NA NA 6.33 6.37 0.49 090 

42508 .... ............ A ........ Parotid duct diversion ......................... 9.22 NA NA 8.07 8.12 1.04 090 

42509 .... ............ A ........ Parotid duct diversion ......................... 11.65 NA NA 8.93 9.53 0.93 090 

42510 .... ............ A ........ Parotid duct diversion ......................... 8.26 NA NA 6.95 7.28 0.66 090 

42550 .... ............ A ........ Injection for salivary x-ray .................. 1.25 2.27 2.71 0.45 0.42 0.07 000 

42600 .... ............ A ........ Closure of salivary fistula ................... 4.86 6.55 6.56 3.43 3.77 0.43 090 

42650 .... ............ A ........ Dilation of salivary duct ...................... 0.77 1.28 1.18 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 4.98 4.53 2.40 2.47 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 2.96 2.77 1.65 1.66 0.13 010 

42720 .... ............ A ........ Drainage of throat abscess ................ 6.31 4.72 4.71 3.20 3.45 0.44 010 

42725 .... ............ A ........ Drainage of throat abscess ................ 12.28 NA NA 7.07 7.58 0.91 090 

42800 .... ............ A ........ Biopsy of throat .................................. 1.41 2.46 2.29 1.30 1.33 0.11 010 

42802 .... ............ A ........ Biopsy of throat .................................. 1.56 4.11 4.39 1.67 1.84 0.12 010 

42804 .... ............ A ........ Biopsy of upper nose/throat ............... 1.26 3.56 3.61 1.49 1.59 0.10 010 

42806 .... ............ A ........ Biopsy of upper nose/throat ............... 1.60 3.81 3.90 1.61 1.75 0.13 010 

42808 .... ............ A ........ Excise pharynx lesion ......................... 2.32 3.22 3.12 1.61 1.75 0.19 010 

42809 .... ............ A ........ Remove pharynx foreign body ........... 1.83 2.22 2.26 1.31 1.31 0.16 010 

42810 .... ............ A ........ Excision of neck cyst .......................... 3.30 6.19 5.88 3.72 3.58 0.29 090 

42815 .... ............ A ........ Excision of neck cyst .......................... 7.23 NA NA 6.25 6.25 0.61 090 

42820 .... ............ A ........ Remove tonsils and adenoids ............ 4.17 NA NA 2.86 3.03 0.31 090 

42821 .... ............ A ........ Remove tonsils and adenoids ............ 4.31 NA NA 3.00 3.21 0.35 090 

42825 .... ............ A ........ Removal of tonsils .............................. 3.45 NA NA 2.90 2.96 0.25 090 

42826 .... ............ A ........ Removal of tonsils .............................. 3.40 NA NA 2.69 2.82 0.27 090 

42830 .... ............ A ........ Removal of adenoids .......................... 2.60 NA NA 2.43 2.46 0.20 090 

42831 .... ............ A ........ Removal of adenoids .......................... 2.75 NA NA 2.66 2.71 0.22 090 

42835 .... ............ A ........ Removal of adenoids .......................... 2.33 NA NA 1.76 2.11 0.21 090 

42836 .... ............ A ........ Removal of adenoids .......................... 3.21 NA NA 2.65 2.77 0.26 090 

42842 .... ............ A ........ Extensive surgery of throat ................ 12.02 NA NA 12.03 11.35 0.71 090 

42844 .... ............ A ........ Extensive surgery of throat ................ 17.57 NA NA 15.48 15.64 1.16 090 

42845 .... ............ A ........ Extensive surgery of throat ................ 32.35 NA NA 21.21 21.88 1.99 090 

42860 .... ............ A ........ Excision of tonsil tags ......................... 2.25 NA NA 2.30 2.32 0.18 090 

42870 .... ............ A ........ Excision of lingual tonsil ..................... 5.44 NA NA 8.68 8.51 0.44 090 

42890 .... ............ A ........ Partial removal of pharynx ................. 18.92 NA NA 15.27 14.50 1.05 090 

42892 .... ............ A ........ Revision of pharyngeal walls .............. 25.77 NA NA 19.24 17.93 1.28 090 

42894 .... ............ A ........ Revision of pharyngeal walls .............. 33.61 NA NA 23.59 22.44 1.87 090 

42900 .... ............ A ........ Repair throat wound ........................... 5.26 NA NA 2.96 3.27 0.50 010 

42950 .... ............ A ........ Reconstruction of throat ..................... 8.16 NA NA 11.04 11.33 0.72 090 

42953 .... ............ A ........ Repair throat, esophagus ................... 9.33 NA NA 13.73 15.40 0.88 090 

42955 .... ............ A ........ Surgical opening of throat .................. 7.92 NA NA 10.07 10.25 0.80 090 

42960 .... ............ A ........ Control throat bleeding ....................... 2.35 NA NA 1.72 1.82 0.19 010 

42961 .... ............ A ........ Control throat bleeding ....................... 5.69 NA NA 4.50 4.67 0.45 090 

42962 .... ............ A ........ Control throat bleeding ....................... 7.31 NA NA 5.19 5.48 0.58 090 

42970 .... ............ A ........ Control nose/throat bleeding .............. 5.76 NA NA 3.57 3.87 0.39 090 

42971 .... ............ A ........ Control nose/throat bleeding .............. 6.54 NA NA 4.52 4.76 0.51 090 

42972 .... ............ A ........ Control nose/throat bleeding .............. 7.53 NA NA 5.00 5.27 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 4.55 4.95 0.87 090 

mstockstill on PROD1PC66 with PROPOSALS2

38279 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

43030 .... ............ A ........ Throat muscle surgery ........................ 7.91 NA NA 4.53 4.96 0.70 090 

43045 .... ............ A ........ Incision of esophagus ......................... 21.70 NA NA 9.31 10.13 2.59 090 

43100 .... ............ A ........ Excision of esophagus lesion ............. 9.55 NA NA 5.21 5.70 0.93 090 

43101 .... ............ A ........ Excision of esophagus lesion ............. 16.99 NA NA 7.17 7.54 2.32 090 

43107 .... ............ A ........ Removal of esophagus ....................... 43.97 NA NA 16.27 17.32 5.24 090 

43108 .... ............ A ........ Removal of esophagus ....................... 82.66 NA NA 24.57 19.58 4.08 090 

43112 .... ............ A ........ Removal of esophagus ....................... 47.27 NA NA 17.03 18.20 5.81 090 

43113 .... ............ A ........ Removal of esophagus ....................... 79.85 NA NA 25.44 20.67 4.43 090 

43116 .... ............ A ........ Partial removal of esophagus ............. 92.78 NA NA 30.90 23.47 3.06 090 

43117 .... ............ A ........ Partial removal of esophagus ............. 43.52 NA NA 15.19 16.25 5.19 090 

43118 .... ............ A ........ Partial removal of esophagus ............. 66.86 NA NA 21.59 17.65 4.11 090 

43121 .... ............ A ........ Partial removal of esophagus ............. 51.22 NA NA 18.33 15.99 3.91 090 

43122 .... ............ A ........ Partial removal of esophagus ............. 43.97 NA NA 15.61 16.52 5.42 090 

43123 .... ............ A ........ Partial removal of esophagus ............. 82.91 NA NA 25.88 19.99 4.16 090 

43124 .... ............ A ........ Removal of esophagus ....................... 68.83 NA NA 24.51 18.70 3.74 090 

43130 .... ............ A ........ Removal of esophagus pouch ............ 12.41 NA NA 6.40 6.91 1.16 090 

43135 .... ............ A ........ Removal of esophagus pouch ............ 26.09 NA NA 9.93 9.02 2.34 090 

43200 .... ............ A ........ Esophagus endoscopy ....................... 1.59 3.70 3.89 0.98 1.02 0.13 000 

43201 .... ............ A ........ Esoph scope w/submucous inj ........... 2.09 5.58 5.10 1.20 1.15 0.15 000 

43202 .... ............ A ........ Esophagus endoscopy, biopsy ........... 1.89 5.14 5.34 0.99 0.96 0.15 000 

43204 .... ............ A ........ Esoph scope w/sclerosis inj ............... 3.76 NA NA 2.02 1.76 0.30 000 

43205 .... ............ A ........ Esophagus endoscopy/ligation ........... 3.78 NA NA 2.07 1.80 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 3.10 2.07 1.28 1.16 0.20 000 

43217 .... ............ A ........ Esophagus endoscopy ....................... 2.90 6.53 6.74 1.39 1.30 0.26 000 

43219 .... ............ A ........ Esophagus endoscopy ....................... 2.80 NA NA 1.56 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 1.62 0.28 000 

43228 .... ............ A ........ Esoph endoscopy, ablation ................ 3.76 NA NA 1.90 1.72 0.34 000 

43231 .... ............ A ........ Esoph endoscopy w/us exam ............ 3.19 NA NA 1.77 1.54 0.23 000 

43232 .... ............ A ........ Esoph endoscopy w/us fn bx ............. 4.47 NA NA 2.40 2.11 0.34 000 

43234 .... ............ A ........ Upper GI endoscopy, exam ............... 2.01 4.94 5.13 1.02 0.95 0.17 000 

43235 .... ............ A ........ Uppr gi endoscopy, diagnosis ............ 2.39 5.26 5.21 1.36 1.19 0.19 000 

43236 .... ............ A ........ Uppr gi scope w/submuc inj ............... 2.92 6.67 6.54 1.66 1.44 0.21 000 

43237 .... ............ A ........ Endoscopic us exam, esoph .............. 3.98 NA NA 2.18 1.89 0.43 000 

43238 .... ............ A ........ Uppr gi endoscopy w/us fn bx ............ 5.02 NA NA 2.59 2.27 0.43 000 

43239 .... ............ A ........ Upper GI endoscopy, biopsy .............. 2.87 6.01 5.86 1.56 1.38 0.22 000 

43240 .... ............ A ........ Esoph endoscope w/drain cyst .......... 6.85 NA NA 3.30 2.98 0.56 000 

43241 .... ............ A ........ Upper GI endoscopy with tube ........... 2.59 NA NA 1.41 1.26 0.21 000 

43242 .... ............ A ........ Uppr gi endoscopy w/us fn bx ............ 7.30 NA NA 3.70 3.22 0.53 000 

43243 .... ............ A ........ Upper gi endoscopy & inject .............. 4.56 NA NA 2.37 2.08 0.33 000 

43244 .... ............ A ........ Upper GI endoscopy/ligation .............. 5.04 NA NA 2.66 2.31 0.37 000 

43245 .... ............ A ........ Uppr gi scope dilate strictr ................. 3.18 NA NA 1.64 1.47 0.26 000 

43246 .... ............ A ........ Place gastrostomy tube ...................... 4.32 NA NA 2.12 1.91 0.34 000 

43247 .... ............ A ........ Operative upper GI endoscopy .......... 3.38 NA NA 1.79 1.58 0.27 000 

43248 .... ............ A ........ Uppr gi endoscopy/guide wire ............ 3.15 NA NA 1.78 1.55 0.23 000 

43249 .... ............ A ........ Esoph endoscopy, dilation ................. 2.90 NA NA 1.63 1.42 0.22 000 

43250 .... ............ A ........ Upper GI endoscopy/tumor ................ 3.20 NA NA 1.62 1.47 0.26 000 

43251 .... ............ A ........ Operative upper GI endoscopy .......... 3.69 NA NA 1.93 1.71 0.29 000 

43255 .... ............ A ........ Operative upper GI endoscopy .......... 4.81 NA NA 2.54 2.21 0.35 000 

43256 .... ............ A ........ Uppr gi endoscopy w/stent ................. 4.34 NA NA 2.27 1.99 0.32 000 

43257 .... ............ A ........ Uppr gi scope w/thrml txmnt .............. 5.50 NA NA 2.15 2.16 0.36 000 

43258 .... ............ A ........ Operative upper GI endoscopy .......... 4.54 NA NA 2.38 2.09 0.33 000 

43259 .... ............ A ........ Endoscopic ultrasound exam ............. 5.19 NA NA 2.71 2.35 0.35 000 

43260 .... ............ A ........ Endo cholangiopancreatograph .......... 5.95 NA NA 3.08 2.69 0.43 000 

43261 .... ............ A ........ Endo cholangiopancreatograph .......... 6.26 NA NA 3.23 2.82 0.46 000 

43262 .... ............ A ........ Endo cholangiopancreatograph .......... 7.38 NA NA 3.76 3.27 0.54 000 

43263 .... ............ A ........ Endo cholangiopancreatograph .......... 7.28 NA NA 3.66 3.23 0.54 000 

43264 .... ............ A ........ Endo cholangiopancreatograph .......... 8.89 NA NA 4.47 3.90 0.65 000 

43265 .... ............ A ........ Endo cholangiopancreatograph .......... 10.00 NA NA 5.02 4.36 0.73 000 

43267 .... ............ A ........ Endo cholangiopancreatograph .......... 7.38 NA NA 3.41 3.14 0.54 000 

43268 .... ............ A ........ Endo cholangiopancreatograph .......... 7.38 NA NA 3.91 3.40 0.54 000 

43269 .... ............ A ........ Endo cholangiopancreatograph .......... 8.20 NA NA 4.13 3.61 0.60 000 

43271 .... ............ A ........ Endo cholangiopancreatograph .......... 7.38 NA NA 3.73 3.26 0.54 000 

43272 .... ............ A ........ Endo cholangiopancreatograph .......... 7.38 NA NA 3.80 3.30 0.54 000 

43280 .... ............ A ........ Laparoscopy, fundoplasty ................... 18.00 NA NA 6.64 6.97 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 5.38 5.85 1.12 090 

43305 .... ............ A ........ Repair esophagus and fistula ............. 17.98 NA NA 8.39 9.42 1.54 090 

43310 .... ............ A ........ Repair of esophagus .......................... 26.18 NA NA 9.83 10.49 3.61 090 

43312 .... ............ A ........ Repair esophagus and fistula ............. 29.23 NA NA 10.28 11.03 4.01 090 

mstockstill on PROD1PC66 with PROPOSALS2

38280 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

43313 .... ............ A ........ Esophagoplasty congenital ................. 48.17 NA NA 17.46 18.11 5.47 090 

43314 .... ............ A ........ Tracheo-esophagoplasty cong ........... 53.15 NA NA 17.17 18.38 6.65 090 

43320 .... ............ A ........ Fuse esophagus & stomach ............... 23.18 NA NA 8.66 8.96 2.74 090 

43324 .... ............ A ........ Revise esophagus & stomach ............ 22.86 NA NA 8.33 8.56 2.76 090 

43325 .... ............ A ........ Revise esophagus & stomach ............ 22.47 NA NA 8.29 8.55 2.60 090 

43326 .... ............ A ........ Revise esophagus & stomach ............ 22.15 NA NA 9.19 9.26 2.85 090 

43330 .... ............ A ........ Repair of esophagus .......................... 22.06 NA NA 8.09 8.34 2.63 090 

43331 .... ............ A ........ Repair of esophagus .......................... 22.93 NA NA 9.83 9.76 2.94 090 

43340 .... ............ A ........ Fuse esophagus & intestine ............... 22.86 NA NA 9.29 9.09 2.46 090 

43341 .... ............ A ........ Fuse esophagus & intestine ............... 24.10 NA NA 9.63 9.90 2.92 090 

43350 .... ............ A ........ Surgical opening, esophagus ............. 19.31 NA NA 8.77 8.48 1.42 090 

43351 .... ............ A ........ Surgical opening, esophagus ............. 21.87 NA NA 10.81 10.10 2.47 090 

43352 .... ............ A ........ Surgical opening, esophagus ............. 17.68 NA NA 7.94 8.20 2.06 090 

43360 .... ............ A ........ Gastrointestinal repair ........................ 39.90 NA NA 14.92 15.15 4.97 090 

43361 .... ............ A ........ Gastrointestinal repair ........................ 45.50 NA NA 17.70 17.15 4.50 090 

43400 .... ............ A ........ Ligate esophagus veins ...................... 25.47 NA NA 13.65 11.56 1.96 090 

43401 .... ............ A ........ Esophagus surgery for veins .............. 26.36 NA NA 9.56 9.50 3.05 090 

43405 .... ............ A ........ Ligate/staple esophagus ..................... 24.55 NA NA 10.62 10.06 2.84 090 

43410 .... ............ A ........ Repair esophagus wound ................... 16.28 NA NA 7.67 7.63 1.72 090 

43415 .... ............ A ........ Repair esophagus wound ................... 28.70 NA NA 11.82 11.80 3.53 090 

43420 .... ............ A ........ Repair esophagus opening ................ 16.65 NA NA 7.52 7.37 1.43 090 

43425 .... ............ A ........ Repair esophagus opening ................ 24.91 NA NA 10.47 10.20 3.03 090 

43450 .... ............ A ........ Dilate esophagus ................................ 1.38 2.66 2.65 0.93 0.81 0.11 000 

43453 .... ............ A ........ Dilate esophagus ................................ 1.51 6.26 6.17 1.01 0.87 0.11 000 

43456 .... ............ A ........ Dilate esophagus ................................ 2.57 12.90 13.33 1.46 1.29 0.20 000 

43458 .... ............ A ........ Dilate esophagus ................................ 3.06 6.88 6.77 1.60 1.45 0.24 000 

43460 .... ............ A ........ Pressure treatment esophagus .......... 3.79 NA NA 1.77 1.62 0.31 000 

43496 .... ............ C ........ Free jejunum flap, microvasc ............. 2.20 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 5.27 5.12 1.45 090 

43501 .... ............ A ........ Surgical repair of stomach ................. 22.47 NA NA 8.08 8.20 2.65 090 

43502 .... ............ A ........ Surgical repair of stomach ................. 25.56 NA NA 8.95 9.21 3.10 090 

43510 .... ............ A ........ Surgical opening of stomach .............. 15.01 NA NA 9.10 7.47 1.48 090 

43520 .... ............ A ........ Incision of pyloric muscle ................... 11.21 NA NA 4.82 5.04 1.36 090 

43600 .... ............ A ........ Biopsy of stomach .............................. 1.91 NA NA 0.78 0.73 0.14 000 

43605 .... ............ A ........ Biopsy of stomach .............................. 13.64 NA NA 5.35 5.33 1.58 090 

43610 .... ............ A ........ Excision of stomach lesion ................. 16.26 NA NA 6.02 6.09 1.94 090 

43611 .... ............ A ........ Excision of stomach lesion ................. 20.25 NA NA 7.47 7.53 2.36 090 

43620 .... ............ A ........ Removal of stomach ........................... 33.91 NA NA 11.10 11.45 3.96 090 

43621 .... ............ A ........ Removal of stomach ........................... 39.40 NA NA 12.41 12.20 4.04 090 

43622 .... ............ A ........ Removal of stomach ........................... 39.90 NA NA 12.51 12.56 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 11.27 10.22 2.99 090 

43633 .... ............ A ........ Removal of stomach, partial ............... 33.01 NA NA 10.75 10.06 3.06 090 

43634 .... ............ A ........ Removal of stomach, partial ............... 36.51 NA NA 11.81 10.96 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 7.33 7.30 2.26 090 

43641 .... ............ A ........ Vagotomy & pylorus repair ................. 19.68 NA NA 7.60 7.50 2.25 090 

43644 .... ............ A ........ Lap gastric bypass/roux-en-y ............. 29.24 NA NA 10.09 10.68 3.16 090 

43645 .... ............ A ........ Lap gastr bypass incl smll i ................ 31.37 NA NA 10.46 11.35 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 4.60 4.69 1.33 090 

43652 .... ............ A ........ Laparoscopy, vagus nerve ................. 12.13 NA NA 5.20 5.47 1.55 090 

43653 .... ............ A ........ Laparoscopy, gastrostomy ................. 8.38 NA NA 4.44 4.30 1.01 090 

43659 .... ............ C ........ Laparoscope proc, stom ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43750 .... ............ A ........ Place gastrostomy tube ...................... 4.62 NA NA 2.03 2.09 0.43 010 

43752 .... ............ A ........ Nasal/orogastric w/stent ..................... 0.81 NA NA 0.27 0.26 0.02 000 

43760 .... ............ A ........ Change gastrostomy tube .................. 1.10 12.86 7.47 0.40 0.43 0.09 000 

43761 .... ............ A ........ Reposition gastrostomy tube .............. 2.01 1.04 1.09 0.71 0.66 0.13 000 

43770 .... ............ A ........ Lap, place gastr adjust band .............. 17.85 NA NA 7.38 7.56 2.19 090 

43771 .... ............ A ........ Lap, revise adjust gast band .............. 20.64 NA NA 8.10 8.35 2.55 090 

43772 .... ............ A ........ Lap, remove adjust gast band ............ 15.62 NA NA 5.98 6.20 1.93 090 

43773 .... ............ A ........ Lap, change adjust gast band ............ 20.64 NA NA 8.09 8.35 2.56 090 

43774 .... ............ A ........ Lap remov adj gast band/port ............ 15.66 NA NA 6.17 6.36 1.85 090 

43800 .... ............ A ........ Reconstruction of pylorus ................... 15.35 NA NA 5.80 5.86 1.82 090 

43810 .... ............ A ........ Fusion of stomach and bowel ............ 16.80 NA NA 6.14 6.18 1.94 090 

43820 .... ............ A ........ Fusion of stomach and bowel ............ 22.40 NA NA 8.06 7.25 2.04 090 

43825 .... ............ A ........ Fusion of stomach and bowel ............ 21.63 NA NA 7.89 7.96 2.54 090 

43830 .... ............ A ........ Place gastrostomy tube ...................... 10.75 NA NA 5.15 5.00 1.25 090 

43831 .... ............ A ........ Place gastrostomy tube ...................... 8.38 NA NA 4.90 4.75 1.03 090 

43832 .... ............ A ........ Place gastrostomy tube ...................... 17.26 NA NA 7.06 6.97 1.98 090 

mstockstill on PROD1PC66 with PROPOSALS2

38281 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

43840 .... ............ A ........ Repair of stomach lesion .................... 22.70 NA NA 8.13 7.46 2.06 090 

43842 .... ............ N ........ V-band gastroplasty ............................ 20.90 NA NA 6.74 7.27 2.45 090 

43843 .... ............ A ........ Gastroplasty w/o v-band ..................... 21.08 NA NA 7.82 7.79 2.46 090 

43845 .... ............ A ........ Gastroplasty duodenal switch ............ 33.12 NA NA 12.93 11.77 4.06 090 

43846 .... ............ A ........ Gastric bypass for obesity .................. 27.23 NA NA 9.95 10.00 3.19 090 

43847 .... ............ A ........ Gastric bypass incl small i .................. 30.10 NA NA 10.50 10.73 3.56 090 

43848 .... ............ A ........ Revision gastroplasty ......................... 32.57 NA NA 11.28 11.56 3.88 090 

43850 .... ............ A ........ Revise stomach-bowel fusion ............. 27.45 NA NA 9.50 9.65 3.28 090 

43855 .... ............ A ........ Revise stomach-bowel fusion ............. 28.56 NA NA 9.69 10.02 3.47 090 

43860 .... ............ A ........ Revise stomach-bowel fusion ............. 27.76 NA NA 9.46 9.72 3.31 090 

43865 .... ............ A ........ Revise stomach-bowel fusion ............. 28.92 NA NA 9.72 10.18 3.51 090 

43870 .... ............ A ........ Repair stomach opening .................... 11.36 NA NA 4.94 4.74 1.27 090 

43880 .... ............ A ........ Repair stomach-bowel fistula ............. 27.05 NA NA 9.26 9.59 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 3.43 3.27 0.25 090 

43887 .... ............ A ........ Remove gastric port, open ................. 4.24 NA NA 3.04 2.89 0.51 090 

43888 .... ............ A ........ Change gastric port, open .................. 6.34 NA NA 4.00 3.86 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 6.57 6.65 2.15 090 

44010 .... ............ A ........ Incision of small bowel ....................... 14.18 NA NA 5.52 5.49 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 5.97 1.86 090 

44021 .... ............ A ........ Decompress small bowel ................... 16.23 NA NA 6.14 6.08 1.87 090 

44025 .... ............ A ........ Incision of large bowel ........................ 16.43 NA NA 6.04 6.05 1.90 090 

44050 .... ............ A ........ Reduce bowel obstruction .................. 15.44 NA NA 5.81 5.89 1.86 090 

44055 .... ............ A ........ Correct malrotation of bowel .............. 25.53 NA NA 8.50 8.62 2.91 090 

44100 .... ............ A ........ Biopsy of bowel .................................. 2.01 NA NA 0.92 0.81 0.17 000 

44110 .... ............ A ........ Excise intestine lesion(s) .................... 13.96 NA NA 5.51 5.38 1.55 090 

44111 .... ............ A ........ Excision of bowel lesion(s) ................. 16.44 NA NA 6.09 6.11 1.87 090 

44120 .... ............ A ........ Removal of small intestine ................. 20.74 NA NA 7.14 7.12 2.25 090 

44121 .... ............ A ........ Removal of small intestine ................. 4.44 NA NA 1.12 1.33 0.58 ZZZ 

44125 .... ............ A ........ Removal of small intestine ................. 19.93 NA NA 7.02 7.15 2.27 090 

44126 .... ............ A ........ Enterectomy w/o taper, cong ............. 42.02 NA NA 13.59 13.90 4.69 090 

44127 .... ............ A ........ Enterectomy w/taper, cong ................. 49.09 NA NA 15.65 15.54 5.77 090 

44128 .... ............ A ........ Enterectomy cong, add-on ................. 4.44 NA NA 1.22 1.35 0.61 ZZZ 

44130 .... ............ A ........ Bowel to bowel fusion ........................ 21.98 NA NA 7.96 7.09 1.88 090 

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 8.37 2.71 090 

44141 .... ............ A ........ Partial removal of colon ...................... 29.75 NA NA 11.81 10.94 2.53 090 

44143 .... ............ A ........ Partial removal of colon ...................... 27.63 NA NA 10.27 10.49 3.05 090 

44144 .... ............ A ........ Partial removal of colon ...................... 29.75 NA NA 10.61 10.12 2.86 090 

44145 .... ............ A ........ Partial removal of colon ...................... 28.45 NA NA 9.49 10.16 3.29 090 

44146 .... ............ A ........ Partial removal of colon ...................... 35.14 NA NA 13.35 13.11 3.41 090 

44147 .... ............ A ........ Partial removal of colon ...................... 33.56 NA NA 10.79 9.78 2.56 090 

44150 .... ............ A ........ Removal of colon ................................ 29.99 NA NA 12.57 12.32 3.04 090 

44151 .... ............ A ........ Removal of colon/ileostomy ............... 34.73 NA NA 13.89 13.68 3.49 090 

44155 .... ............ A ........ Removal of colon/ileostomy ............... 34.23 NA NA 13.44 13.39 3.28 090 

44156 .... ............ A ........ Removal of colon/ileostomy ............... 37.23 NA NA 14.45 14.80 3.95 090 

44157 .... ............ A ........ Colectomy w/ileoanal anast ................ 35.49 NA NA 17.13 16.16 3.93 090 

44158 .... ............ A ........ Colectomy w/neo-rectum pouch ......... 36.49 NA NA 17.47 16.47 4.06 090 

44160 .... ............ A ........ Removal of colon ................................ 20.78 NA NA 7.51 7.64 2.37 090 

44180 .... ............ A ........ Lap, enterolysis .................................. 15.19 NA NA 5.79 5.99 1.86 090 

44186 .... ............ A ........ Lap, jejunostomy ................................ 10.30 NA NA 4.57 4.66 1.27 090 

44187 .... ............ A ........ Lap, ileo/jejuno-stomy ......................... 17.27 NA NA 8.10 8.20 1.96 090 

44188 .... ............ A ........ Lap, colostomy ................................... 19.20 NA NA 8.65 8.76 2.24 090 

44202 .... ............ A ........ Lap, enterectomy ................................ 23.26 NA NA 8.30 8.62 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 9.43 3.11 090 

44205 .... ............ A ........ Lap colectomy part w/ileum ................ 22.86 NA NA 7.81 8.34 2.75 090 

44206 .... ............ A ........ Lap part colectomy w/stoma .............. 29.63 NA NA 10.46 10.87 3.46 090 

44207 .... ............ A ........ L colectomy/coloproctostomy ............. 31.79 NA NA 10.12 10.82 3.67 090 

44208 .... ............ A ........ L colectomy/coloproctostomy ............. 33.86 NA NA 12.02 12.60 3.88 090 

44210 .... ............ A ........ Laparo total proctocolectomy ............. 29.88 NA NA 11.17 11.54 3.42 090 

44211 .... ............ A ........ Lap colectomy w/proctectomy ............ 36.87 NA NA 13.56 14.17 4.17 090 

44212 .... ............ A ........ Laparo total proctocolectomy ............. 34.37 NA NA 13.04 13.40 3.78 090 

44213 .... ............ A ........ Lap, mobil splenic fl add-on ............... 3.50 NA NA 0.87 1.05 0.44 ZZZ 

44227 .... ............ A ........ Lap, close enterostomy ...................... 28.49 NA NA 9.49 10.07 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 5.54 5.52 1.60 090 

44310 .... ............ A ........ Ileostomy/jejunostomy ........................ 17.49 NA NA 6.40 6.55 1.99 090 

mstockstill on PROD1PC66 with PROPOSALS2

38282 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

44312 .... ............ A ........ Revision of ileostomy ......................... 9.33 NA NA 4.66 4.33 0.92 090 

44314 .... ............ A ........ Revision of ileostomy ......................... 16.61 NA NA 6.77 6.68 1.75 090 

44316 .... ............ A ........ Devise bowel pouch ........................... 23.46 NA NA 8.89 8.79 2.38 090 

44320 .... ............ A ........ Colostomy ........................................... 19.75 NA NA 7.58 7.63 2.26 090 

44322 .... ............ A ........ Colostomy with biopsies ..................... 13.15 NA NA 9.04 8.87 1.54 090 

44340 .... ............ A ........ Revision of colostomy ........................ 9.12 NA NA 4.91 4.60 0.99 090 

44345 .... ............ A ........ Revision of colostomy ........................ 17.06 NA NA 6.91 6.90 1.97 090 

44346 .... ............ A ........ Revision of colostomy ........................ 19.47 NA NA 7.51 7.46 2.13 090 

44360 .... ............ A ........ Small bowel endoscopy ...................... 2.59 NA NA 1.50 1.31 0.19 000 

44361 .... ............ A ........ Small bowel endoscopy/biopsy .......... 2.87 NA NA 1.63 1.42 0.21 000 

44363 .... ............ A ........ Small bowel endoscopy ...................... 3.49 NA NA 1.87 1.64 0.27 000 

44364 .... ............ A ........ Small bowel endoscopy ...................... 3.73 NA NA 1.99 1.75 0.27 000 

44365 .... ............ A ........ Small bowel endoscopy ...................... 3.31 NA NA 1.75 1.56 0.24 000 

44366 .... ............ A ........ Small bowel endoscopy ...................... 4.40 NA NA 2.39 2.06 0.32 000 

44369 .... ............ A ........ Small bowel endoscopy ...................... 4.51 NA NA 2.38 2.07 0.33 000 

44370 .... ............ A ........ Small bowel endoscopy/stent ............. 4.79 NA NA 2.57 2.27 0.37 000 

44372 .... ............ A ........ Small bowel endoscopy ...................... 4.40 NA NA 2.14 1.94 0.35 000 

44373 .... ............ A ........ Small bowel endoscopy ...................... 3.49 NA NA 1.78 1.59 0.27 000 

44376 .... ............ A ........ Small bowel endoscopy ...................... 5.25 NA NA 2.49 2.26 0.42 000 

44377 .... ............ A ........ Small bowel endoscopy/biopsy .......... 5.52 NA NA 2.78 2.47 0.40 000 

44378 .... ............ A ........ Small bowel endoscopy ...................... 7.12 NA NA 3.60 3.15 0.52 000 

44379 .... ............ A ........ S bowel endoscope w/stent ............... 7.46 NA NA 3.95 3.33 0.62 000 

44380 .... ............ A ........ Small bowel endoscopy ...................... 1.05 NA NA 0.75 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 1.63 1.45 0.21 000 

44385 .... ............ A ........ Endoscopy of bowel pouch ................ 1.82 4.86 4.11 0.89 0.82 0.15 000 

44386 .... ............ A ........ Endoscopy, bowel pouch/biop ............ 2.12 6.60 6.64 1.02 0.96 0.20 000 

44388 .... ............ A ........ Colonoscopy ....................................... 2.82 6.08 5.59 1.36 1.26 0.26 000 

44389 .... ............ A ........ Colonoscopy with biopsy .................... 3.13 7.06 6.84 1.58 1.43 0.27 000 

44390 .... ............ A ........ Colonoscopy for foreign body ............ 3.82 8.29 7.64 1.93 1.69 0.32 000 

44391 .... ............ A ........ Colonoscopy for bleeding ................... 4.31 8.88 8.81 2.23 1.96 0.34 000 

44392 .... ............ A ........ Colonoscopy & polypectomy .............. 3.81 7.31 6.96 1.72 1.61 0.34 000 

44393 .... ............ A ........ Colonoscopy, lesion removal ............. 4.83 7.99 7.42 2.15 1.99 0.42 000 

44394 .... ............ A ........ Colonoscopy w/snare ......................... 4.42 8.45 8.13 2.09 1.90 0.38 000 

44397 .... ............ A ........ Colonoscopy w/stent .......................... 4.70 NA NA 2.17 2.01 0.39 000 

44500 .... ............ A ........ Intro, gastrointestinal tube .................. 0.49 NA NA 0.17 0.16 0.03 000 

44602 .... ............ A ........ Suture, small intestine ........................ 24.64 NA NA 7.62 7.02 2.12 090 

44603 .... ............ A ........ Suture, small intestine ........................ 28.03 NA NA 8.97 8.14 2.42 090 

44604 .... ............ A ........ Suture, large intestine ........................ 18.06 NA NA 6.07 6.27 2.12 090 

44605 .... ............ A ........ Repair of bowel lesion ........................ 22.00 NA NA 7.82 8.13 2.52 090 

44615 .... ............ A ........ Intestinal stricturoplasty ...................... 18.08 NA NA 6.53 6.62 2.07 090 

44620 .... ............ A ........ Repair bowel opening ......................... 14.35 NA NA 5.50 5.42 1.51 090 

44625 .... ............ A ........ Repair bowel opening ......................... 17.20 NA NA 6.14 6.23 1.86 090 

44626 .... ............ A ........ Repair bowel opening ......................... 27.82 NA NA 8.89 9.37 3.27 090 

44640 .... ............ A ........ Repair bowel-skin fistula .................... 24.12 NA NA 8.01 8.31 2.78 090 

44650 .... ............ A ........ Repair bowel fistula ............................ 25.04 NA NA 8.30 8.61 2.93 090 

44660 .... ............ A ........ Repair bowel-bladder fistula ............... 23.83 NA NA 9.84 9.08 2.14 090 

44661 .... ............ A ........ Repair bowel-bladder fistula ............... 27.27 NA NA 9.43 9.50 2.81 090 

44680 .... ............ A ........ Surgical revision, intestine .................. 17.88 NA NA 6.66 6.54 2.00 090 

44700 .... ............ A ........ Suspend bowel w/prosthesis .............. 17.40 NA NA 6.17 6.44 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 1.49 0.37 XXX 

44721 .... ............ A ........ Prep donor intestine/artery ................. 7.00 NA NA 1.77 2.09 0.97 XXX 

44799 .... ............ C ........ Unlisted procedure intestine ............... 0.00 0.00 7.75 0.00 7.75 0.00 YYY 

44800 .... ............ A ........ Excision of bowel pouch ..................... 11.94 NA NA 5.48 5.44 1.47 090 

44820 .... ............ A ........ Excision of mesentery lesion .............. 13.63 NA NA 5.56 5.53 1.59 090 

44850 .... ............ A ........ Repair of mesentery ........................... 12.03 NA NA 5.00 5.01 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 5.01 4.86 1.33 090 

44901 .... ............ A ........ Drain app abscess, percut ................. 3.37 19.64 23.62 1.21 1.12 0.22 000 

44950 .... ............ A ........ Appendectomy .................................... 10.52 NA NA 4.03 4.18 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 5.39 5.37 1.63 090 

44970 .... ............ A ........ Laparoscopy, appendectomy ............. 9.35 NA NA 4.18 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 3.56 3.25 0.52 090 

45005 .... ............ A ........ Drainage of rectal abscess ................. 2.00 3.95 4.00 1.58 1.58 0.25 010 

45020 .... ............ A ........ Drainage of rectal abscess ................. 8.43 NA NA 4.54 3.90 0.55 090 

45100 .... ............ A ........ Biopsy of rectum ................................. 3.96 NA NA 2.80 2.59 0.44 090 

45108 .... ............ A ........ Removal of anorectal lesion ............... 5.04 NA NA 3.09 2.92 0.59 090 

45110 .... ............ A ........ Removal of rectum ............................. 30.57 NA NA 11.84 12.14 3.36 090 

mstockstill on PROD1PC66 with PROPOSALS2

38283 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

45111 .... ............ A ........ Partial removal of rectum ................... 17.89 NA NA 6.99 7.08 2.07 090 

45112 .... ............ A ........ Removal of rectum ............................. 33.05 NA NA 10.33 11.06 3.43 090 

45113 .... ............ A ........ Partial proctectomy ............................. 33.09 NA NA 11.59 12.10 3.49 090 

45114 .... ............ A ........ Partial removal of rectum ................... 30.63 NA NA 10.29 10.60 3.36 090 

45116 .... ............ A ........ Partial removal of rectum ................... 27.56 NA NA 9.58 9.78 2.88 090 

45119 .... ............ A ........ Remove rectum w/reservoir ............... 33.35 NA NA 11.55 12.04 3.36 090 

45120 .... ............ A ........ Removal of rectum ............................. 26.25 NA NA 9.24 9.72 2.90 090 

45121 .... ............ A ........ Removal of rectum and colon ............ 28.93 NA NA 10.04 10.62 3.25 090 

45123 .... ............ A ........ Partial proctectomy ............................. 18.70 NA NA 6.95 6.93 1.86 090 

45126 .... ............ A ........ Pelvic exenteration ............................. 48.89 NA NA 18.00 18.50 4.33 090 

45130 .... ............ A ........ Excision of rectal prolapse ................. 18.37 NA NA 6.67 6.74 1.80 090 

45135 .... ............ A ........ Excision of rectal prolapse ................. 22.15 NA NA 8.62 8.64 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 3.17 0.61 090 

45160 .... ............ A ........ Excision of rectal lesion ...................... 16.17 NA NA 6.43 6.56 1.68 090 

45170 .... ............ A ........ Excision of rectal lesion ...................... 12.48 NA NA 5.35 5.30 1.35 090 

45190 .... ............ A ........ Destruction, rectal tumor .................... 10.29 NA NA 5.51 5.08 1.13 090 

45300 .... ............ A ........ Proctosigmoidoscopy dx ..................... 0.80 1.95 1.74 0.45 0.35 0.04 000 

45303 .... ............ A ........ Proctosigmoidoscopy dilate ................ 1.50 19.71 19.14 0.66 0.45 0.05 000 

45305 .... ............ A ........ Proctosigmoidoscopy w/bx ................. 1.25 3.16 2.91 0.59 0.54 0.11 000 

45307 .... ............ A ........ Proctosigmoidoscopy fb ..................... 1.70 3.22 3.14 0.70 0.56 0.11 000 

45308 .... ............ A ........ Proctosigmoidoscopy removal ............ 1.40 3.37 2.66 0.63 0.51 0.09 000 

45309 .... ............ A ........ Proctosigmoidoscopy removal ............ 1.50 3.49 3.20 0.67 0.78 0.22 000 

45315 .... ............ A ........ Proctosigmoidoscopy removal ............ 1.80 3.79 3.29 0.88 0.72 0.15 000 

45317 .... ............ A ........ Proctosigmoidoscopy bleed ................ 2.00 3.35 2.91 0.77 0.70 0.15 000 

45320 .... ............ A ........ Proctosigmoidoscopy ablate ............... 1.78 3.37 3.24 0.80 0.75 0.16 000 

45321 .... ............ A ........ Proctosigmoidoscopy volvul ............... 1.75 NA NA 0.86 0.67 0.13 000 

45327 .... ............ A ........ Proctosigmoidoscopy w/stent ............. 2.00 NA NA 0.91 0.78 0.16 000 

45330 .... ............ A ........ Diagnostic sigmoidoscopy .................. 0.96 2.50 2.39 0.62 0.56 0.08 000 

45331 .... ............ A ........ Sigmoidoscopy and biopsy ................. 1.15 3.25 3.16 0.79 0.69 0.09 000 

45332 .... ............ A ........ Sigmoidoscopy w/fb removal .............. 1.79 5.49 5.26 1.00 0.91 0.16 000 

45333 .... ............ A ........ Sigmoidoscopy & polypectomy .......... 1.79 5.62 5.25 0.99 0.90 0.15 000 

45334 .... ............ A ........ Sigmoidoscopy for bleeding ............... 2.73 NA NA 1.55 1.34 0.20 000 

45335 .... ............ A ........ Sigmoidoscopy w/submuc inj ............. 1.46 5.30 4.26 0.90 0.80 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 5.86 5.53 1.28 1.14 0.19 000 

45339 .... ............ A ........ Sigmoidoscopy w/ablate tumr ............ 3.14 5.70 4.59 1.67 1.48 0.26 000 

45340 .... ............ A ........ Sig w/balloon dilation .......................... 1.89 10.17 8.18 1.04 0.94 0.15 000 

45341 .... ............ A ........ Sigmoidoscopy w/ultrasound .............. 2.60 NA NA 1.48 1.27 0.19 000 

45342 .... ............ A ........ Sigmoidoscopy w/us guide bx ............ 4.05 NA NA 2.18 1.87 0.30 000 

45345 .... ............ A ........ Sigmoidoscopy w/stent ....................... 2.92 NA NA 1.51 1.34 0.23 000 

45355 .... ............ A ........ Surgical colonoscopy .......................... 3.51 NA NA 1.59 1.48 0.36 000 

45378 .... ............ A ........ Diagnostic colonoscopy ...................... 3.69 6.35 6.25 1.83 1.66 0.30 000 

45378 .... 53 ....... A ........ Diagnostic colonoscopy ...................... 0.96 2.50 2.39 0.62 0.56 0.08 000 

45379 .... ............ A ........ Colonoscopy w/fb removal ................. 4.68 8.03 7.86 2.18 2.01 0.39 000 

45380 .... ............ A ........ Colonoscopy and biopsy .................... 4.43 7.71 7.46 2.25 2.00 0.35 000 

45381 .... ............ A ........ Colonoscopy, submucous inj .............. 4.19 7.68 7.40 2.17 1.92 0.30 000 

45382 .... ............ A ........ Colonoscopy/control bleeding ............ 5.68 10.30 10.13 2.90 2.55 0.41 000 

45383 .... ............ A ........ Lesion removal colonoscopy .............. 5.86 8.51 8.22 2.65 2.44 0.48 000 

45384 .... ............ A ........ Lesion remove colonoscopy ............... 4.69 7.15 6.98 2.19 2.02 0.38 000 

45385 .... ............ A ........ Lesion removal colonoscopy .............. 5.30 8.33 8.07 2.60 2.32 0.42 000 

45386 .... ............ A ........ Colonoscopy dilate stricture ............... 4.57 12.27 12.34 2.19 1.99 0.39 000 

45387 .... ............ A ........ Colonoscopy w/stent .......................... 5.90 NA NA 2.81 2.60 0.48 000 

45391 .... ............ A ........ Colonoscopy w/endoscope us ............ 5.09 NA NA 2.62 2.29 0.42 000 

45392 .... ............ A ........ Colonoscopy w/endoscopic fnb .......... 6.54 NA NA 3.23 2.84 0.42 000 

45395 .... ............ A ........ Lap, removal of rectum ...................... 32.79 NA NA 12.94 13.32 3.63 090 

45397 .... ............ A ........ Lap, remove rectum w/pouch ............. 36.29 NA NA 13.40 13.87 3.67 090 

45400 .... ............ A ........ Laparoscopic proc .............................. 19.31 NA NA 7.09 7.48 2.03 090 

45402 .... ............ A ........ Lap proctopexy w/sig resect ............... 26.38 NA NA 8.76 9.39 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 4.45 3.98 0.75 090 

45505 .... ............ A ........ Repair of rectum ................................. 8.20 NA NA 5.02 4.45 0.86 090 

45520 .... ............ A ........ Treatment of rectal prolapse .............. 0.55 2.83 2.27 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 6.58 6.27 1.55 090 

45550 .... ............ A ........ Repair rectum/remove sigmoid .......... 24.67 NA NA 8.96 9.10 2.62 090 

45560 .... ............ A ........ Repair of rectocele ............................. 11.42 NA NA 5.55 5.30 1.13 090 

45562 .... ............ A ........ Exploration/repair of rectum ............... 17.82 NA NA 8.12 7.56 1.84 090 

45563 .... ............ A ........ Exploration/repair of rectum ............... 26.22 NA NA 10.74 10.66 3.11 090 

45800 .... ............ A ........ Repair rect/bladder fistula .................. 20.18 NA NA 9.24 8.34 1.86 090 

45805 .... ............ A ........ Repair fistula w/colostomy .................. 23.19 NA NA 9.94 9.61 2.03 090 

45820 .... ............ A ........ Repair rectourethral fistula ................. 20.24 NA NA 9.14 8.42 1.58 090 

mstockstill on PROD1PC66 with PROPOSALS2

38284 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

45825 .... ............ A ........ Repair fistula w/colostomy .................. 24.01 NA NA 9.49 9.91 2.32 090 

45900 .... ............ A ........ Reduction of rectal prolapse .............. 2.96 NA NA 1.65 1.58 0.30 010 

45905 .... ............ A ........ Dilation of anal sphincter .................... 2.32 NA NA 1.60 1.53 0.27 010 

45910 .... ............ A ........ Dilation of rectal narrowing ................. 2.82 NA NA 1.85 1.75 0.30 010 

45915 .... ............ A ........ Remove rectal obstruction .................. 3.16 4.18 4.26 2.01 2.06 0.30 010 

45990 .... ............ A ........ Surg dx exam, anorectal .................... 1.80 NA NA 0.72 0.77 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 3.24 2.79 2.33 2.10 0.31 010 

46030 .... ............ A ........ Removal of rectal marker ................... 1.24 1.87 1.61 0.81 0.76 0.14 010 

46040 .... ............ A ........ Incision of rectal abscess ................... 5.26 6.48 5.99 3.96 3.77 0.62 090 

46045 .... ............ A ........ Incision of rectal abscess ................... 5.79 NA NA 3.92 3.41 0.54 090 

46050 .... ............ A ........ Incision of anal abscess ..................... 1.21 3.16 2.85 0.97 0.91 0.14 010 

46060 .... ............ A ........ Incision of rectal abscess ................... 6.24 NA NA 4.39 3.82 0.67 090 

46070 .... ............ A ........ Incision of anal septum ...................... 2.74 NA NA 2.33 2.08 0.36 090 

46080 .... ............ A ........ Incision of anal sphincter .................... 2.50 3.04 2.70 1.12 1.13 0.30 010 

46083 .... ............ A ........ Incise external hemorrhoid ................. 1.42 2.34 2.43 0.95 0.94 0.15 010 

46200 .... ............ A ........ Removal of anal fissure ...................... 3.48 6.24 5.05 3.70 3.29 0.39 090 

46210 .... ............ A ........ Removal of anal crypt ........................ 2.73 5.77 5.47 3.27 2.96 0.31 090 

46211 .... ............ A ........ Removal of anal crypts ....................... 4.31 7.79 6.48 4.64 3.98 0.48 090 

46220 .... ............ A ........ Removal of anal tag ........................... 1.58 2.99 2.64 1.09 1.02 0.17 010 

46221 .... ............ A ........ Ligation of hemorrhoid(s) ................... 2.31 3.70 3.17 1.99 1.87 0.23 010 

46230 .... ............ A ........ Removal of anal tags ......................... 2.59 3.48 3.28 1.33 1.31 0.30 010 

46250 .... ............ A ........ Hemorrhoidectomy ............................. 4.17 5.90 5.61 2.82 2.72 0.48 090 

46255 .... ............ A ........ Hemorrhoidectomy ............................. 4.88 6.28 6.07 3.05 2.95 0.58 090 

46257 .... ............ A ........ Remove hemorrhoids & fissure .......... 5.68 NA NA 3.83 3.35 0.64 090 

46258 .... ............ A ........ Remove hemorrhoids & fistula ........... 6.28 NA NA 3.94 3.62 0.68 090 

46260 .... ............ A ........ Hemorrhoidectomy ............................. 6.65 NA NA 4.04 3.61 0.76 090 

46261 .... ............ A ........ Remove hemorrhoids & fissure .......... 7.63 NA NA 4.28 3.95 0.79 090 

46262 .... ............ A ........ Remove hemorrhoids & fistula ........... 7.80 NA NA 4.62 4.19 0.83 090 

46270 .... ............ A ........ Removal of anal fistula ....................... 4.81 6.33 5.65 3.88 3.35 0.46 090 

46275 .... ............ A ........ Removal of anal fistula ....................... 5.31 6.57 5.60 3.95 3.46 0.52 090 

46280 .... ............ A ........ Removal of anal fistula ....................... 6.28 NA NA 4.25 3.76 0.66 090 

46285 .... ............ A ........ Removal of anal fistula ....................... 5.31 6.49 5.13 3.94 3.35 0.44 090 

46288 .... ............ A ........ Repair anal fistula ............................... 7.68 NA NA 4.66 4.17 0.79 090 

46320 .... ............ A ........ Removal of hemorrhoid clot ............... 1.62 2.39 2.26 0.88 0.87 0.18 010 

46500 .... ............ A ........ Injection into hemorrhoid(s) ................ 1.64 3.58 2.85 1.24 1.20 0.16 010 

46505 .... ............ A ........ Chemodenervation anal musc ............ 3.13 3.26 3.15 2.27 2.12 0.14 010 

46600 .... ............ A ........ Diagnostic anoscopy .......................... 0.55 1.36 1.47 0.38 0.36 0.05 000 

46604 .... ............ A ........ Anoscopy and dilation ........................ 1.03 12.39 10.78 0.51 0.58 0.12 000 

46606 .... ............ A ........ Anoscopy and biopsy ......................... 1.20 3.84 3.82 0.58 0.49 0.09 000 

46608 .... ............ A ........ Anoscopy, remove for body ............... 1.30 3.73 4.10 0.58 0.62 0.16 000 

46610 .... ............ A ........ Anoscopy, remove lesion ................... 1.28 3.76 3.95 0.59 0.62 0.15 000 

46611 .... ............ A ........ Anoscopy ............................................ 1.30 2.52 2.97 0.57 0.70 0.19 000 

46612 .... ............ A ........ Anoscopy, remove lesions ................. 1.50 4.66 5.02 0.72 0.89 0.28 000 

46614 .... ............ A ........ Anoscopy, control bleeding ................ 1.00 1.92 2.23 0.52 0.73 0.20 000 

46615 .... ............ A ........ Anoscopy ............................................ 1.50 1.76 2.21 0.64 0.91 0.33 000 

46700 .... ............ A ........ Repair of anal stricture ....................... 9.68 NA NA 5.14 4.68 0.94 090 

46705 .... ............ A ........ Repair of anal stricture ....................... 7.32 NA NA 4.04 3.86 0.91 090 

46706 .... ............ A ........ Repr of anal fistula w/glue .................. 2.41 NA NA 1.48 1.36 0.28 010 

46710 .... ............ A ........ Repr per/vag pouch sngl proc ............ 17.01 NA NA 7.54 7.69 1.38 090 

46712 .... ............ A ........ Repr per/vag pouch dbl proc .............. 36.32 NA NA 14.06 14.59 3.67 090 

46715 .... ............ A ........ Rep perf anoper fistu .......................... 7.54 NA NA 3.73 3.65 0.92 090 

46716 .... ............ A ........ Rep perf anoper/vestib fistu ............... 17.14 NA NA 9.53 8.76 1.58 090 

46730 .... ............ A ........ Construction of absent anus .............. 30.17 NA NA 12.51 12.10 2.47 090 

46735 .... ............ A ........ Construction of absent anus .............. 35.66 NA NA 14.95 14.02 3.21 090 

46740 .... ............ A ........ Construction of absent anus .............. 33.42 NA NA 15.36 14.16 2.42 090 

46742 .... ............ A ........ Repair of imperforated anus ............... 39.66 NA NA 13.72 15.95 3.20 090 

46744 .... ............ A ........ Repair of cloacal anomaly .................. 58.46 NA NA 18.11 20.16 6.40 090 

46746 .... ............ A ........ Repair of cloacal anomaly .................. 64.93 NA NA 19.65 22.40 7.70 090 

46748 .... ............ A ........ Repair of cloacal anomaly .................. 70.91 NA NA 21.03 22.34 3.37 090 

46750 .... ............ A ........ Repair of anal sphincter ..................... 12.02 NA NA 5.77 5.42 1.10 090 

46751 .... ............ A ........ Repair of anal sphincter ..................... 9.19 NA NA 5.04 5.12 0.94 090 

46753 .... ............ A ........ Reconstruction of anus ....................... 8.81 NA NA 4.57 4.22 0.94 090 

46754 .... ............ A ........ Removal of suture from anus ............. 2.88 3.60 3.61 2.20 1.95 0.19 010 

46760 .... ............ A ........ Repair of anal sphincter ..................... 17.21 NA NA 7.87 7.54 1.59 090 

46761 .... ............ A ........ Repair of anal sphincter ..................... 15.16 NA NA 6.48 6.25 1.43 090 

46762 .... ............ A ........ Implant artificial sphincter ................... 14.66 NA NA 7.09 6.26 1.24 090 

46900 .... ............ A ........ Destruction, anal lesion(s) .................. 1.91 3.63 3.10 1.31 1.29 0.17 010 

46910 .... ............ A ........ Destruction, anal lesion(s) .................. 1.88 3.85 3.38 1.20 1.13 0.19 010 

46916 .... ............ A ........ Cryosurgery, anal lesion(s) ................ 1.88 3.76 3.46 1.59 1.50 0.11 010 

46917 .... ............ A ........ Laser surgery, anal lesions ................ 1.88 8.72 8.91 1.22 1.17 0.21 010 

46922 .... ............ A ........ Excision of anal lesion(s) ................... 1.88 4.10 3.69 1.19 1.13 0.22 010 

mstockstill on PROD1PC66 with PROPOSALS2

38285 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

46924 .... ............ A ........ Destruction, anal lesion(s) .................. 2.78 9.50 9.11 1.52 1.44 0.26 010 

46934 .... ............ A ........ Destruction of hemorrhoids ................ 3.79 5.53 5.28 2.87 2.90 0.32 090 

46935 .... ............ A ........ Destruction of hemorrhoids ................ 2.44 3.84 3.63 1.11 1.16 0.23 010 

46936 .... ............ A ........ Destruction of hemorrhoids ................ 3.70 6.20 5.53 2.65 2.56 0.34 090 

46937 .... ............ A ........ Cryotherapy of rectal lesion ............... 2.70 3.39 3.21 1.43 1.40 0.14 010 

46938 .... ............ A ........ Cryotherapy of rectal lesion ............... 4.70 5.58 4.82 3.53 3.31 0.58 090 

46940 .... ............ A ........ Treatment of anal fissure ................... 2.33 2.83 2.41 1.04 1.07 0.23 010 

46942 .... ............ A ........ Treatment of anal fissure ................... 2.05 2.78 2.31 0.96 0.99 0.19 010 

46945 .... ............ A ........ Ligation of hemorrhoids ...................... 2.13 4.76 4.02 2.96 2.72 0.19 090 

46946 .... ............ A ........ Ligation of hemorrhoids ...................... 2.60 4.60 4.17 2.63 2.52 0.27 090 

46947 .... ............ A ........ Hemorrhoidopexy by stapling ............. 5.49 NA NA 3.09 2.90 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 7.61 5.28 0.71 0.65 0.12 000 

47001 .... ............ A ........ Needle biopsy, liver add-on ................ 1.90 NA NA 0.49 0.57 0.25 ZZZ 

47010 .... ............ A ........ Open drainage, liver lesion ................ 19.27 NA NA 8.31 8.32 1.81 090 

47011 .... ............ A ........ Percut drain, liver lesion ..................... 3.69 NA NA 1.33 1.22 0.22 000 

47015 .... ............ A ........ Inject/aspirate liver cyst ...................... 18.37 NA NA 8.16 7.76 1.84 090 

47100 .... ............ A ........ Wedge biopsy of liver ......................... 12.78 NA NA 6.29 6.17 1.53 090 

47120 .... ............ A ........ Partial removal of liver ........................ 38.82 NA NA 14.07 14.61 4.66 090 

47122 .... ............ A ........ Extensive removal of liver .................. 59.35 NA NA 18.78 20.12 7.21 090 

47125 .... ............ A ........ Partial removal of liver ........................ 52.91 NA NA 17.18 18.33 6.47 090 

47130 .... ............ A ........ Partial removal of liver ........................ 57.06 NA NA 18.14 19.54 6.96 090 

47135 .... ............ R ........ Transplantation of liver ....................... 83.29 NA NA 27.72 29.63 9.96 090 

47136 .... ............ R ........ Transplantation of liver ....................... 70.39 NA NA 24.50 25.63 8.44 090 

47140 .... ............ A ........ Partial removal, donor liver ................ 59.22 NA NA 21.57 21.95 5.19 090 

47141 .... ............ A ........ Partial removal, donor liver ................ 71.27 NA NA 25.30 26.13 5.19 090 

47142 .... ............ A ........ Partial removal, donor liver ................ 79.21 NA NA 27.31 28.42 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 1.79 0.83 XXX 

47147 .... ............ A ........ Prep donor liver/arterial ...................... 7.00 NA NA 1.78 2.09 0.97 XXX 

47300 .... ............ A ........ Surgery for liver lesion ....................... 18.01 NA NA 7.72 7.46 1.99 090 

47350 .... ............ A ........ Repair liver wound .............................. 22.36 NA NA 8.75 8.83 2.59 090 

47360 .... ............ A ........ Repair liver wound .............................. 31.18 NA NA 11.23 11.42 3.38 090 

47361 .... ............ A ........ Repair liver wound .............................. 52.47 NA NA 17.43 17.87 5.87 090 

47362 .... ............ A ........ Repair liver wound .............................. 23.41 NA NA 9.28 9.00 2.51 090 

47370 .... ............ A ........ Laparo ablate liver tumor rf ................ 20.67 NA NA 7.67 7.90 2.56 090 

47371 .... ............ A ........ Laparo ablate liver cryosurg ............... 20.67 NA NA 7.90 8.06 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 8.96 2.87 090 

47381 .... ............ A ........ Open ablate liver tumor cryo .............. 24.72 NA NA 9.34 9.41 2.85 090 

47382 .... ............ A ........ Percut ablate liver rf ........................... 15.19 NA NA 6.26 5.97 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 13.02 13.24 3.08 090 

47420 .... ............ A ........ Incision of bile duct ............................. 21.92 NA NA 8.53 8.66 2.63 090 

47425 .... ............ A ........ Incision of bile duct ............................. 22.20 NA NA 8.63 8.71 2.62 090 

47460 .... ............ A ........ Incise bile duct sphincter .................... 20.41 NA NA 9.13 8.72 2.21 090 

47480 .... ............ A ........ Incision of gallbladder ......................... 13.12 NA NA 6.61 6.26 1.42 090 

47490 .... ............ A ........ Incision of gallbladder ......................... 8.05 NA NA 5.31 5.32 0.43 090 

47500 .... ............ A ........ Injection for liver x-rays ...................... 1.96 NA NA 0.72 0.65 0.12 000 

47505 .... ............ A ........ Injection for liver x-rays ...................... 0.76 NA NA 0.28 0.25 0.04 000 

47510 .... ............ A ........ Insert catheter, bile duct ..................... 7.94 NA NA 4.65 4.72 0.46 090 

47511 .... ............ A ........ Insert bile duct drain ........................... 10.74 NA NA 5.08 4.94 0.62 090 

47525 .... ............ A ........ Change bile duct catheter .................. 5.55 14.76 14.79 2.71 2.68 0.33 010 

47530 .... ............ A ........ Revise/reinsert bile tube ..................... 5.96 30.34 31.82 3.46 3.51 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 2.50 2.37 0.42 000 

47553 .... ............ A ........ Biliary endoscopy thru skin ................ 6.34 NA NA 2.28 2.10 0.37 000 

47554 .... ............ A ........ Biliary endoscopy thru skin ................ 9.05 NA NA 3.31 3.26 0.96 000 

47555 .... ............ A ........ Biliary endoscopy thru skin ................ 7.55 NA NA 2.78 2.53 0.45 000 

47556 .... ............ A ........ Biliary endoscopy thru skin ................ 8.55 NA NA 3.13 2.84 0.50 000 

47560 .... ............ A ........ Laparoscopy w/cholangio ................... 4.88 NA NA 1.24 1.46 0.65 000 

47561 .... ............ A ........ Laparo w/cholangio/biopsy ................. 5.17 NA NA 1.59 1.74 0.66 000 

47562 .... ............ A ........ Laparoscopic cholecystectomy ........... 11.63 NA NA 5.25 5.12 1.46 090 

47563 .... ............ A ........ Laparo cholecystectomy/graph ........... 12.03 NA NA 5.05 5.18 1.58 090 

47564 .... ............ A ........ Laparo cholecystectomy/explr ............ 14.21 NA NA 5.40 5.68 1.89 090 

47570 .... ............ A ........ Laparo cholecystoenterostomy ........... 12.56 NA NA 4.95 5.17 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 7.20 6.67 1.80 090 

47605 .... ............ A ........ Removal of gallbladder ....................... 15.90 NA NA 6.37 6.44 1.95 090 

47610 .... ............ A ........ Removal of gallbladder ....................... 20.84 NA NA 7.64 7.79 2.49 090 

mstockstill on PROD1PC66 with PROPOSALS2

38286 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

47612 .... ............ A ........ Removal of gallbladder ....................... 21.13 NA NA 7.66 7.78 2.48 090 

47620 .... ............ A ........ Removal of gallbladder ....................... 22.99 NA NA 8.15 8.34 2.74 090 

47630 .... ............ A ........ Remove bile duct stone ...................... 9.57 NA NA 4.75 4.72 0.65 090 

47700 .... ............ A ........ Exploration of bile ducts ..................... 16.39 NA NA 7.28 7.34 2.07 090 

47701 .... ............ A ........ Bile duct revision ................................ 28.62 NA NA 10.62 10.96 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 8.58 8.50 2.49 090 

47719 .... ............ A ........ Fusion of bile duct cyst ...................... 19.07 NA NA 7.93 7.86 2.15 090 

47720 .... ............ A ........ Fuse gallbladder & bowel ................... 18.21 NA NA 7.71 7.59 2.11 090 

47721 .... ............ A ........ Fuse upper gi structures .................... 21.86 NA NA 8.53 8.56 2.53 090 

47740 .... ............ A ........ Fuse gallbladder & bowel ................... 21.10 NA NA 8.31 8.37 2.42 090 

47741 .... ............ A ........ Fuse gallbladder & bowel ................... 24.08 NA NA 9.23 9.26 2.83 090 

47760 .... ............ A ........ Fuse bile ducts and bowel ................. 38.14 NA NA 13.03 11.95 3.42 090 

47765 .... ............ A ........ Fuse liver ducts & bowel .................... 52.01 NA NA 16.94 13.87 3.30 090 

47780 .... ............ A ........ Fuse bile ducts and bowel ................. 42.14 NA NA 14.11 12.66 3.50 090 

47785 .... ............ A ........ Fuse bile ducts and bowel ................. 56.01 NA NA 17.87 15.40 4.10 090 

47800 .... ............ A ........ Reconstruction of bile ducts ............... 26.04 NA NA 9.75 9.90 3.08 090 

47801 .... ............ A ........ Placement, bile duct support .............. 17.47 NA NA 8.47 8.16 1.16 090 

47802 .... ............ A ........ Fuse liver duct & intestine .................. 24.80 NA NA 9.66 9.63 2.86 090 

47900 .... ............ A ........ Suture bile duct injury ......................... 22.31 NA NA 8.83 8.83 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 11.18 3.48 090 

48001 .... ............ A ........ Placement of drain, pancreas ............ 39.56 NA NA 12.77 13.31 4.69 090 

48020 .... ............ A ........ Removal of pancreatic stone .............. 18.96 NA NA 7.57 7.44 2.13 090 

48100 .... ............ A ........ Biopsy of pancreas, open ................... 14.38 NA NA 5.95 5.76 1.62 090 

48102 .... ............ A ........ Needle biopsy, pancreas .................... 4.68 9.56 8.66 1.93 1.88 0.28 010 

48105 .... ............ A ........ Resect/debride pancreas .................... 49.05 NA NA 15.77 16.32 5.56 090 

48120 .... ............ A ........ Removal of pancreas lesion ............... 18.33 NA NA 6.85 6.86 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 9.54 9.71 3.18 090 

48146 .... ............ A ........ Pancreatectomy .................................. 30.42 NA NA 11.91 11.94 3.50 090 

48148 .... ............ A ........ Removal of pancreatic duct ................ 20.26 NA NA 8.20 7.88 2.30 090 

48150 .... ............ A ........ Partial removal of pancreas ............... 52.63 NA NA 18.02 18.77 6.32 090 

48152 .... ............ A ........ Pancreatectomy .................................. 48.47 NA NA 16.83 17.48 5.80 090 

48153 .... ............ A ........ Pancreatectomy .................................. 52.61 NA NA 17.90 18.73 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 11.93 11.80 3.27 090 

48400 .... ............ A ........ Injection, intraop add-on ..................... 1.95 NA NA 0.67 0.68 0.15 ZZZ 

48500 .... ............ A ........ Surgery of pancreatic cyst .................. 18.03 NA NA 7.64 7.55 2.03 090 

48510 .... ............ A ........ Drain pancreatic pseudocyst .............. 17.06 NA NA 7.58 7.50 1.83 090 

48511 .... ............ A ........ Drain pancreatic pseudocyst .............. 3.99 20.03 20.30 1.45 1.33 0.24 000 

48520 .... ............ A ........ Fuse pancreas cyst and bowel .......... 18.07 NA NA 6.82 6.75 2.06 090 

48540 .... ............ A ........ Fuse pancreas cyst and bowel .......... 21.86 NA NA 7.79 7.94 2.61 090 

48545 .... ............ A ........ Pancreatorrhaphy ............................... 22.10 NA NA 8.40 8.14 2.38 090 

48547 .... ............ A ........ Duodenal exclusion ............................ 30.25 NA NA 10.28 10.38 3.42 090 

48548 .... ............ A ........ Fuse pancreas and bowel .................. 27.96 NA NA 9.88 10.07 3.28 090 

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 1.15 1.30 0.31 XXX 

48554 .... ............ R ........ Transpl allograft pancreas .................. 37.03 NA NA 20.43 19.36 4.19 090 

48556 .... ............ A ........ Removal, allograft pancreas ............... 19.24 NA NA 9.18 8.66 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 5.71 1.37 090 

49010 .... ............ A ........ Exploration behind abdomen .............. 15.98 NA NA 6.21 6.07 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 19.48 20.11 1.23 1.12 0.20 000 

49040 .... ............ A ........ Drain, open, abdom abscess ............. 16.41 NA NA 6.50 6.46 1.70 090 

49041 .... ............ A ........ Drain, percut, abdom abscess ........... 3.99 19.76 19.47 1.45 1.33 0.24 000 

49060 .... ............ A ........ Drain, open, retrop abscess ............... 18.42 NA NA 7.25 7.32 1.75 090 

49061 .... ............ A ........ Drain, percut, retroper absc ............... 3.69 19.59 19.45 1.34 1.23 0.22 000 

49062 .... ............ A ........ Drain to peritoneal cavity .................... 12.12 NA NA 5.12 5.29 1.39 090 

49080 .... ............ A ........ Puncture, peritoneal cavity ................. 1.35 2.71 3.32 0.49 0.46 0.08 000 

49081 .... ............ A ........ Removal of abdominal fluid ................ 1.26 2.92 2.74 0.47 0.44 0.09 000 

49180 .... ............ A ........ Biopsy, abdominal mass .................... 1.73 2.47 2.75 0.63 0.58 0.10 000 

49200 .... ............ A ........ Removal of abdominal lesion ............. 10.94 NA NA 4.85 4.94 1.24 090 

49201 .... ............ A ........ Remove abdom lesion, complex ........ 15.67 NA NA 6.42 6.73 1.88 090 

49215 .... ............ A ........ Excise sacral spine tumor .................. 37.66 NA NA 12.75 13.40 4.38 090 

49220 .... ............ A ........ Multiple surgery, abdomen ................. 15.70 NA NA 6.48 6.51 1.89 090 

49250 .... ............ A ........ Excision of umbilicus .......................... 8.93 NA NA 4.34 4.29 1.08 090 

49255 .... ............ A ........ Removal of omentum ......................... 12.41 NA NA 5.61 5.61 1.43 090 

49320 .... ............ A ........ Diag laparo separate proc .................. 5.09 NA NA 2.44 2.54 0.65 010 

mstockstill on PROD1PC66 with PROPOSALS2

38287 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

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 4.59 1.20 090 

49324 .... ............ A ........ Lap insertion perm ip cath .................. 6.27 NA NA 2.78 2.79 0.73 010 

49325 .... ............ A ........ Lap revision perm ip cath ................... 6.77 NA NA 2.90 2.92 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 2.46 2.74 0.62 0.61 0.15 000 

49402 .... ............ A ........ Remove foreign body, adbomen ........ 14.01 NA NA 5.51 5.51 1.62 090 

49419 .... ............ A ........ Insrt abdom cath for chemotx ............ 7.03 NA NA 3.44 3.49 0.81 090 

49420 .... ............ A ........ Insert abdom drain, temp ................... 2.22 NA NA 1.19 1.14 0.21 000 

49421 .... ............ A ........ Insert abdom drain, perm ................... 5.87 NA NA 3.10 3.13 0.74 090 

49422 .... ............ A ........ Remove perm cannula/catheter ......... 6.26 NA NA 2.60 2.75 0.83 010 

49423 .... ............ A ........ Exchange drainage catheter .............. 1.46 12.97 13.44 0.57 0.53 0.09 000 

49424 .... ............ A ........ Assess cyst, contrast inject ................ 0.76 3.06 3.36 0.31 0.29 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 4.55 4.65 1.28 090 

49427 .... ............ A ........ Injection, abdominal shunt .................. 0.89 NA NA 0.32 0.30 0.07 000 

49428 .... ............ A ........ Ligation of shunt ................................. 6.79 NA NA 2.99 3.47 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 0.62 0.61 0.28 ZZZ 

49436 .... ............ A ........ Embedded ip cath exit-site ................. 2.69 NA NA 1.66 1.64 0.28 010 

49491 .... ............ A ........ Rpr hern preemie reduc ..................... 12.42 NA NA 4.60 4.97 1.40 090 

49492 .... ............ A ........ Rpr ing hern premie, blocked ............. 15.32 NA NA 6.21 6.10 1.81 090 

49495 .... ............ A ........ Rpr ing hernia baby, reduc ................. 6.15 NA NA 3.04 2.99 0.74 090 

49496 .... ............ A ........ Rpr ing hernia baby, blocked ............. 9.32 NA NA 4.42 4.33 1.07 090 

49500 .... ............ A ........ Rpr ing hernia, init, reduce ................. 5.76 NA NA 3.69 3.39 0.71 090 

49501 .... ............ A ........ Rpr ing hernia, init blocked ................ 9.28 NA NA 4.25 4.22 1.12 090 

49505 .... ............ A ........ Prp i/hern init reduc >5 yr .................. 7.88 NA NA 3.86 3.81 1.03 090 

49507 .... ............ A ........ Prp i/hern init block >5 yr ................... 9.97 NA NA 4.43 4.45 1.27 090 

49520 .... ............ A ........ Rerepair ing hernia, reduce ................ 9.91 NA NA 4.36 4.40 1.28 090 

49521 .... ............ A ........ Rerepair ing hernia, blocked .............. 12.36 NA NA 4.97 5.11 1.59 090 

49525 .... ............ A ........ Repair ing hernia, sliding .................... 8.85 NA NA 4.10 4.09 1.13 090 

49540 .... ............ A ........ Repair lumbar hernia .......................... 10.66 NA NA 4.56 4.67 1.37 090 

49550 .... ............ A ........ Rpr rem hernia, init, reduce ............... 8.91 NA NA 4.09 4.11 1.14 090 

49553 .... ............ A ........ Rpr fem hernia, init blocked ............... 9.84 NA NA 4.39 4.40 1.24 090 

49555 .... ............ A ........ Rerepair fem hernia, reduce .............. 9.31 NA NA 4.19 4.23 1.20 090 

49557 .... ............ A ........ Rerepair fem hernia, blocked ............. 11.54 NA NA 4.81 4.90 1.47 090 

49560 .... ............ A ........ Rpr ventral hern init, reduc ................. 11.84 NA NA 4.86 5.01 1.52 090 

49561 .... ............ A ........ Rpr ventral hern init, block ................. 15.30 NA NA 5.78 5.93 1.89 090 

49565 .... ............ A ........ Rerepair ventrl hern, reduce .............. 12.29 NA NA 5.07 5.15 1.52 090 

49566 .... ............ A ........ Rerepair ventrl hern, block ................. 15.45 NA NA 5.83 5.98 1.91 090 

49568 .... ............ A ........ Hernia repair w/mesh ......................... 4.88 NA NA 1.25 1.46 0.64 ZZZ 

49570 .... ............ A ........ Rpr epigastric hern, reduce ................ 5.97 NA NA 3.36 3.26 0.75 090 

49572 .... ............ A ........ Rpr epigastric hern, blocked .............. 7.79 NA NA 3.81 3.64 0.88 090 

49580 .... ............ A ........ Rpr umbil hern, reduc < 5 yr .............. 4.39 NA NA 2.91 2.76 0.54 090 

49582 .... ............ A ........ Rpr umbil hern, block < 5 yr .............. 7.05 NA NA 3.67 3.56 0.88 090 

49585 .... ............ A ........ Rpr umbil hern, reduc > 5 yr .............. 6.51 NA NA 3.49 3.40 0.82 090 

49587 .... ............ A ........ Rpr umbil hern, block > 5 yr .............. 7.96 NA NA 3.84 3.79 0.99 090 

49590 .... ............ A ........ Repair spigelian hernia ....................... 8.82 NA NA 4.07 4.08 1.13 090 

49600 .... ............ A ........ Repair umbilical lesion ....................... 11.47 NA NA 5.39 5.32 1.32 090 

49605 .... ............ A ........ Repair umbilical lesion ....................... 86.85 NA NA 26.29 27.42 9.39 090 

49606 .... ............ A ........ Repair umbilical lesion ....................... 18.92 NA NA 6.77 7.20 2.46 090 

49610 .... ............ A ........ Repair umbilical lesion ....................... 10.83 NA NA 5.31 5.15 1.07 090 

49611 .... ............ A ........ Repair umbilical lesion ....................... 9.26 NA NA 4.24 5.51 0.78 090 

49650 .... ............ A ........ Laparo hernia repair initial .................. 6.30 NA NA 3.32 3.26 0.93 090 

49651 .... ............ A ........ Laparo hernia repair recur .................. 8.29 NA NA 4.21 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 6.26 6.25 1.62 090 

49904 .... ............ A ........ Omental flap, extra-abdom ................. 22.16 NA NA 11.89 13.62 2.70 090 

49905 .... ............ A ........ Omental flap, intra-abdom .................. 6.54 NA NA 1.71 2.01 0.75 ZZZ 

49906 .... ............ C ........ Free omental flap, microvasc ............. 2.08 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 6.79 6.02 0.93 090 

50020 .... ............ A ........ Renal abscess, open drain ................. 17.88 NA NA 8.52 8.13 1.34 090 

50021 .... ............ A ........ Renal abscess, percut drain ............... 3.37 20.92 21.13 1.23 1.12 0.20 000 

50040 .... ............ A ........ Drainage of kidney ............................. 16.48 NA NA 8.94 7.87 1.03 090 

50045 .... ............ A ........ Exploration of kidney .......................... 16.67 NA NA 8.19 7.45 1.24 090 

50060 .... ............ A ........ Removal of kidney stone .................... 20.80 NA NA 10.95 9.44 1.36 090 

50065 .... ............ A ........ Incision of kidney ................................ 22.17 NA NA 11.67 8.90 1.59 090 

50070 .... ............ A ........ Incision of kidney ................................ 21.70 NA NA 11.47 9.87 1.44 090 

50075 .... ............ A ........ Removal of kidney stone .................... 26.91 NA NA 13.67 11.83 1.81 090 

mstockstill on PROD1PC66 with PROPOSALS2

38288 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

50080 .... ............ A ........ Removal of kidney stone .................... 15.61 NA NA 8.65 7.47 1.04 090 

50081 .... ............ A ........ Removal of kidney stone .................... 23.32 NA NA 12.33 10.56 1.54 090 

50100 .... ............ A ........ Revise kidney blood vessels .............. 17.30 NA NA 6.37 7.22 2.07 090 

50120 .... ............ A ........ Exploration of kidney .......................... 17.06 NA NA 9.22 7.94 1.21 090 

50125 .... ............ A ........ Explore and drain kidney .................... 17.67 NA NA 9.83 8.42 1.43 090 

50130 .... ............ A ........ Removal of kidney stone .................... 18.67 NA NA 10.17 8.68 1.22 090 

50135 .... ............ A ........ Exploration of kidney .......................... 20.44 NA NA 10.81 9.32 1.33 090 

50200 .... ............ A ........ Biopsy of kidney ................................. 2.63 NA NA 1.19 1.22 0.16 000 

50205 .... ............ A ........ Biopsy of kidney ................................. 12.19 NA NA 5.52 5.28 1.30 090 

50220 .... ............ A ........ Remove kidney, open ......................... 18.53 NA NA 9.62 8.45 1.35 090 

50225 .... ............ A ........ Removal kidney open, complex ......... 21.73 NA NA 11.15 9.66 1.50 090 

50230 .... ............ A ........ Removal kidney open, radical ............ 23.68 NA NA 11.80 10.21 1.55 090 

50234 .... ............ A ........ Removal of kidney & ureter ................ 23.90 NA NA 12.19 10.54 1.59 090 

50236 .... ............ A ........ Removal of kidney & ureter ................ 26.74 NA NA 14.08 12.19 1.77 090 

50240 .... ............ A ........ Partial removal of kidney .................... 24.01 NA NA 12.76 10.91 1.55 090 

50250 .... ............ A ........ Cryoablate renal mass open .............. 22.06 NA NA 11.63 10.25 1.39 090 

50280 .... ............ A ........ Removal of kidney lesion ................... 16.94 NA NA 9.15 7.96 1.19 090 

50290 .... ............ A ........ Removal of kidney lesion ................... 16.00 NA NA 7.78 7.20 1.41 090 

50320 .... ............ A ........ Remove kidney, living donor .............. 22.28 NA NA 12.27 11.49 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 1.10 1.23 0.29 XXX 

50328 .... ............ A ........ Prep renal graft/arterial ....................... 3.50 NA NA 0.99 1.08 0.26 XXX 

50329 .... ............ A ........ Prep renal graft/ureteral ..................... 3.34 NA NA 1.07 1.08 0.25 XXX 

50340 .... ............ A ........ Removal of kidney .............................. 13.86 NA NA 7.86 7.14 1.65 090 

50360 .... ............ A ........ Transplantation of kidney ................... 40.45 NA NA 18.64 17.09 3.82 090 

50365 .... ............ A ........ Transplantation of kidney ................... 45.68 NA NA 19.28 18.78 4.43 090 

50370 .... ............ A ........ Remove transplanted kidney .............. 18.68 NA NA 9.18 8.18 1.68 090 

50380 .... ............ A ........ Reimplantation of kidney .................... 29.66 NA NA 16.13 14.12 2.51 090 

50382 .... ............ A ........ Change ureter stent, percut ............... 5.50 26.17 30.92 2.08 1.90 0.34 000 

50384 .... ............ A ........ Remove ureter stent, percut ............... 5.00 20.53 27.71 1.88 1.73 0.31 000 

50387 .... ............ A ........ Change ext/int ureter stent ................. 2.00 12.51 15.28 0.74 0.68 0.12 000 

50389 .... ............ A ........ Remove renal tube w/fluoro ............... 1.10 6.63 9.64 0.41 0.38 0.07 000 

50390 .... ............ A ........ Drainage of kidney lesion ................... 1.96 NA NA 0.72 0.65 0.12 000 

50391 .... ............ A ........ Instll rx agnt into rnal tub .................... 1.96 1.39 1.50 0.73 0.69 0.14 000 

50392 .... ............ A ........ Insert kidney drain .............................. 3.37 NA NA 1.53 1.48 0.20 000 

50393 .... ............ A ........ Insert ureteral tube ............................. 4.15 NA NA 1.82 1.75 0.25 000 

50394 .... ............ A ........ Injection for kidney x-ray .................... 0.76 1.86 2.25 0.58 0.61 0.05 000 

50395 .... ............ A ........ Create passage to kidney .................. 3.37 NA NA 1.58 1.51 0.21 000 

50396 .... ............ A ........ Measure kidney pressure ................... 2.09 NA NA 1.09 1.06 0.13 000 

50398 .... ............ A ........ Change kidney tube ........................... 1.46 11.74 13.95 0.57 0.53 0.09 000 

50400 .... ............ A ........ Revision of kidney/ureter .................... 21.12 NA NA 11.08 9.51 1.38 090 

50405 .... ............ A ........ Revision of kidney/ureter .................... 25.68 NA NA 13.07 11.09 1.79 090 

50500 .... ............ A ........ Repair of kidney wound ...................... 21.07 NA NA 8.75 8.66 2.02 090 

50520 .... ............ A ........ Close kidney-skin fistula ..................... 18.73 NA NA 9.33 8.41 1.49 090 

50525 .... ............ A ........ Repair renal-abdomen fistula ............. 24.21 NA NA 11.91 10.31 1.84 090 

50526 .... ............ A ........ Repair renal-abdomen fistula ............. 26.13 NA NA 8.14 9.00 1.97 090 

50540 .... ............ A ........ Revision of horseshoe kidney ............ 20.95 NA NA 10.74 9.56 1.36 090 

50541 .... ............ A ........ Laparo ablate renal cyst ..................... 16.76 NA NA 8.81 7.66 1.13 090 

50542 .... ............ A ........ Laparo ablate renal mass ................... 21.18 NA NA 11.32 9.73 1.39 090 

50543 .... ............ A ........ Laparo partial nephrectomy ................ 27.18 NA NA 14.27 12.25 1.81 090 

50544 .... ............ A ........ Laparoscopy, pyeloplasty ................... 23.27 NA NA 11.59 10.07 1.58 090 

50545 .... ............ A ........ Laparo radical nephrectomy ............... 24.93 NA NA 12.31 10.78 1.71 090 

50546 .... ............ A ........ Laparoscopic nephrectomy ................ 21.69 NA NA 11.42 9.91 1.57 090 

50547 .... ............ A ........ Laparo removal donor kidney ............. 26.24 NA NA 12.54 11.85 2.77 090 

50548 .... ............ A ........ Laparo remove w/ureter ..................... 25.26 NA NA 12.29 10.76 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 4.62 4.38 2.69 2.33 0.40 000 

50553 .... ............ A ........ Kidney endoscopy .............................. 5.98 4.51 4.40 2.66 2.39 0.39 000 

50555 .... ............ A ........ Kidney endoscopy & biopsy ............... 6.52 5.13 4.97 3.07 2.70 0.45 000 

50557 .... ............ A ........ Kidney endoscopy & treatment .......... 6.61 5.30 4.94 3.12 2.71 0.47 000 

50561 .... ............ A ........ Kidney endoscopy & treatment .......... 7.58 5.84 5.45 3.46 3.05 0.54 000 

50562 .... ............ A ........ Renal scope w/tumor resect ............... 10.90 NA NA 5.43 4.88 0.73 090 

50570 .... ............ A ........ Kidney endoscopy .............................. 9.53 NA NA 4.21 3.73 0.68 000 

50572 .... ............ A ........ Kidney endoscopy .............................. 10.33 NA NA 4.38 3.99 0.85 000 

50574 .... ............ A ........ Kidney endoscopy & biopsy ............... 11.00 NA NA 4.87 4.30 0.77 000 

50575 .... ............ A ........ Kidney endoscopy .............................. 13.96 NA NA 6.05 5.36 0.99 000 

50576 .... ............ A ........ Kidney endoscopy & treatment .......... 10.97 NA NA 4.85 4.27 0.78 000 

50580 .... ............ A ........ Kidney endoscopy & treatment .......... 11.84 NA NA 5.17 4.58 0.83 000 

50590 .... ............ A ........ Fragmenting of kidney stone .............. 9.64 17.08 14.76 6.18 5.16 0.65 090 

50592 .... ............ A ........ Perc rf ablate renal tumor .................. 6.77 74.72 111.68 3.03 2.94 0.43 010 

50600 .... ............ A ........ Exploration of ureter ........................... 17.04 NA NA 8.60 7.65 1.13 090 

mstockstill on PROD1PC66 with PROPOSALS2

38289 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

50605 .... ............ A ........ Insert ureteral support ........................ 16.66 NA NA 7.94 7.35 1.45 090 

50610 .... ............ A ........ Removal of ureter stone ..................... 17.12 NA NA 9.01 8.02 1.43 090 

50620 .... ............ A ........ Removal of ureter stone ..................... 16.30 NA NA 8.98 7.67 1.07 090 

50630 .... ............ A ........ Removal of ureter stone ..................... 16.08 NA NA 8.24 7.28 1.09 090 

50650 .... ............ A ........ Removal of ureter ............................... 18.67 NA NA 10.11 8.69 1.23 090 

50660 .... ............ A ........ Removal of ureter ............................... 20.87 NA NA 10.85 9.42 1.38 090 

50684 .... ............ A ........ Injection for ureter x-ray ..................... 0.76 3.94 4.47 0.63 0.55 0.05 000 

50686 .... ............ A ........ Measure ureter pressure .................... 1.51 2.28 2.82 0.82 0.80 0.11 000 

50688 .... ............ A ........ Change of ureter tube/stent ............... 1.18 NA NA 0.95 0.99 0.07 010 

50690 .... ............ A ........ Injection for ureter x-ray ..................... 1.16 1.45 1.62 0.75 0.72 0.07 000 

50700 .... ............ A ........ Revision of ureter ............................... 16.54 NA NA 8.86 7.91 1.27 090 

50715 .... ............ A ........ Release of ureter ................................ 20.49 NA NA 8.63 8.70 2.14 090 

50722 .... ............ A ........ Release of ureter ................................ 17.80 NA NA 7.32 7.68 1.91 090 

50725 .... ............ A ........ Release/revise ureter ......................... 20.05 NA NA 8.89 8.61 1.52 090 

50727 .... ............ A ........ Revise ureter ...................................... 8.17 NA NA 5.76 5.02 0.61 090 

50728 .... ............ A ........ Revise ureter ...................................... 12.00 NA NA 6.79 6.25 1.00 090 

50740 .... ............ A ........ Fusion of ureter & kidney ................... 19.92 NA NA 8.99 8.38 1.97 090 

50750 .... ............ A ........ Fusion of ureter & kidney ................... 21.07 NA NA 11.22 9.38 1.38 090 

50760 .... ............ A ........ Fusion of ureters ................................ 19.92 NA NA 9.98 8.81 1.55 090 

50770 .... ............ A ........ Splicing of ureters ............................... 21.07 NA NA 11.01 9.46 1.45 090 

50780 .... ............ A ........ Reimplant ureter in bladder ................ 19.80 NA NA 10.22 8.91 1.51 090 

50782 .... ............ A ........ Reimplant ureter in bladder ................ 19.51 NA NA 10.19 9.20 1.61 090 

50783 .... ............ A ........ Reimplant ureter in bladder ................ 20.52 NA NA 10.31 9.23 1.99 090 

50785 .... ............ A ........ Reimplant ureter in bladder ................ 22.08 NA NA 11.33 9.81 1.45 090 

50800 .... ............ A ........ Implant ureter in bowel ....................... 16.23 NA NA 9.25 7.88 1.19 090 

50810 .... ............ A ........ Fusion of ureter & bowel .................... 22.38 NA NA 10.64 9.69 2.32 090 

50815 .... ............ A ........ Urine shunt to intestine ...................... 22.06 NA NA 11.59 10.04 1.54 090 

50820 .... ............ A ........ Construct bowel bladder ..................... 23.89 NA NA 11.97 10.33 1.90 090 

50825 .... ............ A ........ Construct bowel bladder ..................... 30.48 NA NA 15.08 13.13 2.08 090 

50830 .... ............ A ........ Revise urine flow ................................ 33.57 NA NA 15.78 14.03 2.38 090 

50840 .... ............ A ........ Replace ureter by bowel .................... 22.19 NA NA 12.06 10.25 1.47 090 

50845 .... ............ A ........ Appendico-vesicostomy ...................... 22.21 NA NA 12.35 10.66 1.57 090 

50860 .... ............ A ........ Transplant ureter to skin .................... 16.93 NA NA 9.31 7.94 1.29 090 

50900 .... ............ A ........ Repair of ureter .................................. 14.89 NA NA 8.06 7.11 1.14 090 

50920 .... ............ A ........ Closure ureter/skin fistula ................... 15.66 NA NA 8.60 7.57 1.01 090 

50930 .... ............ A ........ Closure ureter/bowel fistula ................ 20.04 NA NA 9.56 8.90 1.28 090 

50940 .... ............ A ........ Release of ureter ................................ 15.78 NA NA 7.85 7.20 1.26 090 

50945 .... ............ A ........ Laparoscopy ureterolithotomy ............ 17.87 NA NA 9.40 8.13 1.36 090 

50947 .... ............ A ........ Laparo new ureter/bladder ................. 25.63 NA NA 12.42 11.09 2.17 090 

50948 .... ............ A ........ Laparo new ureter/bladder ................. 23.69 NA NA 11.31 10.14 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 4.85 4.58 2.80 2.43 0.41 000 

50953 .... ............ A ........ Endoscopy of ureter ........................... 6.23 4.95 4.69 3.25 2.82 0.43 000 

50955 .... ............ A ........ Ureter endoscopy & biopsy ................ 6.74 5.17 5.80 3.49 3.09 0.48 000 

50957 .... ............ A ........ Ureter endoscopy & treatment ........... 6.78 5.41 4.98 3.19 2.78 0.48 000 

50961 .... ............ A ........ Ureter endoscopy & treatment ........... 6.04 4.77 4.57 2.82 2.49 0.41 000 

50970 .... ............ A ........ Ureter endoscopy ............................... 7.13 NA NA 3.29 2.88 0.52 000 

50972 .... ............ A ........ Ureter endoscopy & catheter ............. 6.88 NA NA 3.10 2.77 0.49 000 

50974 .... ............ A ........ Ureter endoscopy & biopsy ................ 9.16 NA NA 3.82 3.49 0.64 000 

50976 .... ............ A ........ Ureter endoscopy & treatment ........... 9.03 NA NA 3.91 3.45 0.66 000 

50980 .... ............ A ........ Ureter endoscopy & treatment ........... 6.84 NA NA 3.17 2.76 0.48 000 

51000 .... ............ A ........ Drainage of bladder ............................ 0.78 0.92 1.43 0.27 0.26 0.05 000 

51005 .... ............ A ........ Drainage of bladder ............................ 1.02 2.40 3.55 0.35 0.34 0.10 000 

51010 .... ............ A ........ Drainage of bladder ............................ 4.27 4.75 5.18 2.39 2.13 0.28 010 

51020 .... ............ A ........ Incise & treat bladder ......................... 7.56 NA NA 5.42 4.63 0.47 090 

51030 .... ............ A ........ Incise & treat bladder ......................... 7.68 NA NA 4.78 4.39 0.58 090 

51040 .... ............ A ........ Incise & drain bladder ........................ 4.43 NA NA 3.71 3.24 0.31 090 

51045 .... ............ A ........ Incise bladder/drain ureter .................. 7.68 NA NA 5.18 4.57 0.52 090 

51050 .... ............ A ........ Removal of bladder stone .................. 7.87 NA NA 5.37 4.52 0.49 090 

51060 .... ............ A ........ Removal of ureter stone ..................... 9.82 NA NA 6.48 5.49 0.62 090 

51065 .... ............ A ........ Remove ureter calculus ...................... 9.82 NA NA 6.30 5.35 0.63 090 

51080 .... ............ A ........ Drainage of bladder abscess ............. 6.61 NA NA 4.67 4.04 0.43 090 

51500 .... ............ A ........ Removal of bladder cyst ..................... 10.92 NA NA 5.76 5.40 1.03 090 

51520 .... ............ A ........ Removal of bladder lesion .................. 10.08 NA NA 6.37 5.56 0.69 090 

51525 .... ............ A ........ Removal of bladder lesion .................. 15.29 NA NA 8.56 7.37 0.99 090 

51530 .... ............ A ........ Removal of bladder lesion .................. 13.58 NA NA 7.45 6.58 1.05 090 

51535 .... ............ A ........ Repair of ureter lesion ........................ 13.77 NA NA 7.43 6.80 1.23 090 

51550 .... ............ A ........ Partial removal of bladder .................. 17.10 NA NA 8.79 7.79 1.31 090 

51555 .... ............ A ........ Partial removal of bladder .................. 23.03 NA NA 11.48 10.09 1.70 090 

51565 .... ............ A ........ Revise bladder & ureter(s) ................. 23.50 NA NA 12.26 10.60 1.63 090 

51570 .... ............ A ........ Removal of bladder ............................ 27.31 NA NA 13.65 11.68 1.72 090 

51575 .... ............ A ........ Removal of bladder & nodes .............. 34.00 NA NA 16.66 14.40 2.17 090 

mstockstill on PROD1PC66 with PROPOSALS2

38290 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

51580 .... ............ A ........ Remove bladder/revise tract .............. 35.14 NA NA 17.81 15.16 2.25 090 

51585 .... ............ A ........ Removal of bladder & nodes .............. 39.41 NA NA 19.51 16.67 2.49 090 

51590 .... ............ A ........ Remove bladder/revise tract .............. 36.15 NA NA 17.48 15.08 2.28 090 

51595 .... ............ A ........ Remove bladder/revise tract .............. 41.12 NA NA 19.85 17.02 2.60 090 

51596 .... ............ A ........ Remove bladder/create pouch ........... 44.01 NA NA 21.49 18.38 2.78 090 

51597 .... ............ A ........ Removal of pelvic structures .............. 42.61 NA NA 20.44 17.62 2.82 090 

51600 .... ............ A ........ Injection for bladder x-ray ................... 0.88 4.21 4.61 0.33 0.30 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 2.09 0.71 0.65 0.07 000 

51700 .... ............ A ........ Irrigation of bladder ............................ 0.88 1.50 1.55 0.35 0.32 0.06 000 

51701 .... ............ A ........ Insert bladder catheter ....................... 0.50 1.03 1.31 0.25 0.22 0.04 000 

51702 .... ............ A ........ Insert temp bladder cath .................... 0.50 1.52 1.80 0.34 0.29 0.04 000 

51703 .... ............ A ........ Insert bladder cath, complex .............. 1.47 2.26 2.50 0.81 0.69 0.10 000 

51705 .... ............ A ........ Change of bladder tube ...................... 1.03 2.02 2.15 0.85 0.73 0.07 010 

51710 .... ............ A ........ Change of bladder tube ...................... 1.50 2.72 3.03 1.18 0.98 0.11 010 

51715 .... ............ A ........ Endoscopic injection/implant .............. 3.73 4.42 4.17 1.75 1.56 0.29 000 

51720 .... ............ A ........ Treatment of bladder lesion ............... 1.50 1.62 1.69 0.75 0.72 0.14 000 

51725 .... ............ A ........ Simple cystometrogram ...................... 1.51 4.22 4.91 4.22 4.91 0.16 000 

51725 .... 26 ....... A ........ Simple cystometrogram ...................... 1.51 0.56 0.53 0.56 0.53 0.12 000 

51725 .... TC ...... A ........ Simple cystometrogram ...................... 0.00 3.66 4.39 3.66 4.39 0.04 000 

51726 .... ............ A ........ Complex cystometrogram ................... 1.71 7.08 7.30 7.08 7.30 0.18 000 

51726 .... 26 ....... A ........ Complex cystometrogram ................... 1.71 0.65 0.61 0.65 0.61 0.13 000 

51726 .... TC ...... A ........ Complex cystometrogram ................... 0.00 6.43 6.69 6.43 6.69 0.05 000 

51736 .... ............ A ........ Urine flow measurement .................... 0.61 0.94 0.76 0.94 0.76 0.06 000 

51736 .... 26 ....... A ........ Urine flow measurement .................... 0.61 0.24 0.22 0.24 0.22 0.05 000 

51736 .... TC ...... A ........ Urine flow measurement .................... 0.00 0.70 0.54 0.70 0.54 0.01 000 

51741 .... ............ A ........ Electro-uroflowmetry, first ................... 1.14 1.28 1.03 1.28 1.03 0.11 000 

51741 .... 26 ....... A ........ Electro-uroflowmetry, first ................... 1.14 0.45 0.41 0.45 0.41 0.09 000 

51741 .... TC ...... A ........ Electro-uroflowmetry, first ................... 0.00 0.82 0.62 0.82 0.62 0.02 000 

51772 .... ............ A ........ Urethra pressure profile ...................... 1.61 5.03 5.30 5.03 5.30 0.20 000 

51772 .... 26 ....... A ........ Urethra pressure profile ...................... 1.61 0.55 0.55 0.55 0.55 0.15 000 

51772 .... TC ...... A ........ Urethra pressure profile ...................... 0.00 4.48 4.75 4.48 4.75 0.05 000 

51784 .... ............ A ........ Anal/urinary muscle study .................. 1.53 4.11 4.00 4.11 4.00 0.16 000 

51784 .... 26 ....... A ........ Anal/urinary muscle study .................. 1.53 0.57 0.53 0.57 0.53 0.12 000 

51784 .... TC ...... A ........ Anal/urinary muscle study .................. 0.00 3.54 3.47 3.54 3.47 0.04 000 

51785 .... ............ A ........ Anal/urinary muscle study .................. 1.53 4.54 4.49 4.54 4.49 0.15 000 

51785 .... 26 ....... A ........ Anal/urinary muscle study .................. 1.53 0.57 0.54 0.57 0.54 0.11 000 

51785 .... TC ...... A ........ Anal/urinary muscle study .................. 0.00 3.97 3.95 3.97 3.95 0.04 000 

51792 .... ............ A ........ Urinary reflex study ............................ 1.10 5.07 5.52 5.07 5.52 0.20 000 

51792 .... 26 ....... A ........ Urinary reflex study ............................ 1.10 0.40 0.41 0.40 0.41 0.07 000 

51792 .... TC ...... A ........ Urinary reflex study ............................ 0.00 4.67 5.11 4.67 5.11 0.13 000 

51795 .... ............ A ........ Urine voiding pressure study .............. 1.53 6.69 7.00 6.69 7.00 0.22 000 

51795 .... 26 ....... A ........ Urine voiding pressure study .............. 1.53 0.58 0.54 0.58 0.54 0.12 000 

51795 .... TC ...... A ........ Urine voiding pressure study .............. 0.00 6.11 6.46 6.11 6.46 0.10 000 

51797 .... ............ A ........ Intraabdominal pressure test .............. 1.60 4.82 5.31 4.82 5.31 0.17 000 

51797 .... 26 ....... A ........ Intraabdominal pressure test .............. 1.60 0.60 0.57 0.60 0.57 0.12 000 

51797 .... TC ...... A ........ Intraabdominal pressure test .............. 0.00 4.22 4.74 4.22 4.74 0.05 000 

51798 .... ............ A ........ Us urine capacity measure ................. 0.00 0.59 0.46 NA NA 0.08 XXX 

51800 .... ............ A ........ Revision of bladder/urethra ................ 18.74 NA NA 9.83 8.76 1.32 090 

51820 .... ............ A ........ Revision of urinary tract ..................... 19.41 NA NA 9.75 9.16 1.75 090 

51840 .... ............ A ........ Attach bladder/urethra ........................ 11.28 NA NA 5.80 5.68 1.06 090 

51841 .... ............ A ........ Attach bladder/urethra ........................ 13.60 NA NA 6.95 6.65 1.24 090 

51845 .... ............ A ........ Repair bladder neck ........................... 10.07 NA NA 5.94 5.34 0.79 090 

51860 .... ............ A ........ Repair of bladder wound .................... 12.49 NA NA 6.76 6.27 1.16 090 

51865 .... ............ A ........ Repair of bladder wound .................... 15.69 NA NA 8.41 7.56 1.23 090 

51880 .... ............ A ........ Repair of bladder opening .................. 7.81 NA NA 4.75 4.35 0.72 090 

51900 .... ............ A ........ Repair bladder/vagina lesion .............. 14.48 NA NA 8.07 7.07 1.21 090 

51920 .... ............ A ........ Close bladder-uterus fistula ................ 13.26 NA NA 8.12 6.83 1.18 090 

51925 .... ............ A ........ Hysterectomy/bladder repair .............. 17.35 NA NA 11.93 10.01 2.04 090 

51940 .... ............ A ........ Correction of bladder defect ............... 30.48 NA NA 11.80 11.89 2.15 090 

51960 .... ............ A ........ Revision of bladder & bowel .............. 25.20 NA NA 13.02 11.37 1.63 090 

51980 .... ............ A ........ Construct bladder opening ................. 12.44 NA NA 7.12 6.29 0.86 090 

51990 .... ............ A ........ Laparo urethral suspension ................ 13.26 NA NA 5.97 6.06 1.39 090 

51992 .... ............ A ........ Laparo sling operation ........................ 14.77 NA NA 6.57 6.40 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 3.49 1.33 1.05 0.14 000 

52001 .... ............ A ........ Cystoscopy, removal of clots ............. 5.44 5.07 5.08 2.60 2.24 0.39 000 

52005 .... ............ A ........ Cystoscopy & ureter catheter ............. 2.37 5.72 5.65 1.38 1.14 0.17 000 

52007 .... ............ A ........ Cystoscopy and biopsy ...................... 3.02 10.67 13.56 1.63 1.40 0.22 000 

52010 .... ............ A ........ Cystoscopy & duct catheter ............... 3.02 8.02 9.41 1.63 1.40 0.21 000 

52204 .... ............ A ........ Cystoscopy w/biopsy(s) ...................... 2.59 8.28 11.41 1.39 1.15 0.17 000 

52214 .... ............ A ........ Cystoscopy and treatment .................. 3.70 19.80 28.97 1.85 1.60 0.26 000 

mstockstill on PROD1PC66 with PROPOSALS2

38291 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

52224 .... ............ A ........ Cystoscopy and treatment .................. 3.14 18.98 27.73 1.62 1.39 0.22 000 

52234 .... ............ A ........ Cystoscopy and treatment .................. 4.62 NA NA 2.30 1.99 0.33 000 

52235 .... ............ A ........ Cystoscopy and treatment .................. 5.44 NA NA 2.67 2.31 0.39 000 

52240 .... ............ A ........ Cystoscopy and treatment .................. 9.71 NA NA 4.41 3.87 0.69 000 

52250 .... ............ A ........ Cystoscopy and radiotracer ................ 4.49 NA NA 2.33 2.00 0.32 000 

52260 .... ............ A ........ Cystoscopy and treatment .................. 3.91 NA NA 1.96 1.70 0.28 000 

52265 .... ............ A ........ Cystoscopy and treatment .................. 2.94 7.47 10.44 1.48 1.31 0.22 000 

52270 .... ............ A ........ Cystoscopy & revise urethra .............. 3.36 7.01 9.03 1.76 1.51 0.24 000 

52275 .... ............ A ........ Cystoscopy & revise urethra .............. 4.69 9.28 12.43 2.30 1.99 0.33 000 

52276 .... ............ A ........ Cystoscopy and treatment .................. 4.99 NA NA 2.48 2.13 0.35 000 

52277 .... ............ A ........ Cystoscopy and treatment .................. 6.16 NA NA 2.94 2.58 0.44 000 

52281 .... ............ A ........ Cystoscopy and treatment .................. 2.80 5.28 6.19 1.56 1.33 0.20 000 

52282 .... ............ A ........ Cystoscopy, implant stent .................. 6.39 NA NA 3.00 2.63 0.45 000 

52283 .... ............ A ........ Cystoscopy and treatment .................. 3.73 4.08 4.02 1.89 1.64 0.26 000 

52285 .... ............ A ........ Cystoscopy and treatment .................. 3.60 4.33 4.18 1.85 1.60 0.26 000 

52290 .... ............ A ........ Cystoscopy and treatment .................. 4.58 NA NA 2.29 1.98 0.32 000 

52300 .... ............ A ........ Cystoscopy and treatment .................. 5.30 NA NA 2.59 2.26 0.38 000 

52301 .... ............ A ........ Cystoscopy and treatment .................. 5.50 NA NA 2.72 2.26 0.46 000 

52305 .... ............ A ........ Cystoscopy and treatment .................. 5.30 NA NA 2.52 2.19 0.38 000 

52310 .... ............ A ........ Cystoscopy and treatment .................. 2.81 4.01 4.36 1.45 1.24 0.20 000 

52315 .... ............ A ........ Cystoscopy and treatment .................. 5.20 6.63 7.66 2.50 2.17 0.37 000 

52317 .... ............ A ........ Remove bladder stone ....................... 6.71 17.02 23.00 3.04 2.67 0.48 000 

52318 .... ............ A ........ Remove bladder stone ....................... 9.18 NA NA 4.10 3.61 0.65 000 

52320 .... ............ A ........ Cystoscopy and treatment .................. 4.69 NA NA 2.24 1.94 0.33 000 

52325 .... ............ A ........ Cystoscopy, stone removal ................ 6.15 NA NA 2.82 2.48 0.44 000 

52327 .... ............ A ........ Cystoscopy, inject material ................. 5.18 18.03 24.89 2.41 2.11 0.37 000 

52330 .... ............ A ........ Cystoscopy and treatment .................. 5.03 20.33 29.60 2.38 2.07 0.36 000 

52332 .... ............ A ........ Cystoscopy and treatment .................. 2.83 12.37 9.07 1.57 1.32 0.21 000 

52334 .... ............ A ........ Create passage to kidney .................. 4.82 NA NA 2.36 2.05 0.35 000 

52341 .... ............ A ........ Cysto w/ureter stricture tx .................. 6.11 NA NA 3.08 2.65 0.43 000 

52342 .... ............ A ........ Cysto w/up stricture tx ........................ 6.61 NA NA 3.30 2.83 0.46 000 

52343 .... ............ A ........ Cysto w/renal stricture tx .................... 7.31 NA NA 3.53 3.07 0.51 000 

52344 .... ............ A ........ Cysto/uretero, stricture tx ................... 7.81 NA NA 3.95 3.38 0.55 000 

52345 .... ............ A ........ Cysto/uretero w/up stricture ............... 8.31 NA NA 4.16 3.57 0.58 000 

52346 .... ............ A ........ Cystouretero w/renal strict .................. 9.34 NA NA 4.57 3.94 0.65 000 

52351 .... ............ A ........ Cystouretero & or pyeloscope ............ 5.85 NA NA 2.99 2.57 0.41 000 

52352 .... ............ A ........ Cystouretero w/stone remove ............ 6.87 NA NA 3.51 3.02 0.49 000 

52353 .... ............ A ........ Cystouretero w/lithotripsy ................... 7.96 NA NA 3.95 3.41 0.57 000 

52354 .... ............ A ........ Cystouretero w/biopsy ........................ 7.33 NA NA 3.69 3.19 0.52 000 

52355 .... ............ A ........ Cystouretero w/excise tumor .............. 8.81 NA NA 4.30 3.73 0.63 000 

52400 .... ............ A ........ Cystouretero w/congen repr ............... 10.06 NA NA 5.45 4.60 0.68 090 

52402 .... ............ A ........ Cystourethro cut ejacul duct ............... 5.27 NA NA 2.19 1.96 0.40 000 

52450 .... ............ A ........ Incision of prostate ............................. 7.63 NA NA 5.52 4.61 0.54 090 

52500 .... ............ A ........ Revision of bladder neck .................... 9.39 NA NA 6.23 5.09 0.60 090 

52510 .... ............ A ........ Dilation prostatic urethra .................... 7.49 NA NA 4.94 4.03 0.48 090 

52601 .... ............ A ........ Prostatectomy (TURP) ....................... 15.13 NA NA 8.52 6.83 0.87 090 

52606 .... ............ A ........ Control postop bleeding ..................... 8.84 NA NA 5.53 4.56 0.57 090 

52612 .... ............ A ........ Prostatectomy, first stage ................... 9.07 NA NA 5.93 4.84 0.56 090 

52614 .... ............ A ........ Prostatectomy, second stage ............. 7.81 NA NA 5.41 4.39 0.48 090 

52620 .... ............ A ........ Remove residual prostate .................. 7.19 NA NA 4.66 3.83 0.47 090 

52630 .... ............ A ........ Remove prostate regrowth ................. 7.65 NA NA 4.84 4.03 0.51 090 

52640 .... ............ A ........ Relieve bladder contracture ............... 6.89 NA NA 4.45 3.72 0.47 090 

52647 .... ............ A ........ Laser surgery of prostate ................... 11.15 41.80 57.91 6.96 5.76 0.73 090 

52648 .... ............ A ........ Laser surgery of prostate ................... 12.00 42.34 58.18 7.29 6.06 0.79 090 

52700 .... ............ A ........ Drainage of prostate abscess ............ 7.39 NA NA 4.94 4.08 0.48 090 

53000 .... ............ A ........ Incision of urethra ............................... 2.30 NA NA 1.78 1.67 0.16 010 

53010 .... ............ A ........ Incision of urethra ............................... 4.35 NA NA 3.85 3.38 0.24 090 

53020 .... ............ A ........ Incision of urethra ............................... 1.77 NA NA 0.96 0.82 0.13 000 

53025 .... ............ A ........ Incision of urethra ............................... 1.13 NA NA 0.82 0.67 0.08 000 

53040 .... ............ A ........ Drainage of urethra abscess .............. 6.49 NA NA 4.43 3.94 0.45 090 

53060 .... ............ A ........ Drainage of urethra abscess .............. 2.65 2.10 2.07 1.55 1.44 0.28 010 

53080 .... ............ A ........ Drainage of urinary leakage ............... 6.82 NA NA 5.00 5.47 0.52 090 

53085 .... ............ A ........ Drainage of urinary leakage ............... 11.05 NA NA 4.43 5.94 0.92 090 

53200 .... ............ A ........ Biopsy of urethra ................................ 2.59 1.71 1.52 1.31 1.15 0.20 000 

53210 .... ............ A ........ Removal of urethra ............................. 13.59 NA NA 7.76 6.81 0.89 090 

53215 .... ............ A ........ Removal of urethra ............................. 16.72 NA NA 9.23 7.94 1.10 090 

53220 .... ............ A ........ Treatment of urethra lesion ................ 7.53 NA NA 5.03 4.38 0.49 090 

53230 .... ............ A ........ Removal of urethra lesion .................. 10.31 NA NA 6.43 5.59 0.73 090 

53235 .... ............ A ........ Removal of urethra lesion .................. 10.86 NA NA 6.97 5.95 0.72 090 

53240 .... ............ A ........ Surgery for urethra pouch .................. 6.98 NA NA 4.90 4.20 0.52 090 

53250 .... ............ A ........ Removal of urethra gland ................... 6.42 NA NA 4.41 3.91 0.49 090 

53260 .... ............ A ........ Treatment of urethra lesion ................ 3.00 2.46 2.35 1.85 1.64 0.25 010 

mstockstill on PROD1PC66 with PROPOSALS2

38292 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

53265 .... ............ A ........ Treatment of urethra lesion ................ 3.14 2.95 2.84 2.00 1.71 0.24 010 

53270 .... ............ A ........ Removal of urethra gland ................... 3.11 2.47 2.31 1.86 1.68 0.30 010 

53275 .... ............ A ........ Repair of urethra defect ..................... 4.54 NA NA 2.79 2.52 0.32 010 

53400 .... ............ A ........ Revise urethra, stage 1 ...................... 13.98 NA NA 8.28 7.15 0.98 090 

53405 .... ............ A ........ Revise urethra, stage 2 ...................... 15.51 NA NA 8.78 7.59 1.10 090 

53410 .... ............ A ........ Reconstruction of urethra ................... 17.53 NA NA 9.77 8.44 1.16 090 

53415 .... ............ A ........ Reconstruction of urethra ................... 20.55 NA NA 10.88 9.15 1.37 090 

53420 .... ............ A ........ Reconstruct urethra, stage 1 .............. 15.04 NA NA 7.07 6.60 0.96 090 

53425 .... ............ A ........ Reconstruct urethra, stage 2 .............. 16.94 NA NA 9.10 8.05 1.13 090 

53430 .... ............ A ........ Reconstruction of urethra ................... 17.30 NA NA 8.92 7.94 1.15 090 

53431 .... ............ A ........ Reconstruct urethra/bladder ............... 21.03 NA NA 11.11 9.60 1.41 090 

53440 .... ............ A ........ Male sling procedure .......................... 15.34 NA NA 9.27 7.64 0.96 090 

53442 .... ............ A ........ Remove/revise male sling .................. 13.29 NA NA 8.43 6.95 0.82 090 

53444 .... ............ A ........ Insert tandem cuff ............................... 14.06 NA NA 8.11 7.00 0.94 090 

53445 .... ............ A ........ Insert uro/ves nck sphincter ............... 15.21 NA NA 8.85 7.98 0.99 090 

53446 .... ............ A ........ Remove uro sphincter ........................ 10.89 NA NA 7.06 6.15 0.72 090 

53447 .... ............ A ........ Remove/replace ur sphincter ............. 14.15 NA NA 8.46 7.46 0.95 090 

53448 .... ............ A ........ Remov/replc ur sphinctr comp ........... 23.26 NA NA 12.47 10.79 1.50 090 

53449 .... ............ A ........ Repair uro sphincter ........................... 10.43 NA NA 6.67 5.71 0.68 090 

53450 .... ............ A ........ Revision of urethra ............................. 6.67 NA NA 4.79 4.05 0.43 090 

53460 .... ............ A ........ Revision of urethra ............................. 7.65 NA NA 5.08 4.41 0.50 090 

53500 .... ............ A ........ Urethrlys, transvag w/ scope .............. 12.87 NA NA 7.49 6.85 0.90 090 

53502 .... ............ A ........ Repair of urethra injury ....................... 8.16 NA NA 5.11 4.54 0.62 090 

53505 .... ............ A ........ Repair of urethra injury ....................... 8.16 NA NA 5.42 4.65 0.54 090 

53510 .... ............ A ........ Repair of urethra injury ....................... 10.83 NA NA 6.88 6.01 0.74 090 

53515 .... ............ A ........ Repair of urethra injury ....................... 14.09 NA NA 8.04 6.97 1.05 090 

53520 .... ............ A ........ Repair of urethra defect ..................... 9.35 NA NA 6.25 5.36 0.61 090 

53600 .... ............ A ........ Dilate urethra stricture ........................ 1.21 1.16 1.15 0.58 0.51 0.09 000 

53601 .... ............ A ........ Dilate urethra stricture ........................ 0.98 1.36 1.32 0.52 0.45 0.07 000 

53605 .... ............ A ........ Dilate urethra stricture ........................ 1.28 NA NA 0.52 0.47 0.09 000 

53620 .... ............ A ........ Dilate urethra stricture ........................ 1.62 1.70 1.85 0.84 0.72 0.11 000 

53621 .... ............ A ........ Dilate urethra stricture ........................ 1.35 1.81 1.94 0.68 0.59 0.10 000 

53660 .... ............ A ........ Dilation of urethra ............................... 0.71 1.32 1.31 0.46 0.39 0.05 000 

53661 .... ............ A ........ Dilation of urethra ............................... 0.72 1.29 1.30 0.42 0.36 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 49.02 71.59 5.93 4.95 0.67 090 

53852 .... ............ A ........ Prostatic rf thermotx ........................... 10.68 46.18 67.53 6.72 5.56 0.70 090 

53853 .... ............ A ........ Prostatic water thermother ................. 5.54 28.96 42.18 4.37 3.62 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 2.70 2.81 1.49 1.21 0.11 010 

54001 .... ............ A ........ Slitting of prepuce ............................... 2.21 3.06 3.12 1.68 1.40 0.15 010 

54015 .... ............ A ........ Drain penis lesion ............................... 5.33 NA NA 3.24 2.89 0.38 010 

54050 .... ............ A ........ Destruction, penis lesion(s) ................ 1.26 2.09 1.88 1.40 1.21 0.08 010 

54055 .... ............ A ........ Destruction, penis lesion(s) ................ 1.23 1.97 1.78 1.24 1.03 0.08 010 

54056 .... ............ A ........ Cryosurgery, penis lesion(s) ............... 1.26 2.37 2.03 1.54 1.33 0.06 010 

54057 .... ............ A ........ Laser surg, penis lesion(s) ................. 1.26 2.62 2.41 1.37 1.10 0.09 010 

54060 .... ............ A ........ Excision of penis lesion(s) .................. 1.95 3.09 3.10 1.64 1.35 0.13 010 

54065 .... ............ A ........ Destruction, penis lesion(s) ................ 2.44 3.30 2.97 2.01 1.62 0.13 010 

54100 .... ............ A ........ Biopsy of penis ................................... 1.90 3.35 3.08 1.38 1.10 0.10 000 

54105 .... ............ A ........ Biopsy of penis ................................... 3.51 3.98 4.14 2.45 2.20 0.25 010 

54110 .... ............ A ........ Treatment of penis lesion ................... 10.79 NA NA 6.78 5.75 0.72 090 

54111 .... ............ A ........ Treat penis lesion, graft ...................... 14.29 NA NA 8.12 6.96 0.96 090 

54112 .... ............ A ........ Treat penis lesion, graft ...................... 16.83 NA NA 9.41 8.12 1.11 090 

54115 .... ............ A ........ Treatment of penis lesion ................... 6.82 5.78 5.09 4.97 4.23 0.43 090 

54120 .... ............ A ........ Partial removal of penis ...................... 10.88 NA NA 6.79 5.75 0.68 090 

54125 .... ............ A ........ Removal of penis ................................ 14.43 NA NA 8.16 7.02 0.95 090 

54130 .... ............ A ........ Remove penis & nodes ...................... 21.66 NA NA 11.72 9.92 1.52 090 

54135 .... ............ A ........ Remove penis & nodes ...................... 27.99 NA NA 14.29 12.26 1.88 090 

54150 .... ............ A ........ Circumcision w/regionl block .............. 1.90 2.40 3.38 0.75 0.73 0.16 000 

54160 .... ............ A ........ Circumcision, neonate ........................ 2.50 3.80 3.95 1.49 1.29 0.19 010 

54161 .... ............ A ........ Circum 28 days or older ..................... 3.29 NA NA 2.22 1.89 0.23 010 

54162 .... ............ A ........ Lysis penil circumic lesion .................. 3.27 4.01 4.33 2.28 1.86 0.21 010 

54163 .... ............ A ........ Repair of circumcision ........................ 3.27 NA NA 2.86 2.44 0.21 010 

54164 .... ............ A ........ Frenulotomy of penis .......................... 2.77 NA NA 2.66 2.25 0.18 010 

54200 .... ............ A ........ Treatment of penis lesion ................... 1.08 2.01 1.90 1.31 1.14 0.08 010 

54205 .... ............ A ........ Treatment of penis lesion ................... 8.84 NA NA 6.10 5.41 0.56 090 

54220 .... ............ A ........ Treatment of penis lesion ................... 2.42 3.32 3.59 1.36 1.16 0.17 000 

54230 .... ............ A ........ Prepare penis study ........................... 1.34 1.41 1.24 0.91 0.77 0.09 000 

54231 .... ............ A ........ Dynamic cavernosometry ................... 2.04 1.98 1.66 1.26 1.05 0.16 000 

54235 .... ............ A ........ Penile injection ................................... 1.19 1.39 1.18 0.90 0.74 0.08 000 

54240 .... ............ A ........ Penis study ......................................... 1.31 1.51 1.28 1.51 1.28 0.17 000 

54240 .... 26 ....... A ........ Penis study ......................................... 1.31 0.49 0.46 0.49 0.46 0.11 000 

mstockstill on PROD1PC66 with PROPOSALS2

38293 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

54240 .... TC ...... A ........ Penis study ......................................... 0.00 1.02 0.81 1.02 0.81 0.06 000 

54250 .... ............ A ........ Penis study ......................................... 2.22 1.23 1.08 1.23 1.08 0.18 000 

54250 .... 26 ....... A ........ Penis study ......................................... 2.22 0.87 0.80 0.87 0.80 0.16 000 

54250 .... TC ...... A ........ Penis study ......................................... 0.00 0.37 0.28 0.37 0.28 0.02 000 

54300 .... ............ A ........ Revision of penis ................................ 11.07 NA NA 6.76 6.18 0.76 090 

54304 .... ............ A ........ Revision of penis ................................ 13.15 NA NA 7.87 7.12 0.88 090 

54308 .... ............ A ........ Reconstruction of urethra ................... 12.49 NA NA 4.74 5.83 0.84 090 

54312 .... ............ A ........ Reconstruction of urethra ................... 14.36 NA NA 9.28 8.03 1.24 090 

54316 .... ............ A ........ Reconstruction of urethra ................... 17.90 NA NA 10.05 9.02 1.21 090 

54318 .... ............ A ........ Reconstruction of urethra ................... 12.28 NA NA 4.81 5.54 1.39 090 

54322 .... ............ A ........ Reconstruction of urethra ................... 13.85 NA NA 8.02 7.23 0.92 090 

54324 .... ............ A ........ Reconstruction of urethra ................... 17.40 NA NA 9.85 8.92 1.14 090 

54326 .... ............ A ........ Reconstruction of urethra ................... 16.87 NA NA 9.24 8.59 1.11 090 

54328 .... ............ A ........ Revise penis/urethra ........................... 16.74 NA NA 9.58 8.46 0.98 090 

54332 .... ............ A ........ Revise penis/urethra ........................... 18.22 NA NA 10.18 8.97 1.21 090 

54336 .... ............ A ........ Revise penis/urethra ........................... 21.44 NA NA 7.29 9.58 2.21 090 

54340 .... ............ A ........ Secondary urethral surgery ................ 9.58 NA NA 6.41 5.74 0.63 090 

54344 .... ............ A ........ Secondary urethral surgery ................ 16.91 NA NA 9.64 8.74 1.54 090 

54348 .... ............ A ........ Secondary urethral surgery ................ 18.17 NA NA 10.24 8.64 1.23 090 

54352 .... ............ A ........ Reconstruct urethra/penis .................. 25.95 NA NA 14.13 12.61 2.25 090 

54360 .... ............ A ........ Penis plastic surgery .......................... 12.65 NA NA 7.52 6.79 0.84 090 

54380 .... ............ A ........ Repair penis ....................................... 14.03 NA NA 8.04 6.93 0.93 090 

54385 .... ............ A ........ Repair penis ....................................... 16.38 NA NA 11.34 9.31 0.86 090 

54390 .... ............ A ........ Repair penis and bladder ................... 22.59 NA NA 7.40 8.40 1.54 090 

54400 .... ............ A ........ Insert semi-rigid prosthesis ................ 9.09 NA NA 5.80 5.08 0.64 090 

54401 .... ............ A ........ Insert self-contd prosthesis ................ 10.26 NA NA 8.20 6.97 0.73 090 

54405 .... ............ A ........ Insert multi-comp penis pros .............. 14.39 NA NA 8.20 7.07 0.95 090 

54406 .... ............ A ........ Remove muti-comp penis pros .......... 12.76 NA NA 7.68 6.57 0.86 090 

54408 .... ............ A ........ Repair multi-comp penis pros ............ 13.73 NA NA 8.32 7.03 0.90 090 

54410 .... ............ A ........ Remove/replace penis prosth ............. 16.48 NA NA 9.45 8.05 1.10 090 

54411 .... ............ A ........ Remov/replc penis pros, comp ........... 18.14 NA NA 10.51 8.79 1.13 090 

54415 .... ............ A ........ Remove self-contd penis pros ............ 8.75 NA NA 6.05 5.13 0.58 090 

54416 .... ............ A ........ Remv/repl penis contain pros ............. 11.87 NA NA 7.96 6.67 0.77 090 

54417 .... ............ A ........ Remv/replc penis pros, compl ............ 15.94 NA NA 9.19 7.70 1.00 090 

54420 .... ............ A ........ Revision of penis ................................ 12.26 NA NA 7.46 6.55 0.81 090 

54430 .... ............ A ........ Revision of penis ................................ 10.93 NA NA 7.04 6.07 0.72 090 

54435 .... ............ A ........ Revision of penis ................................ 6.71 NA NA 5.03 4.32 0.43 090 

54440 .... ............ C ........ Repair of penis ................................... 0.42 NA NA 0.00 0.00 0.00 090 

54450 .... ............ A ........ Preputial stretching ............................. 1.12 0.86 0.91 0.49 0.46 0.08 000 

54500 .... ............ A ........ Biopsy of testis ................................... 1.31 NA NA 0.77 0.67 0.10 000 

54505 .... ............ A ........ Biopsy of testis ................................... 3.47 NA NA 2.46 2.18 0.27 010 

54512 .... ............ A ........ Excise lesion testis ............................. 9.23 NA NA 5.72 4.93 0.67 090 

54520 .... ............ A ........ Removal of testis ................................ 5.25 NA NA 3.74 3.27 0.50 090 

54522 .... ............ A ........ Orchiectomy, partial ............................ 10.15 NA NA 5.59 5.26 0.89 090 

54530 .... ............ A ........ Removal of testis ................................ 9.31 NA NA 6.11 5.18 0.66 090 

54535 .... ............ A ........ Extensive testis surgery ..................... 13.06 NA NA 6.95 6.36 0.95 090 

54550 .... ............ A ........ Exploration for testis ........................... 8.31 NA NA 5.24 4.55 0.59 090 

54560 .... ............ A ........ Exploration for testis ........................... 11.97 NA NA 6.92 5.94 0.90 090 

54600 .... ............ A ........ Reduce testis torsion .......................... 7.54 NA NA 5.15 4.36 0.51 090 

54620 .... ............ A ........ Suspension of testis ........................... 5.16 NA NA 3.25 2.85 0.37 010 

54640 .... ............ A ........ Suspension of testis ........................... 7.57 NA NA 5.38 4.58 0.62 090 

54650 .... ............ A ........ Orchiopexy (Fowler-Stephens) ........... 12.24 NA NA 5.68 5.89 1.16 090 

54660 .... ............ A ........ Revision of testis ................................ 5.64 NA NA 4.37 3.70 0.44 090 

54670 .... ............ A ........ Repair testis injury .............................. 6.57 NA NA 4.81 4.18 0.47 090 

54680 .... ............ A ........ Relocation of testis(es) ....................... 13.91 NA NA 7.74 6.96 1.16 090 

54690 .... ............ A ........ Laparoscopy, orchiectomy .................. 11.60 NA NA 5.60 5.37 1.02 090 

54692 .... ............ A ........ Laparoscopy, orchiopexy .................... 13.64 NA NA 7.64 6.55 1.30 090 

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 2.39 2.16 0.28 010 

54800 .... ............ A ........ Biopsy of epididymis ........................... 2.33 NA NA 1.24 1.03 0.23 000 

54830 .... ............ A ........ Remove epididymis lesion .................. 5.91 NA NA 4.46 3.75 0.41 090 

54840 .... ............ A ........ Remove epididymis lesion .................. 5.22 NA NA 3.82 3.31 0.37 090 

54860 .... ............ A ........ Removal of epididymis ....................... 6.85 NA NA 4.91 4.12 0.45 090 

54861 .... ............ A ........ Removal of epididymis ....................... 9.57 NA NA 6.30 5.31 0.63 090 

54865 .... ............ A ........ Explore epididymis ............................. 5.67 NA NA 4.28 3.39 0.40 090 

54900 .... ............ A ........ Fusion of spermatic ducts .................. 14.05 NA NA 5.23 5.50 0.93 090 

54901 .... ............ A ........ Fusion of spermatic ducts .................. 18.92 NA NA 10.63 8.40 1.83 090 

55000 .... ............ A ........ Drainage of hydrocele ........................ 1.43 1.85 1.96 0.92 0.79 0.11 000 

55040 .... ............ A ........ Removal of hydrocele ......................... 5.39 NA NA 3.97 3.44 0.43 090 

55041 .... ............ A ........ Removal of hydroceles ....................... 8.41 NA NA 5.72 4.85 0.60 090 

55060 .... ............ A ........ Repair of hydrocele ............................ 6.05 NA NA 4.48 3.78 0.46 090 

55100 .... ............ A ........ Drainage of scrotum abscess ............. 2.40 3.49 3.58 2.11 1.84 0.17 010 

mstockstill on PROD1PC66 with PROPOSALS2

38294 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

55110 .... ............ A ........ Explore scrotum .................................. 6.23 NA NA 4.51 3.82 0.43 090 

55120 .... ............ A ........ Removal of scrotum lesion ................. 5.62 NA NA 4.23 3.60 0.39 090 

55150 .... ............ A ........ Removal of scrotum ........................... 8.01 NA NA 5.49 4.67 0.56 090 

55175 .... ............ A ........ Revision of scrotum ............................ 5.77 NA NA 4.36 3.69 0.37 090 

55180 .... ............ A ........ Revision of scrotum ............................ 11.63 NA NA 7.33 6.36 0.90 090 

55200 .... ............ A ........ Incision of sperm duct ........................ 4.50 7.99 10.19 3.34 2.87 0.33 090 

55250 .... ............ A ........ Removal of sperm duct(s) .................. 3.32 7.83 9.63 3.08 2.63 0.25 090 

55300 .... ............ A ........ Prepare, sperm duct x-ray .................. 3.50 NA NA 1.77 1.52 0.25 000 

55400 .... ............ A ........ Repair of sperm duct .......................... 8.53 NA NA 5.46 4.77 0.64 090 

55450 .... ............ A ........ Ligation of sperm duct ........................ 4.38 5.46 6.31 2.58 2.27 0.29 010 

55500 .... ............ A ........ Removal of hydrocele ......................... 6.12 NA NA 4.21 3.66 0.55 090 

55520 .... ............ A ........ Removal of sperm cord lesion ........... 6.56 NA NA 3.80 3.53 0.75 090 

55530 .... ............ A ........ Revise spermatic cord veins .............. 5.69 NA NA 4.11 3.57 0.45 090 

55535 .... ............ A ........ Revise spermatic cord veins .............. 7.09 NA NA 4.86 4.13 0.47 090 

55540 .... ............ A ........ Revise hernia & sperm veins ............. 8.20 NA NA 4.23 4.02 0.94 090 

55550 .... ............ A ........ Laparo ligate spermatic vein .............. 7.10 NA NA 4.57 3.94 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 4.94 4.14 0.62 090 

55605 .... ............ A ........ Incise sperm duct pouch .................... 8.63 NA NA 4.60 4.50 0.64 090 

55650 .... ............ A ........ Remove sperm duct pouch ................ 12.52 NA NA 7.47 6.35 0.92 090 

55680 .... ............ A ........ Remove sperm pouch lesion .............. 5.59 NA NA 3.95 3.45 0.47 090 

55700 .... ............ A ........ Biopsy of prostate ............................... 2.58 3.71 3.96 1.34 0.99 0.11 000 

55705 .... ............ A ........ Biopsy of prostate ............................... 4.58 NA NA 2.88 2.59 0.32 010 

55720 .... ............ A ........ Drainage of prostate abscess ............ 7.67 NA NA 4.93 4.36 0.95 090 

55725 .... ............ A ........ Drainage of prostate abscess ............ 9.90 NA NA 6.32 5.41 0.70 090 

55801 .... ............ A ........ Removal of prostate ........................... 19.62 NA NA 10.44 9.08 1.34 090 

55810 .... ............ A ........ Extensive prostate surgery ................. 24.14 NA NA 12.49 10.74 1.60 090 

55812 .... ............ A ........ Extensive prostate surgery ................. 29.69 NA NA 14.55 12.88 2.05 090 

55815 .... ............ A ........ Extensive prostate surgery ................. 32.75 NA NA 16.40 14.19 2.17 090 

55821 .... ............ A ........ Removal of prostate ........................... 15.63 NA NA 8.77 7.50 1.01 090 

55831 .... ............ A ........ Removal of prostate ........................... 17.06 NA NA 9.35 8.02 1.10 090 

55840 .... ............ A ........ Extensive prostate surgery ................. 24.45 NA NA 12.84 11.07 1.61 090 

55842 .... ............ A ........ Extensive prostate surgery ................. 26.31 NA NA 13.64 11.77 1.73 090 

55845 .... ............ A ........ Extensive prostate surgery ................. 30.52 NA NA 15.06 13.03 2.03 090 

55860 .... ............ A ........ Surgical exposure, prostate ................ 15.71 NA NA 8.64 7.55 1.02 090 

55862 .... ............ A ........ Extensive prostate surgery ................. 19.89 NA NA 10.82 9.35 1.49 090 

55865 .... ............ A ........ Extensive prostate surgery ................. 24.39 NA NA 12.56 11.00 1.63 090 

55866 .... ............ A ........ Laparo radical prostatectomy ............. 32.25 NA NA 16.16 13.97 2.17 090 

55870 .... ............ A ........ Electroejaculation ............................... 2.58 2.49 2.01 1.47 1.28 0.16 000 

55873 .... ............ A ........ Cryoablate prostate ............................ 20.25 NA NA 11.41 10.20 1.38 090 

55875 .... ............ A ........ Transperi needle place, pros .............. 13.31 NA NA 7.91 6.54 0.89 090 

55876 .... ............ A ........ Place rt device/marker, pros .............. 1.73 2.07 2.05 1.06 1.04 0.28 000 

55899 .... ............ C ........ Genital surgery procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

56405 .... ............ A ........ I & D of vulva/perineum ...................... 1.46 1.17 1.25 1.16 1.15 0.17 010 

56420 .... ............ A ........ Drainage of gland abscess ................. 1.41 1.51 1.89 0.78 0.91 0.16 010 

56440 .... ............ A ........ Surgery for vulva lesion ...................... 2.86 NA NA 1.57 1.64 0.34 010 

56441 .... ............ A ........ Lysis of labial lesion(s) ....................... 1.99 1.71 1.76 1.56 1.49 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 1.70 1.22 1.23 0.18 010 

56515 .... ............ A ........ Destroy vulva lesion/s compl .............. 3.03 2.39 2.46 1.74 1.77 0.33 010 

56605 .... ............ A ........ Biopsy of vulva/perineum ................... 1.10 0.92 0.99 0.35 0.40 0.13 000 

56606 .... ............ A ........ Biopsy of vulva/perineum ................... 0.55 0.36 0.43 0.15 0.18 0.07 ZZZ 

56620 .... ............ A ........ Partial removal of vulva ...................... 8.44 NA NA 4.41 4.60 0.90 090 

56625 .... ............ A ........ Complete removal of vulva ................. 9.55 NA NA 4.83 5.06 1.02 090 

56630 .... ............ A ........ Extensive vulva surgery ..................... 14.67 NA NA 6.32 6.57 1.49 090 

56631 .... ............ A ........ Extensive vulva surgery ..................... 18.81 NA NA 7.83 8.30 1.96 090 

56632 .... ............ A ........ Extensive vulva surgery ..................... 21.61 NA NA 9.36 9.43 2.39 090 

56633 .... ............ A ........ Extensive vulva surgery ..................... 19.47 NA NA 7.87 8.22 1.98 090 

56634 .... ............ A ........ Extensive vulva surgery ..................... 20.48 NA NA 8.25 8.83 2.17 090 

56637 .... ............ A ........ Extensive vulva surgery ..................... 24.57 NA NA 9.38 10.21 2.61 090 

56640 .... ............ A ........ Extensive vulva surgery ..................... 24.65 NA NA 8.91 9.79 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 2.34 2.45 0.56 010 

56800 .... ............ A ........ Repair of vagina ................................. 3.90 NA NA 1.97 2.08 0.44 010 

56805 .... ............ A ........ Repair clitoris ...................................... 19.75 NA NA 7.75 8.84 2.15 090 

56810 .... ............ A ........ Repair of perineum ............................. 4.26 NA NA 2.05 2.17 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 0.69 0.80 0.25 000 

57000 .... ............ A ........ Exploration of vagina .......................... 2.99 NA NA 1.77 1.74 0.31 010 

57010 .... ............ A ........ Drainage of pelvic abscess ................ 6.74 NA NA 3.80 3.81 0.71 090 

57020 .... ............ A ........ Drainage of pelvic fluid ....................... 1.50 0.78 0.85 0.46 0.52 0.18 000 

57022 .... ............ A ........ I & d vaginal hematoma, pp ............... 2.70 NA NA 1.43 1.46 0.26 010 

mstockstill on PROD1PC66 with PROPOSALS2

38295 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

57023 .... ............ A ........ I & d vag hematoma, non-ob ............. 5.13 NA NA 2.38 2.48 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 2.03 2.16 1.50 1.59 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 1.38 0.20 010 

57106 .... ............ A ........ Remove vagina wall, partial ............... 7.35 NA NA 4.28 4.23 0.73 090 

57107 .... ............ A ........ Remove vagina tissue, part ................ 24.43 NA NA 9.14 9.79 2.72 090 

57109 .... ............ A ........ Vaginectomy partial w/nodes ............. 28.25 NA NA 10.36 10.81 3.22 090 

57110 .... ............ A ........ Remove vagina wall, complete .......... 15.38 NA NA 6.24 6.75 1.74 090 

57111 .... ............ A ........ Remove vagina tissue, compl ............ 28.25 NA NA 10.53 11.52 3.18 090 

57112 .... ............ A ........ Vaginectomy w/nodes, compl ............. 30.37 NA NA 10.71 11.56 3.08 090 

57120 .... ............ A ........ Closure of vagina ............................... 8.18 NA NA 4.21 4.40 0.89 090 

57130 .... ............ A ........ Remove vagina lesion ........................ 2.44 1.96 2.06 1.47 1.51 0.29 010 

57135 .... ............ A ........ Remove vagina lesion ........................ 2.68 2.03 2.14 1.54 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 3.52 4.04 0.43 090 

57160 .... ............ A ........ Insert pessary/other device ................ 0.89 1.04 1.03 0.26 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 1.85 2.00 0.93 1.10 0.19 010 

57200 .... ............ A ........ Repair of vagina ................................. 4.34 NA NA 3.00 2.93 0.46 090 

57210 .... ............ A ........ Repair vagina/perineum ..................... 5.63 NA NA 3.28 3.35 0.62 090 

57220 .... ............ A ........ Revision of urethra ............................. 4.77 NA NA 3.01 3.06 0.51 090 

57230 .... ............ A ........ Repair of urethral lesion ..................... 6.22 NA NA 3.66 3.55 0.54 090 

57240 .... ............ A ........ Repair bladder & vagina ..................... 11.42 NA NA 5.53 4.66 0.62 090 

57250 .... ............ A ........ Repair rectum & vagina ...................... 11.42 NA NA 5.07 4.31 0.65 090 

57260 .... ............ A ........ Repair of vagina ................................. 14.36 NA NA 5.90 5.35 0.97 090 

57265 .... ............ A ........ Extensive repair of vagina .................. 15.86 NA NA 6.37 6.19 1.32 090 

57267 .... ............ A ........ Insert mesh/pelvic flr addon ............... 4.88 NA NA 1.52 1.75 0.64 ZZZ 

57268 .... ............ A ........ Repair of bowel bulge ........................ 7.47 NA NA 4.35 4.26 0.79 090 

57270 .... ............ A ........ Repair of bowel pouch ....................... 13.57 NA NA 5.89 6.03 1.42 090 

57280 .... ............ A ........ Suspension of vagina ......................... 16.62 NA NA 7.03 7.19 1.68 090 

57282 .... ............ A ........ Colpopexy, extraperitoneal ................. 7.84 NA NA 4.51 4.49 1.02 090 

57283 .... ............ A ........ Colpopexy, intraperitoneal .................. 11.58 NA NA 5.15 5.54 1.02 090 

57284 .... ............ A ........ Repair paravaginal defect .................. 13.51 NA NA 6.92 7.00 1.41 090 

57287 .... ............ A ........ Revise/remove sling repair ................. 11.49 NA NA 6.40 5.95 0.90 090 

57288 .... ............ A ........ Repair bladder defect ......................... 14.01 NA NA 7.09 6.50 1.12 090 

57289 .... ............ A ........ Repair bladder & vagina ..................... 12.69 NA NA 6.72 6.29 1.21 090 

57291 .... ............ A ........ Construction of vagina ........................ 8.54 NA NA 4.91 4.82 0.93 090 

57292 .... ............ A ........ Construct vagina with graft ................. 13.91 NA NA 5.95 6.46 1.58 090 

57295 .... ............ A ........ Revise vag graft via vagina ................ 7.74 NA NA 4.11 4.26 0.91 090 

57296 .... ............ A ........ Revise vag graft, open abd ................ 16.46 NA NA 6.73 6.74 1.68 090 

57300 .... ............ A ........ Repair rectum-vagina fistula ............... 8.58 NA NA 4.44 4.37 0.87 090 

57305 .... ............ A ........ Repair rectum-vagina fistula ............... 15.24 NA NA 6.19 6.22 1.73 090 

57307 .... ............ A ........ Fistula repair & colostomy .................. 17.02 NA NA 6.91 6.97 2.02 090 

57308 .... ............ A ........ Fistula repair, transperine ................... 10.48 NA NA 4.97 5.02 1.14 090 

57310 .... ............ A ........ Repair urethrovaginal lesion ............... 7.55 NA NA 5.03 4.44 0.54 090 

57311 .... ............ A ........ Repair urethrovaginal lesion ............... 8.81 NA NA 5.56 4.78 0.65 090 

57320 .... ............ A ........ Repair bladder-vagina lesion .............. 8.78 NA NA 5.32 4.85 0.69 090 

57330 .... ............ A ........ Repair bladder-vagina lesion .............. 13.11 NA NA 7.28 6.49 1.06 090 

57335 .... ............ A ........ Repair vagina ..................................... 19.87 NA NA 7.89 8.65 1.92 090 

57400 .... ............ A ........ Dilation of vagina ................................ 2.27 NA NA 1.01 1.06 0.26 000 

57410 .... ............ A ........ Pelvic examination .............................. 1.75 NA NA 0.92 0.91 0.18 000 

57415 .... ............ A ........ Remove vaginal foreign body ............. 2.44 NA NA 1.50 1.46 0.24 010 

57420 .... ............ A ........ Exam of vagina w/scope .................... 1.60 1.23 1.29 0.56 0.62 0.19 000 

57421 .... ............ A ........ Exam/biopsy of vag w/scope .............. 2.20 1.59 1.72 0.73 0.84 0.27 000 

57425 .... ............ A ........ Laparoscopy, surg, colpopexy ............ 16.93 NA NA 6.97 6.80 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 1.52 0.95 1.05 0.28 000 

57455 .... ............ A ........ Biopsy of cervix w/scope .................... 1.99 1.50 1.61 0.66 0.77 0.24 000 

57456 .... ............ A ........ Endocerv curettage w/scope .............. 1.85 1.45 1.55 0.63 0.72 0.22 000 

57460 .... ............ A ........ Bx of cervix w/scope, leep ................. 2.83 4.26 5.05 1.10 1.24 0.34 000 

57461 .... ............ A ........ Conz of cervix w/scope, leep ............. 3.43 4.55 5.32 1.06 1.27 0.41 000 

57500 .... ............ A ........ Biopsy of cervix .................................. 1.20 2.00 2.27 0.64 0.63 0.12 000 

57505 .... ............ A ........ Endocervical curettage ....................... 1.16 1.32 1.39 1.06 1.08 0.14 010 

57510 .... ............ A ........ Cauterization of cervix ........................ 1.90 1.31 1.44 0.90 0.97 0.23 010 

57511 .... ............ A ........ Cryocautery of cervix .......................... 1.92 1.60 1.71 1.27 1.32 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 3.37 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 3.11 3.24 0.58 090 

57531 .... ............ A ........ Removal of cervix, radical .................. 29.77 NA NA 10.96 12.03 3.35 090 

57540 .... ............ A ........ Removal of residual cervix ................. 13.19 NA NA 5.47 5.88 1.49 090 

mstockstill on PROD1PC66 with PROPOSALS2

38296 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

57545 .... ............ A ........ Remove cervix/repair pelvis ............... 14.00 NA NA 5.74 6.29 1.52 090 

57550 .... ............ A ........ Removal of residual cervix ................. 6.24 NA NA 3.62 3.72 0.67 090 

57555 .... ............ A ........ Remove cervix/repair vagina .............. 9.84 NA NA 4.78 4.93 1.09 090 

57556 .... ............ A ........ Remove cervix, repair bowel .............. 9.26 NA NA 4.64 4.75 0.92 090 

57558 .... ............ A ........ D&c of cervical stump ........................ 1.69 1.34 1.43 1.05 1.11 0.20 010 

57700 .... ............ A ........ Revision of cervix ............................... 4.22 NA NA 3.27 3.18 0.41 090 

57720 .... ............ A ........ Revision of cervix ............................... 4.53 NA NA 2.94 3.01 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 0.40 0.47 0.21 0.26 0.09 ZZZ 

58120 .... ............ A ........ Dilation and curettage ........................ 3.54 2.70 2.50 1.66 1.77 0.39 010 

58140 .... ............ A ........ Myomectomy abdom method ............. 15.69 NA NA 6.21 6.66 1.82 090 

58145 .... ............ A ........ Myomectomy vag method .................. 8.81 NA NA 4.25 4.52 0.97 090 

58146 .... ............ A ........ Myomectomy abdom complex ............ 20.24 NA NA 7.40 8.19 2.33 090 

58150 .... ............ A ........ Total hysterectomy ............................. 17.21 NA NA 6.61 7.04 1.85 090 

58152 .... ............ A ........ Total hysterectomy ............................. 21.73 NA NA 8.10 8.98 2.48 090 

58180 .... ............ A ........ Partial hysterectomy ........................... 16.50 NA NA 6.38 6.91 1.64 090 

58200 .... ............ A ........ Extensive hysterectomy ...................... 23.00 NA NA 8.23 9.10 2.55 090 

58210 .... ............ A ........ Extensive hysterectomy ...................... 30.76 NA NA 10.82 12.00 3.38 090 

58240 .... ............ A ........ Removal of pelvis contents ................ 49.02 NA NA 17.79 17.70 4.23 090 

58260 .... ............ A ........ Vaginal hysterectomy ......................... 14.02 NA NA 5.82 6.25 1.57 090 

58262 .... ............ A ........ Vag hyst including t/o ......................... 15.81 NA NA 6.28 6.83 1.80 090 

58263 .... ............ A ........ Vag hyst w/t/o & vag repair ................ 17.10 NA NA 6.69 7.28 1.95 090 

58267 .... ............ A ........ Vag hyst w/urinary repair ................... 18.23 NA NA 7.02 7.69 2.07 090 

58270 .... ............ A ........ Vag hyst w/enterocele repair .............. 15.20 NA NA 5.98 6.51 1.74 090 

58275 .... ............ A ........ Hysterectomy/revise vagina ............... 16.90 NA NA 6.66 7.21 1.92 090 

58280 .... ............ A ........ Hysterectomy/revise vagina ............... 18.20 NA NA 7.01 7.64 2.07 090 

58285 .... ............ A ........ Extensive hysterectomy ...................... 23.30 NA NA 8.01 8.98 2.71 090 

58290 .... ............ A ........ Vag hyst complex ............................... 20.17 NA NA 7.41 8.26 2.30 090 

58291 .... ............ A ........ Vag hyst incl t/o, complex .................. 21.96 NA NA 7.89 8.87 2.53 090 

58292 .... ............ A ........ Vag hyst t/o & repair, compl ............... 23.25 NA NA 8.29 9.32 2.68 090 

58293 .... ............ A ........ Vag hyst w/uro repair, compl ............. 24.23 NA NA 8.60 9.61 2.79 090 

58294 .... ............ A ........ Vag hyst w/enterocele, compl ............ 21.45 NA NA 7.57 8.50 2.40 090 

58300 .... ............ N ........ Insert intrauterine device .................... 1.01 0.63 1.02 0.23 0.30 0.12 XXX 

58301 .... ............ A ........ Remove intrauterine device ................ 1.27 1.04 1.18 0.35 0.42 0.15 000 

58321 .... ............ A ........ Artificial insemination .......................... 0.92 0.93 1.04 0.23 0.30 0.10 000 

58322 .... ............ A ........ Artificial insemination .......................... 1.10 1.03 1.12 0.31 0.36 0.13 000 

58323 .... ............ A ........ Sperm washing ................................... 0.23 0.16 0.35 0.07 0.08 0.03 000 

58340 .... ............ A ........ Catheter for hysterography ................. 0.88 2.14 2.65 0.57 0.61 0.09 000 

58345 .... ............ A ........ Reopen fallopian tube ........................ 4.67 NA NA 2.13 2.26 0.41 010 

58346 .... ............ A ........ Insert heyman uteri capsule ............... 7.48 NA NA 3.76 3.85 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 22.66 29.16 1.72 1.89 0.43 010 

58356 .... ............ A ........ Endometrial cryoablation .................... 6.36 43.03 52.21 1.88 2.28 0.82 010 

58400 .... ............ A ........ Suspension of uterus .......................... 7.06 NA NA 3.88 3.89 0.75 090 

58410 .... ............ A ........ Suspension of uterus .......................... 13.70 NA NA 5.61 6.06 1.45 090 

58520 .... ............ A ........ Repair of ruptured uterus ................... 13.38 NA NA 5.53 5.77 1.47 090 

58540 .... ............ A ........ Revision of uterus ............................... 15.61 NA NA 6.19 6.57 1.79 090 

58541 .... ............ A ........ Lsh, uterus 250 g or less ................... 14.57 NA NA 6.17 6.15 1.68 090 

58542 .... ............ A ........ Lsh w/t/o ut 250 g or less ................... 16.43 NA NA 6.68 6.67 1.69 090 

58543 .... ............ A ........ Lsh uterus above 250 g ..................... 16.74 NA NA 6.76 6.74 1.73 090 

58544 .... ............ A ........ Lsh w/t/o uterus above 250 g ............. 18.24 NA NA 7.18 7.17 1.89 090 

58545 .... ............ A ........ Laparoscopic myomectomy ................ 15.45 NA NA 5.91 6.55 1.78 090 

58546 .... ............ A ........ Laparo-myomectomy, complex .......... 19.84 NA NA 7.12 8.01 2.31 090 

58548 .... ............ A ........ Lap radical hyst .................................. 31.45 NA NA 12.62 12.70 3.52 090 

58550 .... ............ A ........ Laparo-asst vag hysterectomy ........... 14.97 NA NA 6.17 6.73 1.73 090 

58552 .... ............ A ........ Laparo-vag hyst incl t/o ...................... 16.78 NA NA 6.61 7.31 1.73 090 

58553 .... ............ A ........ Laparo-vag hyst, complex .................. 19.96 NA NA 7.15 8.03 2.31 090 

58554 .... ............ A ........ Laparo-vag hyst w/t/o, compl ............. 22.98 NA NA 8.33 9.36 2.28 090 

58555 .... ............ A ........ Hysteroscopy, dx, sep proc ................ 3.33 2.75 2.46 1.24 1.39 0.40 000 

58558 .... ............ A ........ Hysteroscopy, biopsy ......................... 4.74 3.62 2.89 1.67 1.92 0.57 000 

58559 .... ............ A ........ Hysteroscopy, lysis ............................. 6.16 NA NA 2.06 2.39 0.74 000 

58560 .... ............ A ........ Hysteroscopy, resect septum ............. 6.99 NA NA 2.34 2.70 0.84 000 

58561 .... ............ A ........ Hysteroscopy, remove myoma ........... 9.99 NA NA 3.15 3.72 1.21 000 

58562 .... ............ A ........ Hysteroscopy, remove fb .................... 5.20 3.53 2.93 1.77 2.06 0.63 000 

58563 .... ............ A ........ Hysteroscopy, ablation ....................... 6.16 36.96 46.57 2.06 2.41 0.74 000 

58565 .... ............ A ........ Hysteroscopy, sterilization .................. 7.06 41.68 44.35 3.39 3.64 1.19 090 

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 2.93 3.13 0.66 090 

58605 .... ............ A ........ Division of fallopian tube .................... 5.25 NA NA 2.72 2.91 0.59 090 

58611 .... ............ A ........ Ligate oviduct(s) add-on ..................... 1.45 NA NA 0.40 0.49 0.18 ZZZ 

mstockstill on PROD1PC66 with PROPOSALS2

38297 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

58615 .... ............ A ........ Occlude fallopian tube(s) .................... 3.91 NA NA 2.04 2.36 0.47 010 

58660 .... ............ A ........ Laparoscopy, lysis .............................. 11.54 NA NA 4.52 4.89 1.40 090 

58661 .... ............ A ........ Laparoscopy, remove adnexa ............ 11.30 NA NA 4.02 4.57 1.34 010 

58662 .... ............ A ........ Laparoscopy, excise lesions .............. 12.08 NA NA 4.79 5.28 1.43 090 

58670 .... ............ A ........ Laparoscopy, tubal cautery ................ 5.86 NA NA 2.96 3.11 0.67 090 

58671 .... ............ A ........ Laparoscopy, tubal block .................... 5.86 NA NA 2.95 3.11 0.68 090 

58672 .... ............ A ........ Laparoscopy, fimbrioplasty ................. 12.88 NA NA 4.82 5.49 1.60 090 

58673 .... ............ A ........ Laparoscopy, salpingostomy .............. 13.99 NA NA 5.16 5.87 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 5.50 5.75 1.51 090 

58720 .... ............ A ........ Removal of ovary/tube(s) ................... 12.08 NA NA 5.11 5.44 1.39 090 

58740 .... ............ A ........ Revise fallopian tube(s) ...................... 14.79 NA NA 6.08 6.61 1.72 090 

58750 .... ............ A ........ Repair oviduct ..................................... 15.56 NA NA 6.09 6.72 1.85 090 

58752 .... ............ A ........ Revise ovarian tube(s) ....................... 15.56 NA NA 5.97 6.46 1.81 090 

58760 .... ............ A ........ Remove tubal obstruction ................... 13.85 NA NA 5.62 6.17 1.80 090 

58770 .... ............ A ........ Create new tubal opening .................. 14.69 NA NA 5.79 6.34 1.74 090 

58800 .... ............ A ........ Drainage of ovarian cyst(s) ................ 4.54 3.21 3.41 2.69 2.78 0.43 090 

58805 .... ............ A ........ Drainage of ovarian cyst(s) ................ 6.34 NA NA 3.50 3.49 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 5.16 5.17 1.16 090 

58823 .... ............ A ........ Drain pelvic abscess, percut .............. 3.37 19.80 20.43 1.17 1.11 0.24 000 

58825 .... ............ A ........ Transposition, ovary(s) ....................... 11.70 NA NA 4.86 5.35 1.32 090 

58900 .... ............ A ........ Biopsy of ovary(s) ............................... 6.51 NA NA 3.55 3.54 0.69 090 

58920 .... ............ A ........ Partial removal of ovary(s) ................. 11.87 NA NA 5.08 5.35 1.43 090 

58925 .... ............ A ........ Removal of ovarian cyst(s) ................. 12.33 NA NA 5.26 5.47 1.41 090 

58940 .... ............ A ........ Removal of ovary(s) ........................... 8.12 NA NA 4.04 4.07 0.91 090 

58943 .... ............ A ........ Removal of ovary(s) ........................... 19.42 NA NA 7.22 7.93 2.23 090 

58950 .... ............ A ........ Resect ovarian malignancy ................ 18.24 NA NA 7.30 7.85 2.05 090 

58951 .... ............ A ........ Resect ovarian malignancy ................ 24.15 NA NA 8.67 9.55 2.64 090 

58952 .... ............ A ........ Resect ovarian malignancy ................ 27.15 NA NA 9.90 10.82 3.03 090 

58953 .... ............ A ........ Tah, rad dissect for debulk ................. 33.97 NA NA 11.75 13.14 3.84 090 

58954 .... ............ A ........ Tah rad debulk/lymph remove ............ 36.97 NA NA 12.63 14.16 4.18 090 

58956 .... ............ A ........ Bso, omentectomy w/tah .................... 22.65 NA NA 8.65 9.48 4.01 090 

58957 .... ............ A ........ Resect recurrent gyn mal ................... 26.06 NA NA 9.58 9.61 2.95 090 

58958 .... ............ A ........ Resect recur gyn mal w/lym ............... 29.06 NA NA 10.39 10.42 3.29 090 

58960 .... ............ A ........ Exploration of abdomen ..................... 15.68 NA NA 6.29 6.82 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 1.93 2.30 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 1.74 1.90 0.55 0.61 0.31 000 

59001 .... ............ A ........ Amniocentesis, therapeutic ................ 3.00 NA NA 1.08 1.25 0.71 000 

59012 .... ............ A ........ Fetal cord puncture,prenatal .............. 3.44 NA NA 1.14 1.34 0.82 000 

59015 .... ............ A ........ Chorion biopsy .................................... 2.20 1.43 1.49 0.80 0.92 0.52 000 

59020 .... ............ A ........ Fetal contract stress test .................... 0.66 1.07 0.92 1.07 0.92 0.26 000 

59020 .... 26 ....... A ........ Fetal contract stress test .................... 0.66 0.18 0.22 0.18 0.22 0.16 000 

59020 .... TC ...... A ........ Fetal contract stress test .................... 0.00 0.88 0.70 0.88 0.70 0.10 000 

59025 .... ............ A ........ Fetal non-stress test ........................... 0.53 0.63 0.54 0.63 0.54 0.15 000 

59025 .... 26 ....... A ........ Fetal non-stress test ........................... 0.53 0.15 0.18 0.15 0.18 0.13 000 

59025 .... TC ...... A ........ Fetal non-stress test ........................... 0.00 0.48 0.35 0.48 0.35 0.02 000 

59030 .... ............ A ........ Fetal scalp blood sample ................... 1.99 NA NA 0.46 0.63 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 4.38 4.76 1.78 2.04 0.28 000 

59072 .... ............ A ........ Umbilical cord occlud w/us ................. 8.99 NA NA 2.39 2.84 0.16 000 

59074 .... ............ A ........ Fetal fluid drainage w/us .................... 5.24 3.58 4.12 1.53 1.95 0.28 000 

59076 .... ............ A ........ Fetal shunt placement, w/us .............. 8.99 NA NA 2.39 2.76 0.16 000 

59100 .... ............ A ........ Remove uterus lesion ......................... 13.26 NA NA 5.57 6.05 2.95 090 

59120 .... ............ A ........ Treat ectopic pregnancy ..................... 12.56 NA NA 5.43 5.84 2.73 090 

59121 .... ............ A ........ Treat ectopic pregnancy ..................... 12.64 NA NA 5.38 5.85 2.79 090 

59130 .... ............ A ........ Treat ectopic pregnancy ..................... 14.98 NA NA 6.74 5.65 3.39 090 

59135 .... ............ A ........ Treat ectopic pregnancy ..................... 14.82 NA NA 5.07 6.14 3.31 090 

59136 .... ............ A ........ Treat ectopic pregnancy ..................... 14.15 NA NA 4.92 5.89 3.14 090 

59140 .... ............ A ........ Treat ectopic pregnancy ..................... 5.86 NA NA 3.31 2.69 1.29 090 

59150 .... ............ A ........ Treat ectopic pregnancy ..................... 12.19 NA NA 5.27 5.62 2.79 090 

59151 .... ............ A ........ Treat ectopic pregnancy ..................... 12.01 NA NA 4.90 5.47 2.74 090 

59160 .... ............ A ........ D & c after delivery ............................. 2.73 1.99 2.64 1.18 1.65 0.64 010 

59200 .... ............ A ........ Insert cervical dilator .......................... 0.79 0.94 1.07 0.22 0.26 0.19 000 

59300 .... ............ A ........ Episiotomy or vaginal repair ............... 2.41 2.19 2.18 1.01 0.99 0.57 000 

59320 .... ............ A ........ Revision of cervix ............................... 2.48 NA NA 1.01 1.12 0.59 000 

59325 .... ............ A ........ Revision of cervix ............................... 4.06 NA NA 1.45 1.64 0.88 000 

59350 .... ............ A ........ Repair of uterus .................................. 4.94 NA NA 1.22 1.57 1.17 000 

mstockstill on PROD1PC66 with PROPOSALS2

38298 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

59400 .... ............ A ........ Obstetrical care .................................. 26.80 NA NA 14.13 14.75 5.50 MMM 

59409 .... ............ A ........ Obstetrical care .................................. 13.48 NA NA 3.75 4.52 3.22 MMM 

59410 .... ............ A ........ Obstetrical care .................................. 15.29 NA NA 4.97 5.63 3.52 MMM 

59412 .... ............ A ........ Antepartum manipulation .................... 1.71 NA NA 0.65 0.73 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 1.70 1.77 1.14 MMM 

59426 .... ............ A ........ Antepartum care only ......................... 11.04 7.78 7.66 3.03 3.12 1.98 MMM 

59430 .... ............ A ........ Care after delivery .............................. 2.13 1.08 1.15 0.72 0.83 0.50 MMM 

59510 .... ............ A ........ Cesarean delivery ............................... 30.34 NA NA 16.03 16.62 6.25 MMM 

59514 .... ............ A ........ Cesarean delivery only ....................... 15.95 NA NA 4.49 5.35 3.80 MMM 

59515 .... ............ A ........ Cesarean delivery ............................... 18.26 NA NA 6.20 7.02 4.13 MMM 

59525 .... ............ A ........ Remove uterus after cesarean ........... 8.53 NA NA 2.28 2.81 1.95 ZZZ 

59610 .... ............ A ........ Vbac delivery ...................................... 28.21 NA NA 14.99 15.34 5.87 MMM 

59612 .... ............ A ........ Vbac delivery only .............................. 15.04 NA NA 4.25 5.15 3.59 MMM 

59614 .... ............ A ........ Vbac care after delivery ..................... 16.59 NA NA 5.18 6.05 3.89 MMM 

59618 .... ............ A ........ Attempted vbac delivery ..................... 31.78 NA NA 16.40 17.29 6.61 MMM 

59620 .... ............ A ........ Attempted vbac delivery only ............. 17.50 NA NA 4.70 5.75 4.17 MMM 

59622 .... ............ A ........ Attempted vbac after care .................. 19.70 NA NA 6.76 7.68 4.50 MMM 

59812 .... ............ A ........ Treatment of miscarriage ................... 4.39 3.10 2.82 2.36 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 4.07 3.24 3.31 1.06 090 

59830 .... ............ A ........ Treat uterus infection .......................... 6.51 NA NA 3.45 3.72 1.44 090 

59840 .... ............ R ........ Abortion .............................................. 3.01 2.00 2.06 1.77 1.95 0.71 010 

59841 .... ............ R ........ Abortion .............................................. 5.57 3.12 3.31 2.56 2.77 1.24 010 

59850 .... ............ R ........ Abortion .............................................. 5.90 NA NA 2.44 2.88 1.28 090 

59851 .... ............ R ........ Abortion .............................................. 5.92 NA NA 3.30 3.52 1.28 090 

59852 .... ............ R ........ Abortion .............................................. 8.23 NA NA 3.80 4.42 1.81 090 

59855 .... ............ R ........ Abortion .............................................. 6.38 NA NA 3.09 3.30 1.45 090 

59856 .... ............ R ........ Abortion .............................................. 7.74 NA NA 3.33 3.78 1.79 090 

59857 .... ............ R ........ Abortion .............................................. 9.30 NA NA 3.67 4.10 2.02 090 

59866 .... ............ R ........ Abortion (mpr) ..................................... 3.99 NA NA 1.37 1.61 0.87 000 

59870 .... ............ A ........ Evacuate mole of uterus .................... 6.40 NA NA 4.38 4.41 1.42 090 

59871 .... ............ A ........ Remove cerclage suture .................... 2.13 NA NA 0.91 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 2.04 1.98 1.66 1.69 0.15 010 

60001 .... ............ A ........ Aspirate/inject thyriod cyst .................. 0.97 1.93 1.66 0.31 0.32 0.07 000 

60100 .... ............ A ........ Biopsy of thyroid ................................. 1.56 1.32 1.34 0.53 0.52 0.10 000 

60200 .... ............ A ........ Remove thyroid lesion ........................ 9.91 NA NA 5.50 5.70 1.01 090 

60210 .... ............ A ........ Partial thyroid excision ....................... 11.15 NA NA 5.23 5.40 1.23 090 

60212 .... ............ A ........ Partial thyroid excision ....................... 16.32 NA NA 6.95 7.28 1.95 090 

60220 .... ............ A ........ Partial removal of thyroid ................... 12.29 NA NA 5.67 5.86 1.32 090 

60225 .... ............ A ........ Partial removal of thyroid ................... 14.67 NA NA 6.92 7.12 1.64 090 

60240 .... ............ A ........ Removal of thyroid ............................. 16.18 NA NA 6.41 6.96 1.86 090 

60252 .... ............ A ........ Removal of thyroid ............................. 21.88 NA NA 8.85 9.40 2.30 090 

60254 .... ............ A ........ Extensive thyroid surgery ................... 28.29 NA NA 11.28 12.57 2.61 090 

60260 .... ............ A ........ Repeat thyroid surgery ....................... 18.18 NA NA 7.43 7.97 1.94 090 

60270 .... ............ A ........ Removal of thyroid ............................. 23.07 NA NA 9.31 9.82 2.33 090 

60271 .... ............ A ........ Removal of thyroid ............................. 17.54 NA NA 7.17 7.82 1.75 090 

60280 .... ............ A ........ Remove thyroid duct lesion ................ 6.05 NA NA 4.48 4.51 0.54 090 

60281 .... ............ A ........ Remove thyroid duct lesion ................ 8.71 NA NA 5.33 5.47 0.73 090 

60500 .... ............ A ........ Explore parathyroid glands ................. 16.69 NA NA 6.85 7.10 2.01 090 

60502 .... ............ A ........ Re-explore parathyroids ..................... 21.01 NA NA 8.61 8.96 2.54 090 

60505 .... ............ A ........ Explore parathyroid glands ................. 22.91 NA NA 9.40 10.13 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 7.00 7.63 2.20 090 

60521 .... ............ A ........ Removal of thymus gland ................... 19.11 NA NA 8.13 8.86 2.82 090 

60522 .... ............ A ........ Removal of thymus gland ................... 23.37 NA NA 9.61 10.46 3.27 090 

60540 .... ............ A ........ Explore adrenal gland ........................ 17.91 NA NA 8.28 7.91 1.75 090 

60545 .... ............ A ........ Explore adrenal gland ........................ 20.82 NA NA 8.96 8.73 2.08 090 

60600 .... ............ A ........ Remove carotid body lesion ............... 24.99 NA NA 8.84 9.89 2.20 090 

60605 .... ............ A ........ Remove carotid body lesion ............... 31.86 NA NA 12.12 12.21 2.50 090 

60650 .... ............ A ........ Laparoscopy adrenalectomy .............. 20.63 NA NA 8.12 8.07 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 1.23 1.09 0.13 000 

61001 .... ............ A ........ Remove cranial cavity fluid ................ 1.49 NA NA 1.06 1.09 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 1.38 0.33 000 

61050 .... ............ A ........ Remove brain canal fluid .................... 1.51 NA NA 1.15 1.20 0.11 000 

61055 .... ............ A ........ Injection into brain canal .................... 2.10 NA NA 1.33 1.36 0.17 000 

mstockstill on PROD1PC66 with PROPOSALS2

38299 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

61070 .... ............ A ........ Brain canal shunt procedure .............. 0.89 NA NA 1.15 1.08 0.17 000 

61105 .... ............ A ........ Twist drill hole ..................................... 5.40 NA NA 4.95 4.44 1.32 090 

61107 .... ............ A ........ Drill skull for implantation ................... 4.99 NA NA 1.86 2.20 1.29 000 

61108 .... ............ A ........ Drill skull for drainage ......................... 11.51 NA NA 8.40 7.79 2.64 090 

61120 .... ............ A ........ Burr hole for puncture ........................ 9.52 NA NA 6.81 6.39 2.10 090 

61140 .... ............ A ........ Pierce skull for biopsy ........................ 17.10 NA NA 10.49 10.19 4.12 090 

61150 .... ............ A ........ Pierce skull for drainage ..................... 18.80 NA NA 10.75 10.58 4.32 090 

61151 .... ............ A ........ Pierce skull for drainage ..................... 13.41 NA NA 8.49 8.17 3.01 090 

61154 .... ............ A ........ Pierce skull & remove clot .................. 16.92 NA NA 10.90 10.19 4.21 090 

61156 .... ............ A ........ Pierce skull for drainage ..................... 17.37 NA NA 9.79 9.85 4.23 090 

61210 .... ............ A ........ Pierce skull, implant device ................ 5.83 NA NA 2.18 2.55 1.50 000 

61215 .... ............ A ........ Insert brain-fluid device ...................... 5.77 NA NA 5.47 4.74 1.26 090 

61250 .... ............ A ........ Pierce skull & explore ......................... 11.41 NA NA 7.43 7.18 2.77 090 

61253 .... ............ A ........ Pierce skull & explore ......................... 13.41 NA NA 7.63 7.72 2.62 090 

61304 .... ............ A ........ Open skull for exploration .................. 23.31 NA NA 12.63 12.76 5.63 090 

61305 .... ............ A ........ Open skull for exploration .................. 28.51 NA NA 15.08 15.23 6.09 090 

61312 .... ............ A ........ Open skull for drainage ...................... 30.07 NA NA 15.38 15.24 6.36 090 

61313 .... ............ A ........ Open skull for drainage ...................... 27.94 NA NA 15.49 15.18 6.45 090 

61314 .... ............ A ........ Open skull for drainage ...................... 25.77 NA NA 14.29 13.68 6.28 090 

61315 .... ............ A ........ Open skull for drainage ...................... 29.52 NA NA 15.63 15.85 7.16 090 

61316 .... ............ A ........ Implt cran bone flap to abdo .............. 1.39 NA NA 0.52 0.56 0.35 ZZZ 

61320 .... ............ A ........ Open skull for drainage ...................... 27.32 NA NA 14.37 14.58 6.62 090 

61321 .... ............ A ........ Open skull for drainage ...................... 30.40 NA NA 16.21 15.88 7.14 090 

61322 .... ............ A ........ Decompressive craniotomy ................ 34.08 NA NA 17.72 16.75 7.63 090 

61323 .... ............ A ........ Decompressive lobectomy ................. 34.93 NA NA 17.48 16.75 8.03 090 

61330 .... ............ A ........ Decompress eye socket ..................... 25.17 NA NA 11.70 12.77 2.32 090 

61332 .... ............ A ........ Explore/biopsy eye socket .................. 28.50 NA NA 13.06 14.43 4.83 090 

61333 .... ............ A ........ Explore orbit/remove lesion ................ 29.17 NA NA 13.09 14.41 3.92 090 

61334 .... ............ A ........ Explore orbit/remove object ................ 19.50 NA NA 9.15 9.91 1.75 090 

61340 .... ............ A ........ Subtemporal decompression .............. 20.01 NA NA 11.77 11.41 4.84 090 

61343 .... ............ A ........ Incise skull (press relief) ..................... 31.73 NA NA 16.12 16.51 7.64 090 

61345 .... ............ A ........ Relieve cranial pressure ..................... 29.10 NA NA 14.98 15.27 7.04 090 

61440 .... ............ A ........ Incise skull for surgery ....................... 28.53 NA NA 15.37 14.60 6.90 090 

61450 .... ............ A ........ Incise skull for surgery ....................... 27.59 NA NA 14.38 14.08 5.79 090 

61458 .... ............ A ........ Incise skull for brain wound ................ 28.71 NA NA 15.02 15.30 7.03 090 

61460 .... ............ A ........ Incise skull for surgery ....................... 30.11 NA NA 14.70 15.67 6.04 090 

61470 .... ............ A ........ Incise skull for surgery ....................... 27.52 NA NA 14.18 13.87 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 14.36 14.37 6.92 090 

61500 .... ............ A ........ Removal of skull lesion ...................... 19.05 NA NA 10.77 10.78 4.11 090 

61501 .... ............ A ........ Remove infected skull bone ............... 16.22 NA NA 9.53 9.39 3.22 090 

61510 .... ............ A ........ Removal of brain lesion ...................... 30.63 NA NA 17.09 16.93 7.35 090 

61512 .... ............ A ........ Remove brain lining lesion ................. 36.99 NA NA 18.64 19.19 9.08 090 

61514 .... ............ A ........ Removal of brain abscess .................. 27.10 NA NA 14.53 14.52 6.54 090 

61516 .... ............ A ........ Removal of brain lesion ...................... 26.45 NA NA 14.16 14.27 6.35 090 

61517 .... ............ A ........ Implt brain chemotx add-on ................ 1.38 NA NA 0.52 0.58 0.35 ZZZ 

61518 .... ............ A ........ Removal of brain lesion ...................... 39.69 NA NA 20.49 20.84 9.65 090 

61519 .... ............ A ........ Remove brain lining lesion ................. 43.28 NA NA 20.91 21.82 10.63 090 

61520 .... ............ A ........ Removal of brain lesion ...................... 56.89 NA NA 26.23 28.26 11.21 090 

61521 .... ............ A ........ Removal of brain lesion ...................... 46.84 NA NA 22.38 23.32 11.39 090 

61522 .... ............ A ........ Removal of brain abscess .................. 31.41 NA NA 15.95 16.15 7.62 090 

61524 .... ............ A ........ Removal of brain lesion ...................... 29.76 NA NA 15.84 15.78 7.16 090 

61526 .... ............ A ........ Removal of brain lesion ...................... 53.90 NA NA 22.68 25.99 7.07 090 

61530 .... ............ A ........ Removal of brain lesion ...................... 45.43 NA NA 19.69 22.19 6.15 090 

61531 .... ............ A ........ Implant brain electrodes ..................... 16.28 NA NA 10.52 9.80 3.79 090 

61533 .... ............ A ........ Implant brain electrodes ..................... 21.36 NA NA 11.88 11.71 5.12 090 

61534 .... ............ A ........ Removal of brain lesion ...................... 22.88 NA NA 13.23 12.68 5.44 090 

61535 .... ............ A ........ Remove brain electrodes ................... 13.05 NA NA 8.89 8.18 3.02 090 

61536 .... ............ A ........ Removal of brain lesion ...................... 37.59 NA NA 18.72 19.26 9.21 090 

61537 .... ............ A ........ Removal of brain tissue ...................... 36.35 NA NA 17.21 16.08 6.94 090 

61538 .... ............ A ........ Removal of brain tissue ...................... 39.35 NA NA 18.56 17.03 6.94 090 

61539 .... ............ A ........ Removal of brain tissue ...................... 34.15 NA NA 16.98 17.17 8.32 090 

61540 .... ............ A ........ Removal of brain tissue ...................... 31.30 NA NA 16.45 16.80 8.32 090 

61541 .... ............ A ........ Incision of brain tissue ........................ 30.81 NA NA 16.23 16.24 6.60 090 

61542 .... ............ A ........ Removal of brain tissue ...................... 33.03 NA NA 16.94 17.30 8.03 090 

61543 .... ............ A ........ Removal of brain tissue ...................... 31.18 NA NA 13.94 15.60 7.56 090 

61544 .... ............ A ........ Remove & treat brain lesion ............... 27.26 NA NA 14.41 14.15 5.97 090 

61545 .... ............ A ........ Excision of brain tumor ....................... 46.23 NA NA 23.05 23.58 10.63 090 

61546 .... ............ A ........ Removal of pituitary gland .................. 33.31 NA NA 16.90 17.19 7.67 090 

61548 .... ............ A ........ Removal of pituitary gland .................. 23.27 NA NA 11.74 12.23 3.43 090 

61550 .... ............ A ........ Release of skull seams ...................... 15.44 NA NA 5.63 6.28 0.98 090 

61552 .... ............ A ........ Release of skull seams ...................... 20.27 NA NA 12.24 9.74 1.06 090 

mstockstill on PROD1PC66 with PROPOSALS2

38300 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

61556 .... ............ A ........ Incise skull/sutures ............................. 24.00 NA NA 13.40 12.31 4.65 090 

61557 .... ............ A ........ Incise skull/sutures ............................. 23.16 NA NA 13.74 13.71 5.80 090 

61558 .... ............ A ........ Excision of skull/sutures ..................... 26.35 NA NA 14.82 13.39 1.36 090 

61559 .... ............ A ........ Excision of skull/sutures ..................... 33.82 NA NA 18.54 19.07 8.51 090 

61563 .... ............ A ........ Excision of skull tumor ....................... 28.35 NA NA 13.20 14.45 5.17 090 

61564 .... ............ A ........ Excision of skull tumor ....................... 34.59 NA NA 18.07 17.92 8.78 090 

61566 .... ............ A ........ Removal of brain tissue ...................... 32.32 NA NA 16.79 17.30 6.94 090 

61567 .... ............ A ........ Incision of brain tissue ........................ 36.84 NA NA 19.25 19.60 6.54 090 

61570 .... ............ A ........ Remove foreign body, brain ............... 26.38 NA NA 14.11 14.06 5.88 090 

61571 .... ............ A ........ Incise skull for brain wound ................ 28.29 NA NA 14.77 15.06 6.79 090 

61575 .... ............ A ........ Skull base/brainstem surgery ............. 36.43 NA NA 16.33 17.91 5.34 090 

61576 .... ............ A ........ Skull base/brainstem surgery ............. 55.11 NA NA 28.10 31.11 5.58 090 

61580 .... ............ A ........ Craniofacial approach, skull ............... 34.34 NA NA 22.87 23.92 3.37 090 

61581 .... ............ A ........ Craniofacial approach, skull ............... 38.88 NA NA 27.92 25.23 3.92 090 

61582 .... ............ A ........ Craniofacial approach, skull ............... 34.93 NA NA 30.64 28.97 7.21 090 

61583 .... ............ A ........ Craniofacial approach, skull ............... 38.41 NA NA 26.05 25.59 9.21 090 

61584 .... ............ A ........ Orbitocranial approach/skull ............... 37.61 NA NA 26.18 25.29 8.18 090 

61585 .... ............ A ........ Orbitocranial approach/skull ............... 42.46 NA NA 25.17 25.83 7.03 090 

61586 .... ............ A ........ Resect nasopharynx, skull ................. 27.28 NA NA 22.71 22.89 4.37 090 

61590 .... ............ A ........ Infratemporal approach/skull .............. 46.87 NA NA 24.91 26.54 5.31 090 

61591 .... ............ A ........ Infratemporal approach/skull .............. 46.87 NA NA 24.75 27.05 5.66 090 

61592 .... ............ A ........ Orbitocranial approach/skull ............... 42.98 NA NA 27.05 26.92 10.07 090 

61595 .... ............ A ........ Transtemporal approach/skull ............ 33.57 NA NA 21.25 21.52 3.98 090 

61596 .... ............ A ........ Transcochlear approach/skull ............. 39.31 NA NA 20.95 22.34 3.40 090 

61597 .... ............ A ........ Transcondylar approach/skull ............. 40.73 NA NA 23.27 23.11 8.84 090 

61598 .... ............ A ........ Transpetrosal approach/skull ............. 36.41 NA NA 22.34 22.61 5.70 090 

61600 .... ............ A ........ Resect/excise cranial lesion ............... 29.84 NA NA 19.82 19.59 3.79 090 

61601 .... ............ A ........ Resect/excise cranial lesion ............... 31.04 NA NA 22.47 21.50 6.63 090 

61605 .... ............ A ........ Resect/excise cranial lesion ............... 32.40 NA NA 19.52 20.47 2.86 090 

61606 .... ............ A ........ Resect/excise cranial lesion ............... 41.94 NA NA 23.89 24.64 8.97 090 

61607 .... ............ A ........ Resect/excise cranial lesion ............... 40.82 NA NA 21.22 22.45 6.90 090 

61608 .... ............ A ........ Resect/excise cranial lesion ............... 45.45 NA NA 26.57 26.63 10.75 090 

61609 .... ............ A ........ Transect artery, sinus ......................... 9.88 NA NA 3.30 4.16 2.56 ZZZ 

61610 .... ............ A ........ Transect artery, sinus ......................... 29.63 NA NA 11.23 12.22 7.68 ZZZ 

61611 .... ............ A ........ Transect artery, sinus ......................... 7.41 NA NA 1.71 2.96 1.89 ZZZ 

61612 .... ............ A ........ Transect artery, sinus ......................... 27.84 NA NA 6.42 10.19 4.31 ZZZ 

61613 .... ............ A ........ Remove aneurysm, sinus ................... 44.94 NA NA 27.55 26.96 8.45 090 

61615 .... ............ A ........ Resect/excise lesion, skull ................. 35.63 NA NA 21.37 21.75 4.73 090 

61616 .... ............ A ........ Resect/excise lesion, skull ................. 46.60 NA NA 27.46 27.97 8.26 090 

61618 .... ............ A ........ Repair dura ......................................... 18.58 NA NA 10.51 10.43 3.72 090 

61619 .... ............ A ........ Repair dura ......................................... 22.01 NA NA 11.76 11.90 3.95 090 

61623 .... ............ A ........ Endovasc tempory vessel occl ........... 9.95 NA NA 3.77 3.82 1.05 000 

61624 .... ............ A ........ Transcath occlusion, cns .................... 20.12 NA NA 7.39 6.96 1.96 000 

61626 .... ............ A ........ Transcath occlusion, non-cns ............. 16.60 NA NA 6.05 5.59 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 2.84 2.85 0.71 000 

61641 .... ............ N ........ Dilate ic vasospasm add-on ............... 4.33 NA NA 1.00 1.00 0.25 ZZZ 

61642 .... ............ N ........ Dilate ic vasospasm add-on ............... 8.66 NA NA 2.00 2.00 0.50 ZZZ 

61680 .... ............ A ........ Intracranial vessel surgery ................. 32.40 NA NA 16.89 17.20 7.95 090 

61682 .... ............ A ........ Intracranial vessel surgery ................. 63.31 NA NA 27.86 30.03 15.90 090 

61684 .... ............ A ........ Intracranial vessel surgery ................. 41.49 NA NA 20.58 21.33 10.31 090 

61686 .... ............ A ........ Intracranial vessel surgery ................. 67.32 NA NA 30.81 32.76 16.71 090 

61690 .... ............ A ........ Intracranial vessel surgery ................. 31.18 NA NA 16.67 16.60 6.94 090 

61692 .... ............ A ........ Intracranial vessel surgery ................. 54.43 NA NA 24.63 26.12 13.43 090 

61697 .... ............ A ........ Brain aneurysm repr, complx ............. 63.22 NA NA 28.96 28.54 12.85 090 

61698 .... ............ A ........ Brain aneurysm repr, complx ............. 69.45 NA NA 31.15 28.97 12.54 090 

61700 .... ............ A ........ Brain aneurysm repr, simple .............. 50.44 NA NA 24.27 26.06 13.02 090 

61702 .... ............ A ........ Inner skull vessel surgery ................... 59.86 NA NA 27.80 27.02 10.79 090 

61703 .... ............ A ........ Clamp neck artery .............................. 18.70 NA NA 10.17 10.45 4.06 090 

61705 .... ............ A ........ Revise circulation to head .................. 37.97 NA NA 18.51 18.78 8.87 090 

61708 .... ............ A ........ Revise circulation to head .................. 37.07 NA NA 15.03 14.73 2.51 090 

61710 .... ............ A ........ Revise circulation to head .................. 31.19 NA NA 13.90 13.58 4.52 090 

61711 .... ............ A ........ Fusion of skull arteries ....................... 38.10 NA NA 18.79 19.31 9.42 090 

61720 .... ............ A ........ Incise skull/brain surgery .................... 17.52 NA NA 7.97 9.02 2.79 090 

61735 .... ............ A ........ Incise skull/brain surgery .................... 22.22 NA NA 9.22 11.07 2.73 090 

61750 .... ............ A ........ Incise skull/brain biopsy ..................... 19.73 NA NA 11.03 10.84 4.72 090 

61751 .... ............ A ........ Brain biopsy w/ct/mr guide ................. 18.64 NA NA 11.45 11.16 4.56 090 

61760 .... ............ A ........ Implant brain electrodes ..................... 22.24 NA NA 12.15 10.42 5.42 090 

61770 .... ............ A ........ Incise skull for treatment .................... 23.09 NA NA 10.05 11.15 3.55 090 

61790 .... ............ A ........ Treat trigeminal nerve ........................ 11.50 NA NA 7.74 6.85 2.82 090 

61791 .... ............ A ........ Treat trigeminal tract .......................... 15.31 NA NA 8.27 8.50 3.40 090 

mstockstill on PROD1PC66 with PROPOSALS2

38301 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

61793 .... ............ A ........ Focus radiation beam ......................... 17.75 NA NA 9.62 9.93 4.46 090 

61795 .... ............ A ........ Brain surgery using computer ............ 4.03 NA NA 1.45 1.73 0.79 ZZZ 

61850 .... ............ A ........ Implant neuroelectrodes ..................... 13.26 NA NA 7.94 7.42 3.22 090 

61860 .... ............ A ........ Implant neuroelectrodes ..................... 22.16 NA NA 11.71 11.83 4.95 090 

61863 .... ............ A ........ Implant neuroelectrode ....................... 20.56 NA NA 12.51 12.16 5.43 090 

61864 .... ............ A ........ Implant neuroelectrde, addl ................ 4.49 NA NA 1.70 1.99 5.43 ZZZ 

61867 .... ............ A ........ Implant neuroelectrode ....................... 32.88 NA NA 16.50 17.33 5.43 090 

61868 .... ............ A ........ Implant neuroelectrde, addœl .............. 7.91 NA NA 2.98 3.50 5.43 ZZZ 

61870 .... ............ A ........ Implant neuroelectrodes ..................... 16.24 NA NA 9.76 9.57 3.87 090 

61875 .... ............ A ........ Implant neuroelectrodes ..................... 16.36 NA NA 5.32 6.95 2.95 090 

61880 .... ............ A ........ Revise/remove neuroelectrode ........... 6.87 NA NA 5.19 4.94 1.66 090 

61885 .... ............ A ........ Insrt/redo neurostim 1 array ............... 7.37 NA NA 7.07 6.26 1.59 090 

61886 .... ............ A ........ Implant neurostim arrays .................... 9.73 NA NA 8.53 7.49 1.97 090 

61888 .... ............ A ........ Revise/remove neuroreceiver ............. 5.20 NA NA 3.48 3.60 1.33 010 

62000 .... ............ A ........ Treat skull fracture .............................. 13.83 NA NA 7.69 6.53 1.06 090 

62005 .... ............ A ........ Treat skull fracture .............................. 17.53 NA NA 9.67 9.22 3.87 090 

62010 .... ............ A ........ Treatment of head injury .................... 21.30 NA NA 11.91 11.84 5.14 090 

62100 .... ............ A ........ Repair brain fluid leakage .................. 23.40 NA NA 12.18 12.46 4.84 090 

62115 .... ............ A ........ Reduction of skull defect .................... 22.71 NA NA 13.99 12.84 5.51 090 

62116 .... ............ A ........ Reduction of skull defect .................... 24.90 NA NA 13.45 13.40 6.11 090 

62117 .... ............ A ........ Reduction of skull defect .................... 28.26 NA NA 12.86 14.46 4.53 090 

62120 .... ............ A ........ Repair skull cavity lesion .................... 24.39 NA NA 17.26 17.65 3.00 090 

62121 .... ............ A ........ Incise skull repair ................................ 22.93 NA NA 14.26 14.85 4.17 090 

62140 .... ............ A ........ Repair of skull defect .......................... 14.45 NA NA 8.70 8.51 3.47 090 

62141 .... ............ A ........ Repair of skull defect .......................... 15.97 NA NA 9.41 9.23 3.76 090 

62142 .... ............ A ........ Remove skull plate/flap ...................... 11.73 NA NA 7.84 7.41 2.73 090 

62143 .... ............ A ........ Replace skull plate/flap ...................... 14.05 NA NA 8.79 8.43 3.37 090 

62145 .... ............ A ........ Repair of skull & brain ........................ 19.99 NA NA 10.33 10.62 4.50 090 

62146 .... ............ A ........ Repair of skull with graft ..................... 17.18 NA NA 9.59 9.55 3.62 090 

62147 .... ............ A ........ Repair of skull with graft ..................... 20.57 NA NA 11.07 11.13 4.32 090 

62148 .... ............ A ........ Retr bone flap to fix skull ................... 2.00 NA NA 0.75 0.81 0.48 ZZZ 

62160 .... ............ A ........ Neuroendoscopy add-on .................... 3.00 NA NA 1.12 1.33 0.77 ZZZ 

62161 .... ............ A ........ Dissect brain w/scope ........................ 21.10 NA NA 12.25 12.18 5.19 090 

62162 .... ............ A ........ Remove colloid cyst w/scope ............. 26.67 NA NA 14.77 14.69 5.91 090 

62163 .... ............ A ........ Neuroendoscopy w/fb removal ........... 16.40 NA NA 9.31 9.84 4.01 090 

62164 .... ............ A ........ Remove brain tumor w/scope ............ 29.27 NA NA 16.35 15.45 5.38 090 

62165 .... ............ A ........ Remove pituit tumor w/scope ............. 23.10 NA NA 11.86 12.59 3.01 090 

62180 .... ............ A ........ Establish brain cavity shunt ................ 22.45 NA NA 12.63 12.38 4.98 090 

62190 .... ............ A ........ Establish brain cavity shunt ................ 12.07 NA NA 7.59 7.36 2.80 090 

62192 .... ............ A ........ Establish brain cavity shunt ................ 13.25 NA NA 8.06 7.91 3.02 090 

62194 .... ............ A ........ Replace/irrigate catheter .................... 5.68 NA NA 3.17 2.90 0.92 010 

62200 .... ............ A ........ Establish brain cavity shunt ................ 19.19 NA NA 10.79 10.82 4.65 090 

62201 .... ............ A ........ Brain cavity shunt w/scope ................. 15.89 NA NA 10.41 9.96 3.68 090 

62220 .... ............ A ........ Establish brain cavity shunt ................ 14.00 NA NA 8.68 8.30 3.35 090 

62223 .... ............ A ........ Establish brain cavity shunt ................ 13.90 NA NA 9.41 8.84 3.14 090 

62225 .... ............ A ........ Replace/irrigate catheter .................... 6.11 NA NA 5.50 4.80 1.39 090 

62230 .... ............ A ........ Replace/revise brain shunt ................. 11.35 NA NA 7.26 6.89 2.71 090 

62252 .... ............ A ........ Csf shunt reprogram ........................... 0.74 1.76 1.62 NA NA 0.21 XXX 

62252 .... 26 ....... A ........ Csf shunt reprogram ........................... 0.74 0.27 0.32 0.27 0.32 0.19 XXX 

62252 .... TC ...... A ........ Csf shunt reprogram ........................... 0.00 1.49 1.30 NA NA 0.02 XXX 

62256 .... ............ A ........ Remove brain cavity shunt ................. 7.30 NA NA 5.92 5.31 1.72 090 

62258 .... ............ A ........ Replace brain cavity shunt ................. 15.54 NA NA 9.37 9.04 3.74 090 

62263 .... ............ A ........ Epidural lysis mult sessions ............... 6.41 9.42 10.99 2.99 3.07 0.41 010 

62264 .... ............ A ........ Epidural lysis on single day ................ 4.42 5.61 6.67 1.26 1.34 0.27 010 

62268 .... ............ A ........ Drain spinal cord cyst ......................... 4.73 6.65 9.06 1.82 1.95 0.43 000 

62269 .... ............ A ........ Needle biopsy, spinal cord ................. 5.01 6.24 10.53 1.50 1.75 0.37 000 

62270 .... ............ A ........ Spinal fluid tap, diagnostic ................. 1.37 2.38 2.67 0.58 0.56 0.08 000 

62272 .... ............ A ........ Drain cerebro spinal fluid ................... 1.35 3.11 3.35 0.62 0.66 0.18 000 

62273 .... ............ A ........ Inject epidural patch ........................... 2.15 1.66 2.19 0.58 0.65 0.13 000 

62280 .... ............ A ........ Treat spinal cord lesion ...................... 2.63 4.62 5.71 1.16 1.07 0.30 010 

62281 .... ............ A ........ Treat spinal cord lesion ...................... 2.66 4.05 4.79 1.03 0.94 0.19 010 

62282 .... ............ A ........ Treat spinal canal lesion .................... 2.33 4.06 6.19 1.12 1.01 0.17 010 

62284 .... ............ A ........ Injection for myelogram ...................... 1.54 3.77 4.34 0.72 0.69 0.13 000 

62287 .... ............ A ........ Percutaneous diskectomy .................. 8.88 NA NA 4.30 4.89 0.58 090 

62290 .... ............ A ........ Inject for spine disk x-ray ................... 3.00 4.48 5.78 1.16 1.26 0.23 000 

62291 .... ............ A ........ Inject for spine disk x-ray ................... 2.91 4.20 5.05 1.09 1.15 0.26 000 

62292 .... ............ A ........ Injection into disk lesion ..................... 9.14 NA NA 2.90 3.73 0.82 090 

62294 .... ............ A ........ Injection into spinal artery .................. 12.77 NA NA 6.54 5.90 1.24 090 

62310 .... ............ A ........ Inject spine c/t .................................... 1.91 2.98 3.89 0.57 0.61 0.12 000 

62311 .... ............ A ........ Inject spine l/s (cd) ............................. 1.54 2.64 3.78 0.53 0.56 0.09 000 

62318 .... ............ A ........ Inject spine w/cath, c/t ........................ 2.04 3.07 4.42 0.43 0.55 0.12 000 

62319 .... ............ A ........ Inject spine w/cath l/s (cd) .................. 1.87 2.78 3.89 0.44 0.53 0.11 000 

mstockstill on PROD1PC66 with PROPOSALS2

38302 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

62350 .... ............ A ........ Implant spinal canal cath .................... 8.04 NA NA 4.01 4.00 1.02 090 

62351 .... ............ A ........ Implant spinal canal cath .................... 11.54 NA NA 7.66 7.41 2.25 090 

62355 .... ............ A ........ Remove spinal canal catheter ............ 6.60 NA NA 3.54 3.36 0.71 090 

62360 .... ............ A ........ Insert spine infusion device ................ 3.68 NA NA 3.15 2.96 0.34 090 

62361 .... ............ A ........ Implant spine infusion pump .............. 6.59 NA NA 4.06 3.98 0.80 090 

62362 .... ............ A ........ Implant spine infusion pump .............. 8.58 NA NA 4.68 4.53 1.18 090 

62365 .... ............ A ........ Remove spine infusion device ........... 6.57 NA NA 3.73 3.68 0.86 090 

62367 .... ............ A ........ Analyze spine infusion pump ............. 0.48 0.42 0.51 0.12 0.11 0.03 XXX 

62368 .... ............ A ........ Analyze spine infusion pump ............. 0.75 0.58 0.64 0.18 0.17 0.06 XXX 

63001 .... ............ A ........ Removal of spinal lamina ................... 17.51 NA NA 9.83 9.70 3.77 090 

63003 .... ............ A ........ Removal of spinal lamina ................... 17.64 NA NA 9.78 9.84 3.73 090 

63005 .... ............ A ........ Removal of spinal lamina ................... 16.28 NA NA 9.78 9.89 3.35 090 

63011 .... ............ A ........ Removal of spinal lamina ................... 15.78 NA NA 9.05 8.70 3.38 090 

63012 .... ............ A ........ Removal of spinal lamina ................... 16.72 NA NA 9.81 9.99 3.49 090 

63015 .... ............ A ........ Removal of spinal lamina ................... 20.70 NA NA 11.94 11.94 4.76 090 

63016 .... ............ A ........ Removal of spinal lamina ................... 21.90 NA NA 11.72 11.81 4.59 090 

63017 .... ............ A ........ Removal of spinal lamina ................... 17.18 NA NA 10.41 10.42 3.64 090 

63020 .... ............ A ........ Neck spine disk surgery ..................... 16.05 NA NA 9.94 9.83 3.72 090 

63030 .... ............ A ........ Low back disk surgery ........................ 13.03 NA NA 8.64 8.55 3.01 090 

63035 .... ............ A ........ Spinal disk surgery add-on ................. 3.15 NA NA 1.21 1.40 0.79 ZZZ 

63040 .... ............ A ........ Laminotomy, single cervical ............... 20.18 NA NA 11.11 11.32 4.68 090 

63042 .... ............ A ........ Laminotomy, single lumbar ................ 18.61 NA NA 10.64 11.01 4.26 090 

63043 .... ............ C ........ Laminotomy, addœl cervical ................ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

63044 .... ............ C ........ Laminotomy, addœlumbar ................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

63045 .... ............ A ........ Removal of spinal lamina ................... 17.82 NA NA 10.40 10.40 3.99 090 

63046 .... ............ A ........ Removal of spinal lamina ................... 17.12 NA NA 9.83 10.03 3.56 090 

63047 .... ............ A ........ Removal of spinal lamina ................... 15.22 NA NA 9.38 9.65 3.24 090 

63048 .... ............ A ........ Remove spinal lamina add-on ............ 3.47 NA NA 1.33 1.50 0.72 ZZZ 

63050 .... ............ A ........ Cervical laminoplasty .......................... 21.88 NA NA 11.89 11.37 4.67 090 

63051 .... ............ A ........ C-laminoplasty w/graft/plate ............... 25.38 NA NA 13.15 13.08 4.67 090 

63055 .... ............ A ........ Decompress spinal cord ..................... 23.42 NA NA 12.55 12.84 5.29 090 

63056 .... ............ A ........ Decompress spinal cord ..................... 21.73 NA NA 11.46 12.03 4.76 090 

63057 .... ............ A ........ Decompress spine cord add-on ......... 5.25 NA NA 2.01 2.32 1.22 ZZZ 

63064 .... ............ A ........ Decompress spinal cord ..................... 26.09 NA NA 13.30 13.91 5.71 090 

63066 .... ............ A ........ Decompress spine cord add-on ......... 3.26 NA NA 1.23 1.45 0.69 ZZZ 

63075 .... ............ A ........ Neck spine disk surgery ..................... 19.47 NA NA 11.07 11.60 4.63 090 

63076 .... ............ A ........ Neck spine disk surgery ..................... 4.04 NA NA 1.53 1.80 0.96 ZZZ 

63077 .... ............ A ........ Spine disk surgery, thorax .................. 22.75 NA NA 11.15 11.99 3.99 090 

63078 .... ............ A ........ Spine disk surgery, thorax .................. 3.28 NA NA 1.22 1.43 0.66 ZZZ 

63081 .... ............ A ........ Removal of vertebral body ................. 25.97 NA NA 13.59 13.99 5.56 090 

63082 .... ............ A ........ Remove vertebral body add-on .......... 4.36 NA NA 1.66 1.95 1.02 ZZZ 

63085 .... ............ A ........ Removal of vertebral body ................. 29.34 NA NA 13.64 14.60 4.49 090 

63086 .... ............ A ........ Remove vertebral body add-on .......... 3.19 NA NA 1.18 1.39 0.59 ZZZ 

63087 .... ............ A ........ Removal of vertebral body ................. 37.38 NA NA 16.74 18.14 6.22 090 

63088 .... ............ A ........ Remove vertebral body add-on .......... 4.32 NA NA 1.61 1.90 0.82 ZZZ 

63090 .... ............ A ........ Removal of vertebral body ................. 30.78 NA NA 14.47 15.21 4.22 090 

63091 .... ............ A ........ Remove vertebral body add-on .......... 3.03 NA NA 1.15 1.30 0.48 ZZZ 

63101 .... ............ A ........ Removal of vertebral body ................. 33.92 NA NA 17.17 18.26 5.71 090 

63102 .... ............ A ........ Removal of vertebral body ................. 33.92 NA NA 16.94 18.13 5.71 090 

63103 .... ............ A ........ Remove vertebral body add-on .......... 4.82 NA NA 1.77 2.14 0.69 ZZZ 

63170 .... ............ A ........ Incise spinal cord tract(s) ................... 22.08 NA NA 10.52 11.57 4.87 090 

63172 .... ............ A ........ Drainage of spinal cyst ....................... 19.66 NA NA 11.15 10.94 4.49 090 

63173 .... ............ A ........ Drainage of spinal cyst ....................... 24.18 NA NA 13.68 13.22 5.70 090 

63180 .... ............ A ........ Revise spinal cord ligaments ............. 20.40 NA NA 11.04 11.00 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 10.19 9.14 2.80 090 

63190 .... ............ A ........ Incise spinal column/nerves ............... 18.76 NA NA 9.66 9.99 3.25 090 

63191 .... ............ A ........ Incise spinal column/nerves ............... 18.79 NA NA 4.14 8.43 6.36 090 

63194 .... ............ A ........ Incise spinal column & cord ............... 21.97 NA NA 11.28 11.10 3.27 090 

63195 .... ............ A ........ Incise spinal column & cord ............... 21.54 NA NA 12.20 11.65 4.88 090 

63196 .... ............ A ........ Incise spinal column & cord ............... 25.14 NA NA 13.90 13.67 5.78 090 

63197 .... ............ A ........ Incise spinal column & cord ............... 23.95 NA NA 7.46 10.85 5.38 090 

63198 .... ............ A ........ Incise spinal column & cord ............... 29.75 NA NA 8.91 8.68 6.45 090 

63199 .... ............ A ........ Incise spinal column & cord ............... 31.32 NA NA 9.27 12.16 1.40 090 

63200 .... ............ A ........ Release of spinal cord ........................ 21.31 NA NA 12.18 11.69 4.97 090 

63250 .... ............ A ........ Revise spinal cord vessels ................. 43.73 NA NA 21.13 20.58 9.04 090 

63251 .... ............ A ........ Revise spinal cord vessels ................. 44.49 NA NA 21.75 22.16 10.44 090 

63252 .... ............ A ........ Revise spinal cord vessels ................. 44.48 NA NA 21.08 21.74 10.67 090 

63265 .... ............ A ........ Excise intraspinal lesion ..................... 23.69 NA NA 13.11 12.96 5.45 090 

63266 .... ............ A ........ Excise intraspinal lesion ..................... 24.55 NA NA 13.27 13.25 5.56 090 

63267 .... ............ A ........ Excise intraspinal lesion ..................... 19.32 NA NA 11.20 11.16 4.38 090 

63268 .... ............ A ........ Excise intraspinal lesion ..................... 19.89 NA NA 10.93 10.65 3.70 090 

mstockstill on PROD1PC66 with PROPOSALS2

38303 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

63270 .... ............ A ........ Excise intraspinal lesion ..................... 29.67 NA NA 15.49 15.56 6.84 090 

63271 .... ............ A ........ Excise intraspinal lesion ..................... 29.79 NA NA 15.44 15.52 6.92 090 

63272 .... ............ A ........ Excise intraspinal lesion ..................... 27.37 NA NA 14.42 14.57 6.20 090 

63273 .... ............ A ........ Excise intraspinal lesion ..................... 26.34 NA NA 14.16 14.22 5.76 090 

63275 .... ............ A ........ Biopsy/excise spinal tumor ................. 25.73 NA NA 13.84 13.77 5.82 090 

63276 .... ............ A ........ Biopsy/excise spinal tumor ................. 25.56 NA NA 13.62 13.69 5.85 090 

63277 .... ............ A ........ Biopsy/excise spinal tumor ................. 22.26 NA NA 12.21 12.38 5.03 090 

63278 .... ............ A ........ Biopsy/excise spinal tumor ................. 21.99 NA NA 11.99 12.22 4.56 090 

63280 .... ............ A ........ Biopsy/excise spinal tumor ................. 30.14 NA NA 16.01 16.20 7.29 090 

63281 .... ............ A ........ Biopsy/excise spinal tumor ................. 29.84 NA NA 16.00 16.09 7.19 090 

63282 .... ............ A ........ Biopsy/excise spinal tumor ................. 28.00 NA NA 15.13 15.26 6.78 090 

63283 .... ............ A ........ Biopsy/excise spinal tumor ................. 26.61 NA NA 14.80 14.65 6.28 090 

63285 .... ............ A ........ Biopsy/excise spinal tumor ................. 37.90 NA NA 18.24 19.27 9.21 090 

63286 .... ............ A ........ Biopsy/excise spinal tumor ................. 37.47 NA NA 18.87 19.42 9.24 090 

63287 .... ............ A ........ Biopsy/excise spinal tumor ................. 39.93 NA NA 19.80 20.11 9.42 090 

63290 .... ............ A ........ Biopsy/excise spinal tumor ................. 40.67 NA NA 19.44 20.17 9.05 090 

63295 .... ............ A ........ Repair of laminectomy defect ............. 5.25 NA NA 1.99 1.96 1.03 ZZZ 

63300 .... ............ A ........ Removal of vertebral body ................. 26.67 NA NA 13.92 14.07 5.99 090 

63301 .... ............ A ........ Removal of vertebral body ................. 31.42 NA NA 14.24 15.05 5.41 090 

63302 .... ............ A ........ Removal of vertebral body ................. 31.00 NA NA 13.91 15.05 5.55 090 

63303 .... ............ A ........ Removal of vertebral body ................. 33.42 NA NA 15.03 15.92 4.69 090 

63304 .... ............ A ........ Removal of vertebral body ................. 33.70 NA NA 17.74 17.43 6.43 090 

63305 .... ............ A ........ Removal of vertebral body ................. 36.09 NA NA 17.08 17.67 5.73 090 

63306 .... ............ A ........ Removal of vertebral body ................. 35.40 NA NA 16.75 17.12 8.35 090 

63307 .... ............ A ........ Removal of vertebral body ................. 34.81 NA NA 14.75 16.30 4.47 090 

63308 .... ............ A ........ Remove vertebral body add-on .......... 5.24 NA NA 1.97 2.28 1.29 ZZZ 

63600 .... ............ A ........ Remove spinal cord lesion ................. 15.02 NA NA 4.08 4.81 1.52 090 

63610 .... ............ A ........ Stimulation of spinal cord ................... 8.72 13.66 36.72 1.46 1.87 0.86 000 

63615 .... ............ A ........ Remove lesion of spinal cord ............. 17.22 NA NA 8.59 8.50 2.85 090 

63650 .... ............ A ........ Implant neuroelectrodes ..................... 7.57 NA NA 2.94 3.05 0.53 090 

63655 .... ............ A ........ Implant neuroelectrodes ..................... 11.43 NA NA 7.67 7.32 2.44 090 

63660 .... ............ A ........ Revise/remove neuroelectrode ........... 6.87 NA NA 3.45 3.51 0.78 090 

63685 .... ............ A ........ Insrt/redo spine n generator ............... 7.87 NA NA 3.68 3.91 1.05 090 

63688 .... ............ A ........ Revise/remove neuroreceiver ............. 6.10 NA NA 3.54 3.55 0.89 090 

63700 .... ............ A ........ Repair of spinal herniation ................. 17.32 NA NA 9.95 10.12 3.53 090 

63702 .... ............ A ........ Repair of spinal herniation ................. 19.26 NA NA 10.03 10.70 4.13 090 

63704 .... ............ A ........ Repair of spinal herniation ................. 22.23 NA NA 11.72 12.48 4.58 090 

63706 .... ............ A ........ Repair of spinal herniation ................. 25.15 NA NA 14.39 14.13 6.25 090 

63707 .... ............ A ........ Repair spinal fluid leakage ................. 12.52 NA NA 7.87 7.80 2.52 090 

63709 .... ............ A ........ Repair spinal fluid leakage ................. 15.52 NA NA 9.02 9.23 3.10 090 

63710 .... ............ A ........ Graft repair of spine defect ................ 15.27 NA NA 9.25 9.16 3.41 090 

63740 .... ............ A ........ Install spinal shunt .............................. 12.50 NA NA 8.31 7.83 2.94 090 

63741 .... ............ A ........ Install spinal shunt .............................. 9.02 NA NA 4.96 4.84 1.66 090 

63744 .... ............ A ........ Revision of spinal shunt ..................... 8.86 NA NA 5.82 5.59 1.90 090 

63746 .... ............ A ........ Removal of spinal shunt ..................... 7.25 NA NA 5.69 4.58 1.53 090 

64400 .... ............ A ........ N block inj, trigeminal ......................... 1.11 1.40 1.65 0.44 0.44 0.07 000 

64402 .... ............ A ........ N block inj, facial ................................ 1.25 1.40 1.51 0.50 0.55 0.09 000 

64405 .... ............ A ........ N block inj, occipital ............................ 1.32 1.15 1.31 0.50 0.48 0.08 000 

64408 .... ............ A ........ N block inj, vagus ............................... 1.41 1.44 1.51 0.71 0.78 0.10 000 

64410 .... ............ A ........ N block inj, phrenic ............................. 1.43 1.91 2.19 0.56 0.51 0.09 000 

64412 .... ............ A ........ N block inj, spinal accessor ................ 1.18 2.12 2.37 0.59 0.50 0.08 000 

64413 .... ............ A ........ N block inj, cervical plexus ................. 1.40 1.30 1.57 0.48 0.49 0.08 000 

64415 .... ............ A ........ N block inj, brachial plexus ................ 1.48 1.40 2.11 0.31 0.39 0.09 000 

64416 .... ............ A ........ N block cont infuse, b plex ................. 3.85 NA NA 0.47 0.65 0.31 010 

64417 .... ............ A ........ N block inj, axillary ............................. 1.44 1.42 2.24 0.32 0.41 0.11 000 

64418 .... ............ A ........ N block inj, suprascapular .................. 1.32 1.89 2.25 0.52 0.48 0.07 000 

64420 .... ............ A ........ N block inj, intercost, sng ................... 1.18 2.38 3.13 0.45 0.44 0.08 000 

64421 .... ............ A ........ N block inj, intercost, mlt .................... 1.68 3.53 4.80 0.53 0.52 0.11 000 

64425 .... ............ A ........ N block inj, ilio-ing/hypogi ................... 1.75 1.29 1.48 0.53 0.54 0.13 000 

64430 .... ............ A ........ N block inj, pudendal .......................... 1.46 2.39 2.45 0.78 0.67 0.10 000 

64435 .... ............ A ........ N block inj, paracervical ..................... 1.45 1.99 2.25 0.56 0.63 0.16 000 

64445 .... ............ A ........ N block inj, sciatic, sng ....................... 1.48 1.62 2.15 0.51 0.51 0.10 000 

64446 .... ............ A ........ N blk inj, sciatic, cont inf .................... 3.61 NA NA 0.49 0.76 0.20 010 

64447 .... ............ A ........ N block inj fem, single ........................ 1.50 NA NA 0.18 0.31 0.09 000 

64448 .... ............ A ........ N block inj fem, cont inf ...................... 3.36 NA NA 0.40 0.62 0.18 010 

64449 .... ............ A ........ N block inj, lumbar plexus .................. 3.24 NA NA 0.42 0.70 0.15 010 

64450 .... ............ A ........ N block, other peripheral .................... 1.27 1.25 1.25 0.48 0.49 0.13 000 

64470 .... ............ A ........ Inj paravertebral c/t ............................. 1.85 3.79 5.51 0.70 0.71 0.11 000 

64472 .... ............ A ........ Inj paravertebral c/t add-on ................ 1.29 1.21 1.77 0.33 0.34 0.08 ZZZ 

64475 .... ............ A ........ Inj paravertebral l/s ............................. 1.41 3.62 5.25 0.58 0.61 0.10 000 

64476 .... ............ A ........ Inj paravertebral l/s add-on ................ 0.98 1.10 1.61 0.23 0.24 0.07 ZZZ 

64479 .... ............ A ........ Inj foramen epidural c/t ....................... 2.20 3.73 5.61 0.81 0.85 0.12 000 

mstockstill on PROD1PC66 with PROPOSALS2

38304 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

64480 .... ............ A ........ Inj foramen epidural add-on ............... 1.54 1.54 2.18 0.40 0.43 0.10 ZZZ 

64483 .... ............ A ........ Inj foramen epidural l/s ....................... 1.90 3.80 5.84 0.75 0.79 0.11 000 

64484 .... ............ A ........ Inj foramen epidural add-on ............... 1.33 1.62 2.45 0.33 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 2.00 2.64 0.55 0.64 0.07 000 

64510 .... ............ A ........ N block, stellate ganglion ................... 1.22 1.89 2.67 0.43 0.47 0.07 000 

64517 .... ............ A ........ N block inj, hypogas plxs ................... 2.20 1.72 2.21 0.69 0.77 0.11 000 

64520 .... ............ A ........ N block, lumbar/thoracic ..................... 1.35 2.56 3.85 0.51 0.53 0.08 000 

64530 .... ............ A ........ N block inj, celiac pelus ...................... 1.58 2.78 3.58 0.66 0.64 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 2.67 2.72 1.46 1.64 0.18 010 

64555 .... ............ A ........ Implant neuroelectrodes ..................... 2.29 2.77 2.90 1.49 1.32 0.19 010 

64560 .... ............ A ........ Implant neuroelectrodes ..................... 2.38 2.40 2.53 1.26 1.29 0.22 010 

64561 .... ............ A ........ Implant neuroelectrodes ..................... 7.07 19.55 24.86 3.80 3.30 0.51 010 

64565 .... ............ A ........ Implant neuroelectrodes ..................... 1.78 2.44 2.87 1.28 1.27 0.13 010 

64573 .... ............ A ........ Implant neuroelectrodes ..................... 8.15 NA NA 5.18 5.27 1.60 090 

64575 .... ............ A ........ Implant neuroelectrodes ..................... 4.37 NA NA 2.06 2.35 0.61 090 

64577 .... ............ A ........ Implant neuroelectrodes ..................... 4.64 NA NA 4.79 3.71 1.04 090 

64580 .... ............ A ........ Implant neuroelectrodes ..................... 4.14 NA NA 2.72 3.13 0.36 090 

64581 .... ............ A ........ Implant neuroelectrodes ..................... 14.15 NA NA 6.69 6.05 1.05 090 

64585 .... ............ A ........ Revise/remove neuroelectrode ........... 2.08 5.89 8.56 2.29 2.20 0.20 010 

64590 .... ............ A ........ Insrt/redo pn/gastr stimul .................... 2.42 6.38 6.76 2.46 2.37 0.19 010 

64595 .... ............ A ........ Revise/rmv pn/gastr stimul ................. 1.75 6.41 8.41 2.17 2.05 0.19 010 

64600 .... ............ A ........ Injection treatment of nerve ................ 3.46 5.41 7.35 1.65 1.64 0.34 010 

64605 .... ............ A ........ Injection treatment of nerve ................ 5.62 7.16 8.41 2.28 2.25 0.79 010 

64610 .... ............ A ........ Injection treatment of nerve ................ 7.17 9.24 9.08 3.48 3.61 1.58 010 

64612 .... ............ A ........ Destroy nerve, face muscle ................ 1.98 1.59 2.04 1.34 1.34 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 1.31 1.31 0.10 010 

64620 .... ............ A ........ Injection treatment of nerve ................ 2.86 3.29 4.19 1.11 1.22 0.20 010 

64622 .... ............ A ........ Destr paravertebrl nerve l/s ................ 3.02 4.04 5.89 1.26 1.31 0.18 010 

64623 .... ............ A ........ Destr paravertebral n add-on ............. 0.99 1.67 2.30 0.22 0.22 0.06 ZZZ 

64626 .... ............ A ........ Destr paravertebrl nerve c/t ................ 3.82 4.72 6.23 1.88 1.91 0.20 010 

64627 .... ............ A ........ Destr paravertebral n add-on ............. 1.16 2.36 3.44 0.25 0.26 0.07 ZZZ 

64630 .... ............ A ........ Injection treatment of nerve ................ 3.02 2.77 2.75 1.85 1.64 0.22 010 

64640 .... ............ A ........ Injection treatment of nerve ................ 2.78 2.36 3.29 1.38 1.63 0.29 010 

64650 .... ............ A ........ Chemodenerv eccrine glands ............. 0.70 0.71 0.80 0.16 0.23 0.06 000 

64653 .... ............ A ........ Chemodenerv eccrine glands ............. 0.88 0.75 0.85 0.19 0.29 0.08 000 

64680 .... ............ A ........ Injection treatment of nerve ................ 2.64 4.22 5.42 1.20 1.29 0.18 010 

64681 .... ............ A ........ Injection treatment of nerve ................ 3.78 4.74 7.03 1.26 1.67 0.28 010 

64702 .... ............ A ........ Revise finger/toe nerve ...................... 6.10 NA NA 5.15 4.54 0.61 090 

64704 .... ............ A ........ Revise hand/foot nerve ...................... 4.61 NA NA 3.05 3.21 0.61 090 

64708 .... ............ A ........ Revise arm/leg nerve ......................... 6.22 NA NA 4.16 4.54 0.96 090 

64712 .... ............ A ........ Revision of sciatic nerve .................... 7.98 NA NA 4.34 4.69 0.95 090 

64713 .... ............ A ........ Revision of arm nerve(s) .................... 11.29 NA NA 6.05 6.04 1.83 090 

64714 .... ............ A ........ Revise low back nerve(s) ................... 10.44 NA NA 4.37 4.38 1.19 090 

64716 .... ............ A ........ Revision of cranial nerve .................... 6.86 NA NA 5.47 5.68 0.63 090 

64718 .... ............ A ........ Revise ulnar nerve at elbow ............... 7.06 NA NA 6.18 6.10 1.05 090 

64719 .... ............ A ........ Revise ulnar nerve at wrist ................. 4.89 NA NA 4.12 4.33 0.77 090 

64721 .... ............ A ........ Carpal tunnel surgery ......................... 4.84 4.69 5.04 4.63 5.00 0.73 090 

64722 .... ............ A ........ Relieve pressure on nerve(s) ............. 4.74 NA NA 2.98 2.99 0.48 090 

64726 .... ............ A ........ Release foot/toe nerve ....................... 4.21 NA NA 2.59 2.72 0.54 090 

64727 .... ............ A ........ Internal nerve revision ........................ 3.10 NA NA 1.19 1.36 0.48 ZZZ 

64732 .... ............ A ........ Incision of brow nerve ........................ 4.81 NA NA 3.67 3.70 0.98 090 

64734 .... ............ A ........ Incision of cheek nerve ...................... 5.45 NA NA 4.45 4.29 0.89 090 

64736 .... ............ A ........ Incision of chin nerve ......................... 5.13 NA NA 3.74 3.91 0.52 090 

64738 .... ............ A ........ Incision of jaw nerve ........................... 6.26 NA NA 4.67 4.58 1.08 090 

64740 .... ............ A ........ Incision of tongue nerve ..................... 6.12 NA NA 5.02 4.97 0.69 090 

64742 .... ............ A ........ Incision of facial nerve ........................ 6.75 NA NA 4.31 4.52 0.73 090 

64744 .... ............ A ........ Incise nerve, back of head ................. 5.64 NA NA 4.08 4.01 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 3.78 4.07 0.93 090 

64755 .... ............ A ........ Incision of stomach nerves ................. 14.97 NA NA 5.50 5.61 1.84 090 

64760 .... ............ A ........ Incision of vagus nerve ...................... 7.49 NA NA 3.76 3.62 0.81 090 

64761 .... ............ A ........ Incision of pelvis nerve ....................... 6.94 NA NA 4.28 3.85 0.53 090 

64763 .... ............ A ........ Incise hip/thigh nerve ......................... 7.46 NA NA 3.89 4.75 0.94 090 

64766 .... ............ A ........ Incise hip/thigh nerve ......................... 9.34 NA NA 4.55 5.02 1.06 090 

64771 .... ............ A ........ Sever cranial nerve ............................ 8.02 NA NA 5.65 5.55 1.23 090 

64772 .... ............ A ........ Incision of spinal nerve ....................... 7.74 NA NA 5.09 5.05 1.40 090 

64774 .... ............ A ........ Remove skin nerve lesion .................. 5.70 NA NA 4.00 3.91 0.74 090 

64776 .... ............ A ........ Remove digit nerve lesion .................. 5.52 NA NA 3.69 3.70 0.76 090 

64778 .... ............ A ........ Digit nerve surgery add-on ................. 3.11 NA NA 1.21 1.36 0.46 ZZZ 

mstockstill on PROD1PC66 with PROPOSALS2

38305 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

64782 .... ............ A ........ Remove limb nerve lesion .................. 6.76 NA NA 4.01 3.91 0.86 090 

64783 .... ............ A ........ Limb nerve surgery add-on ................ 3.71 NA NA 1.37 1.61 0.51 ZZZ 

64784 .... ............ A ........ Remove nerve lesion .......................... 10.49 NA NA 6.38 6.47 1.38 090 

64786 .... ............ A ........ Remove sciatic nerve lesion .............. 16.12 NA NA 8.46 9.25 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 3.73 0.73 090 

64790 .... ............ A ........ Removal of nerve lesion ..................... 11.97 NA NA 6.97 7.07 2.11 090 

64792 .... ............ A ........ Removal of nerve lesion ..................... 15.71 NA NA 8.31 8.60 2.49 090 

64795 .... ............ A ........ Biopsy of nerve ................................... 3.01 NA NA 1.43 1.50 0.52 000 

64802 .... ............ A ........ Remove sympathetic nerves .............. 10.24 NA NA 3.51 4.44 1.29 090 

64804 .... ............ A ........ Remove sympathetic nerves .............. 15.78 NA NA 6.02 6.59 2.15 090 

64809 .... ............ A ........ Remove sympathetic nerves .............. 14.61 NA NA 6.90 6.29 1.50 090 

64818 .... ............ A ........ Remove sympathetic nerves .............. 11.24 NA NA 4.33 4.80 1.33 090 

64820 .... ............ A ........ Remove sympathetic nerves .............. 10.64 NA NA 6.93 7.06 1.49 090 

64821 .... ............ A ........ Remove sympathetic nerves .............. 9.19 NA NA 6.50 6.96 1.24 090 

64822 .... ............ A ........ Remove sympathetic nerves .............. 9.19 NA NA 6.40 6.84 1.30 090 

64823 .... ............ A ........ Remove sympathetic nerves .............. 10.80 NA NA 6.34 7.38 1.57 090 

64831 .... ............ A ........ Repair of digit nerve ........................... 10.23 NA NA 6.60 6.87 1.41 090 

64832 .... ............ A ........ Repair nerve add-on ........................... 5.65 NA NA 2.31 2.64 0.85 ZZZ 

64834 .... ............ A ........ Repair of hand or foot nerve .............. 10.71 NA NA 6.43 6.80 1.54 090 

64835 .... ............ A ........ Repair of hand or foot nerve .............. 11.60 NA NA 6.93 7.39 1.74 090 

64836 .... ............ A ........ Repair of hand or foot nerve .............. 11.60 NA NA 7.12 7.39 1.68 090 

64837 .... ............ A ........ Repair nerve add-on ........................... 6.25 NA NA 2.62 2.95 0.97 ZZZ 

64840 .... ............ A ........ Repair of leg nerve ............................. 13.87 NA NA 7.44 7.47 1.37 090 

64856 .... ............ A ........ Repair/transpose nerve ...................... 14.94 NA NA 8.47 8.87 2.13 090 

64857 .... ............ A ........ Repair arm/leg nerve .......................... 15.69 NA NA 8.75 9.24 2.22 090 

64858 .... ............ A ........ Repair sciatic nerve ............................ 17.69 NA NA 9.59 10.32 3.34 090 

64859 .... ............ A ........ Nerve surgery ..................................... 4.25 NA NA 1.76 2.01 0.67 ZZZ 

64861 .... ............ A ........ Repair of arm nerves .......................... 20.74 NA NA 10.02 10.92 4.09 090 

64862 .... ............ A ........ Repair of low back nerves .................. 20.94 NA NA 9.78 10.35 4.32 090 

64864 .... ............ A ........ Repair of facial nerve ......................... 13.31 NA NA 7.50 8.08 1.26 090 

64865 .... ............ A ........ Repair of facial nerve ......................... 15.96 NA NA 11.55 12.29 1.50 090 

64866 .... ............ A ........ Fusion of facial/other nerve ................ 16.70 NA NA 11.13 12.36 2.05 090 

64868 .... ............ A ........ Fusion of facial/other nerve ................ 14.80 NA NA 9.82 10.52 1.43 090 

64870 .... ............ A ........ Fusion of facial/other nerve ................ 16.95 NA NA 8.17 8.51 1.30 090 

64872 .... ............ A ........ Subsequent repair of nerve ................ 1.99 NA NA 0.78 0.94 0.29 ZZZ 

64874 .... ............ A ........ Repair & revise nerve add-on ............ 2.98 NA NA 1.27 1.40 0.42 ZZZ 

64876 .... ............ A ........ Repair nerve/shorten bone ................. 3.37 NA NA 1.44 1.48 0.47 ZZZ 

64885 .... ............ A ........ Nerve graft, head or neck .................. 17.50 NA NA 9.00 10.31 1.63 090 

64886 .... ............ A ........ Nerve graft, head or neck .................. 20.72 NA NA 10.45 11.92 2.09 090 

64890 .... ............ A ........ Nerve graft, hand or foot .................... 16.11 NA NA 8.96 9.52 2.30 090 

64891 .... ............ A ........ Nerve graft, hand or foot .................... 17.22 NA NA 9.53 8.64 1.63 090 

64892 .... ............ A ........ Nerve graft, arm or leg ....................... 15.61 NA NA 9.14 8.99 2.48 090 

64893 .... ............ A ........ Nerve graft, arm or leg ....................... 16.74 NA NA 9.60 9.78 2.62 090 

64895 .... ............ A ........ Nerve graft, hand or foot .................... 20.26 NA NA 11.09 10.24 2.58 090 

64896 .... ............ A ........ Nerve graft, hand or foot .................... 21.81 NA NA 11.67 11.39 3.17 090 

64897 .... ............ A ........ Nerve graft, arm or leg ....................... 19.25 NA NA 10.51 10.62 2.55 090 

64898 .... ............ A ........ Nerve graft, arm or leg ....................... 20.82 NA NA 11.50 11.65 2.78 090 

64901 .... ............ A ........ Nerve graft add-on ............................. 10.20 NA NA 3.55 4.47 1.37 ZZZ 

64902 .... ............ A ........ Nerve graft add-on ............................. 11.81 NA NA 4.68 5.27 1.55 ZZZ 

64905 .... ............ A ........ Nerve pedicle transfer ........................ 14.98 NA NA 7.01 7.75 2.01 090 

64907 .... ............ A ........ Nerve pedicle transfer ........................ 19.90 NA NA 6.34 9.43 3.17 090 

64910 .... ............ A ........ Nerve repair w/allograft ...................... 11.21 NA NA 4.63 5.02 1.74 090 

64911 .... ............ A ........ Neurorraphy w/vein autograft ............. 14.21 NA NA 5.29 5.74 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 6.76 7.59 0.32 090 

65093 .... ............ A ........ Revise eye with implant ..................... 6.93 NA NA 6.82 7.80 0.34 090 

65101 .... ............ A ........ Removal of eye .................................. 8.10 NA NA 7.99 8.79 0.35 090 

65103 .... ............ A ........ Remove eye/insert implant ................. 8.64 NA NA 8.16 8.99 0.37 090 

65105 .... ............ A ........ Remove eye/attach implant ................ 9.70 NA NA 8.81 9.69 0.42 090 

65110 .... ............ A ........ Removal of eye .................................. 15.42 NA NA 11.50 12.62 0.81 090 

65112 .... ............ A ........ Remove eye/revise socket ................. 18.18 NA NA 13.29 14.70 1.30 090 

65114 .... ............ A ........ Remove eye/revise socket ................. 19.32 NA NA 13.58 15.01 1.02 090 

65125 .... ............ A ........ Revise ocular implant ......................... 3.18 6.69 7.76 3.17 3.39 0.19 090 

65130 .... ............ A ........ Insert ocular implant ........................... 8.22 NA NA 7.71 8.49 0.35 090 

65135 .... ............ A ........ Insert ocular implant ........................... 8.40 NA NA 7.78 8.59 0.36 090 

65140 .... ............ A ........ Attach ocular implant .......................... 9.23 NA NA 8.42 9.19 0.40 090 

65150 .... ............ A ........ Revise ocular implant ......................... 6.32 NA NA 6.31 7.18 0.31 090 

65155 .... ............ A ........ Reinsert ocular implant ....................... 9.87 NA NA 8.81 9.66 0.50 090 

65175 .... ............ A ........ Removal of ocular implant .................. 7.22 NA NA 7.07 7.82 0.31 090 

65205 .... ............ A ........ Remove foreign body from eye .......... 0.71 0.57 0.61 0.32 0.31 0.03 000 

65210 .... ............ A ........ Remove foreign body from eye .......... 0.84 0.71 0.76 0.39 0.39 0.04 000 

mstockstill on PROD1PC66 with PROPOSALS2

38306 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

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 0.84 0.42 0.41 0.04 000 

65235 .... ............ A ........ Remove foreign body from eye .......... 8.78 NA NA 6.83 6.82 0.37 090 

65260 .... ............ A ........ Remove foreign body from eye .......... 12.29 NA NA 8.80 9.28 0.57 090 

65265 .... ............ A ........ Remove foreign body from eye .......... 14.06 NA NA 9.67 10.20 0.62 090 

65270 .... ............ A ........ Repair of eye wound .......................... 1.92 3.82 4.53 1.21 1.30 0.09 010 

65272 .... ............ A ........ Repair of eye wound .......................... 4.49 6.30 7.04 3.18 3.26 0.19 090 

65273 .... ............ A ........ Repair of eye wound .......................... 5.03 NA NA 3.34 3.48 0.22 090 

65275 .... ............ A ........ Repair of eye wound .......................... 6.14 6.31 6.34 3.93 3.96 0.26 090 

65280 .... ............ A ........ Repair of eye wound .......................... 8.87 NA NA 5.88 6.09 0.38 090 

65285 .... ............ A ........ Repair of eye wound .......................... 14.43 NA NA 8.47 8.90 0.64 090 

65286 .... ............ A ........ Repair of eye wound .......................... 6.45 8.71 9.97 4.42 4.55 0.27 090 

65290 .... ............ A ........ Repair of eye socket wound ............... 6.35 NA NA 4.43 4.62 0.31 090 

65400 .... ............ A ........ Removal of eye lesion ........................ 7.27 7.47 7.94 5.88 6.03 0.30 090 

65410 .... ............ A ........ Biopsy of cornea ................................. 1.47 1.67 1.90 0.87 0.92 0.07 000 

65420 .... ............ A ........ Removal of eye lesion ........................ 4.24 6.85 7.88 3.98 4.23 0.21 090 

65426 .... ............ A ........ Removal of eye lesion ........................ 5.93 8.10 9.19 4.53 4.76 0.25 090 

65430 .... ............ A ........ Corneal smear .................................... 1.47 1.10 1.20 0.87 0.93 0.07 000 

65435 .... ............ A ........ Curette/treat cornea ............................ 0.92 0.86 0.93 0.65 0.68 0.04 000 

65436 .... ............ A ........ Curette/treat cornea ............................ 4.72 3.78 3.96 3.45 3.58 0.21 090 

65450 .... ............ A ........ Treatment of corneal lesion ................ 3.35 3.68 3.89 3.61 3.79 0.16 090 

65600 .... ............ A ........ Revision of cornea .............................. 4.07 4.44 4.75 3.40 3.40 0.17 090 

65710 .... ............ A ........ Corneal transplant .............................. 14.09 NA NA 10.22 10.77 0.61 090 

65730 .... ............ A ........ Corneal transplant .............................. 15.99 NA NA 11.05 11.60 0.70 090 

65750 .... ............ A ........ Corneal transplant .............................. 16.60 NA NA 10.71 11.41 0.74 090 

65755 .... ............ A ........ Corneal transplant .............................. 16.49 NA NA 10.68 11.35 0.73 090 

65770 .... ............ A ........ Revise cornea with implant ................ 19.41 NA NA 11.77 12.56 0.87 090 

65772 .... ............ A ........ Correction of astigmatism ................... 4.96 4.86 5.22 3.94 4.06 0.21 090 

65775 .... ............ A ........ Correction of astigmatism ................... 6.73 NA NA 5.33 5.67 0.28 090 

65780 .... ............ A ........ Ocular reconst, transplant .................. 10.43 NA NA 8.98 9.69 0.44 090 

65781 .... ............ A ........ Ocular reconst, transplant .................. 17.84 NA NA 11.68 12.75 0.44 090 

65782 .... ............ A ........ Ocular reconst, transplant .................. 15.16 NA NA 10.28 11.20 0.44 090 

65800 .... ............ A ........ Drainage of eye .................................. 1.91 1.40 1.61 1.03 1.12 0.09 000 

65805 .... ............ A ........ Drainage of eye .................................. 1.91 1.70 1.95 1.03 1.12 0.09 000 

65810 .... ............ A ........ Drainage of eye .................................. 5.67 NA NA 4.69 4.72 0.24 090 

65815 .... ............ A ........ Drainage of eye .................................. 5.85 7.92 9.00 4.61 4.74 0.25 090 

65820 .... ............ A ........ Relieve inner eye pressure ................ 8.72 NA NA 7.68 8.41 0.40 090 

65850 .... ............ A ........ Incision of eye .................................... 11.24 NA NA 7.39 7.96 0.52 090 

65855 .... ............ A ........ Laser surgery of eye .......................... 3.90 3.51 3.93 2.65 2.89 0.19 010 

65860 .... ............ A ........ Incise inner eye adhesions ................. 3.56 3.27 3.68 2.10 2.31 0.18 090 

65865 .... ............ A ........ Incise inner eye adhesions ................. 5.66 NA NA 4.72 5.20 0.28 090 

65870 .... ............ A ........ Incise inner eye adhesions ................. 7.21 NA NA 5.74 6.11 0.31 090 

65875 .... ............ A ........ Incise inner eye adhesions ................. 7.61 NA NA 6.17 6.52 0.32 090 

65880 .... ............ A ........ Incise inner eye adhesions ................. 8.16 NA NA 6.34 6.73 0.35 090 

65900 .... ............ A ........ Remove eye lesion ............................. 12.26 NA NA 8.95 9.65 0.54 090 

65920 .... ............ A ........ Remove implant of eye ...................... 9.74 NA NA 7.51 7.89 0.41 090 

65930 .... ............ A ........ Remove blood clot from eye .............. 8.24 NA NA 5.81 6.36 0.37 090 

66020 .... ............ A ........ Injection treatment of eye ................... 1.61 2.42 2.78 1.28 1.37 0.08 010 

66030 .... ............ A ........ Injection treatment of eye ................... 1.27 2.29 2.64 1.15 1.22 0.06 010 

66130 .... ............ A ........ Remove eye lesion ............................. 7.74 7.54 8.62 4.91 5.30 0.38 090 

66150 .... ............ A ........ Glaucoma surgery .............................. 10.18 NA NA 8.85 9.17 0.46 090 

66155 .... ............ A ........ Glaucoma surgery .............................. 10.17 NA NA 8.85 9.14 0.41 090 

66160 .... ............ A ........ Glaucoma surgery .............................. 12.04 NA NA 9.53 9.92 0.50 090 

66165 .... ............ A ........ Glaucoma surgery .............................. 9.89 NA NA 8.81 9.07 0.40 090 

66170 .... ............ A ........ Glaucoma surgery .............................. 14.57 NA NA 11.61 11.98 0.60 090 

66172 .... ............ A ........ Incision of eye .................................... 18.26 NA NA 14.72 15.05 0.74 090 

66180 .... ............ A ........ Implant eye shunt ............................... 16.02 NA NA 9.78 10.34 0.71 090 

66185 .... ............ A ........ Revise eye shunt ................................ 9.35 NA NA 7.09 7.28 0.40 090 

66220 .... ............ A ........ Repair eye lesion ................................ 8.98 NA NA 7.20 7.17 0.40 090 

66225 .... ............ A ........ Repair/graft eye lesion ....................... 12.38 NA NA 8.18 8.51 0.55 090 

66250 .... ............ A ........ Follow-up surgery of eye .................... 6.92 9.25 10.52 5.28 5.41 0.30 090 

66500 .... ............ A ........ Incision of iris ...................................... 3.75 NA NA 3.96 4.32 0.18 090 

66505 .... ............ A ........ Incision of iris ...................................... 4.13 NA NA 4.32 4.68 0.20 090 

66600 .... ............ A ........ Remove iris and lesion ....................... 9.89 NA NA 8.33 8.32 0.43 090 

66605 .... ............ A ........ Removal of iris .................................... 13.99 NA NA 9.54 9.77 0.77 090 

66625 .... ............ A ........ Removal of iris .................................... 5.19 NA NA 4.23 4.50 0.26 090 

66630 .... ............ A ........ Removal of iris .................................... 7.10 NA NA 5.38 5.58 0.31 090 

66635 .... ............ A ........ Removal of iris .................................... 7.19 NA NA 5.41 5.61 0.31 090 

66680 .... ............ A ........ Repair iris & ciliary body .................... 6.24 NA NA 5.09 5.21 0.27 090 

66682 .... ............ A ........ Repair iris & ciliary body .................... 7.15 NA NA 6.73 6.71 0.31 090 

66700 .... ............ A ........ Destruction, ciliary body ..................... 5.06 4.80 5.05 3.61 3.80 0.24 090 

66710 .... ............ A ........ Ciliary transsleral therapy ................... 5.06 4.62 4.92 3.62 3.75 0.23 090 

mstockstill on PROD1PC66 with PROPOSALS2

38307 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

66711 .... ............ A ........ Ciliary endoscopic ablation ................. 7.70 NA NA 6.32 6.43 0.30 090 

66720 .... ............ A ........ Destruction, ciliary body ..................... 4.86 5.38 5.61 4.33 4.54 0.26 090 

66740 .... ............ A ........ Destruction, ciliary body ..................... 5.06 4.55 4.84 3.63 3.82 0.23 090 

66761 .... ............ A ........ Revision of iris .................................... 4.87 5.03 5.34 4.21 4.28 0.20 090 

66762 .... ............ A ........ Revision of iris .................................... 5.25 5.12 5.41 4.09 4.22 0.23 090 

66770 .... ............ A ........ Removal of inner eye lesion ............... 5.98 5.55 5.85 4.61 4.74 0.26 090 

66820 .... ............ A ........ Incision, secondary cataract ............... 3.93 NA NA 4.63 5.24 0.19 090 

66821 .... ............ A ........ After cataract laser surgery ................ 3.32 3.84 3.98 3.43 3.54 0.11 090 

66825 .... ............ A ........ Reposition intraocular lens ................. 8.82 NA NA 7.81 8.48 0.40 090 

66830 .... ............ A ........ Removal of lens lesion ....................... 9.27 NA NA 6.42 6.73 0.36 090 

66840 .... ............ A ........ Removal of lens material .................... 8.98 NA NA 6.34 6.64 0.39 090 

66850 .... ............ A ........ Removal of lens material .................... 10.32 NA NA 7.12 7.43 0.45 090 

66852 .... ............ A ........ Removal of lens material .................... 11.18 NA NA 7.45 7.82 0.49 090 

66920 .... ............ A ........ Extraction of lens ................................ 9.93 NA NA 6.70 7.04 0.44 090 

66930 .... ............ A ........ Extraction of lens ................................ 11.38 NA NA 7.52 7.88 0.49 090 

66940 .... ............ A ........ Extraction of lens ................................ 10.14 NA NA 7.06 7.38 0.43 090 

66982 .... ............ A ........ Cataract surgery, complex ................. 14.83 NA NA 9.04 9.51 0.63 090 

66983 .... ............ A ........ Cataract surg w/iol, 1 stage ............... 10.20 NA NA 6.57 6.31 0.14 090 

66984 .... ............ A ........ Cataract surg w/iol, 1 stage ............... 10.36 NA NA 6.51 7.00 0.39 090 

66985 .... ............ A ........ Insert lens prosthesis ......................... 9.73 NA NA 7.18 7.35 0.36 090 

66986 .... ............ A ........ Exchange lens prosthesis .................. 12.26 NA NA 8.12 8.70 0.60 090 

66990 .... ............ A ........ Ophthalmic endoscope add-on .......... 1.51 NA NA 0.55 0.62 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 4.60 4.76 0.28 090 

67010 .... ............ A ........ Partial removal of eye fluid ................. 6.94 NA NA 5.03 5.25 0.34 090 

67015 .... ............ A ........ Release of eye fluid ............................ 7.00 NA NA 5.73 6.12 0.34 090 

67025 .... ............ A ........ Replace eye fluid ................................ 7.91 7.89 8.60 5.95 6.12 0.34 090 

67027 .... ............ A ........ Implant eye drug system .................... 11.43 NA NA 7.43 7.76 0.54 090 

67028 .... ............ A ........ Injection eye drug ............................... 2.52 2.16 2.45 1.26 1.37 0.12 000 

67030 .... ............ A ........ Incise inner eye strands ..................... 5.91 NA NA 5.62 5.77 0.24 090 

67031 .... ............ A ........ Laser surgery, eye strands ................. 4.34 4.11 4.38 3.45 3.56 0.18 090 

67036 .... ............ A ........ Removal of inner eye fluid ................. 13.09 NA NA 8.13 8.68 0.58 090 

67038 .... ............ A ........ Strip retinal membrane ....................... 23.30 NA NA 13.59 14.64 1.04 090 

67039 .... ............ A ........ Laser treatment of retina .................... 16.39 NA NA 10.80 11.56 0.71 090 

67040 .... ............ A ........ Laser treatment of retina .................... 19.23 NA NA 12.11 12.98 0.85 090 

67101 .... ............ A ........ Repair detached retina ....................... 8.60 8.52 8.87 6.22 6.41 0.37 090 

67105 .... ............ A ........ Repair detached retina ....................... 8.35 7.45 7.81 5.83 6.03 0.37 090 

67107 .... ............ A ........ Repair detached retina ....................... 16.35 NA NA 10.44 10.94 0.73 090 

67108 .... ............ A ........ Repair detached retina ....................... 22.49 NA NA 13.08 13.84 1.02 090 

67110 .... ............ A ........ Repair detached retina ....................... 10.02 8.97 9.65 7.02 7.25 0.44 090 

67112 .... ............ A ........ Rerepair detached retina .................... 18.45 NA NA 10.97 11.46 0.83 090 

67115 .... ............ A ........ Release encircling material ................ 5.93 NA NA 4.96 5.05 0.25 090 

67120 .... ............ A ........ Remove eye implant material ............. 6.92 7.37 8.02 5.31 5.45 0.29 090 

67121 .... ............ A ........ Remove eye implant material ............. 12.00 NA NA 8.02 8.33 0.53 090 

67141 .... ............ A ........ Treatment of retina ............................. 6.00 5.44 5.68 4.68 4.80 0.26 090 

67145 .... ............ A ........ Treatment of retina ............................. 6.17 5.37 5.58 4.74 4.87 0.27 090 

67208 .... ............ A ........ Treatment of retinal lesion .................. 7.50 5.69 5.94 5.24 5.41 0.33 090 

67210 .... ............ A ........ Treatment of retinal lesion .................. 9.35 5.97 6.31 5.49 5.72 0.44 090 

67218 .... ............ A ........ Treatment of retinal lesion .................. 20.22 NA NA 10.74 11.53 0.92 090 

67220 .... ............ A ........ Treatment of choroid lesion ................ 14.19 9.30 9.92 8.25 8.68 0.65 090 

67221 .... ............ R ........ Ocular photodynamic ther .................. 3.45 2.93 3.65 1.40 1.61 0.20 000 

67225 .... ............ A ........ Eye photodynamic ther add-on .......... 0.47 0.23 0.24 0.17 0.19 0.02 ZZZ 

67227 .... ............ A ........ Treatment of retinal lesion .................. 7.38 6.03 6.34 5.20 5.39 0.33 090 

67228 .... ............ A ........ Treatment of retinal lesion .................. 13.67 9.99 10.80 7.76 8.21 0.63 090 

67250 .... ............ A ........ Reinforce eye wall .............................. 9.46 NA NA 7.71 8.48 0.47 090 

67255 .... ............ A ........ Reinforce/graft eye wall ...................... 9.97 NA NA 8.47 9.23 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 5.54 5.81 0.37 090 

67312 .... ............ A ........ Revise two eye muscles ..................... 9.48 NA NA 6.25 6.54 0.43 090 

67314 .... ............ A ........ Revise eye muscle ............................. 8.59 NA NA 6.20 6.41 0.39 090 

67316 .... ............ A ........ Revise two eye muscles ..................... 10.73 NA NA 6.98 7.29 0.49 090 

67318 .... ............ A ........ Revise eye muscle(s) ......................... 8.92 NA NA 6.56 6.79 0.41 090 

67320 .... ............ A ........ Revise eye muscle(s) add-on ............. 5.40 NA NA 1.96 1.97 0.22 ZZZ 

67331 .... ............ A ........ Eye surgery follow-up add-on ............ 5.13 NA NA 1.85 1.86 0.21 ZZZ 

67332 .... ............ A ........ Rerevise eye muscles add-on ............ 5.56 NA NA 2.01 2.04 0.23 ZZZ 

67334 .... ............ A ........ Revise eye muscle w/suture .............. 5.05 NA NA 1.84 1.83 0.20 ZZZ 

67335 .... ............ A ........ Eye suture during surgery .................. 2.49 NA NA 0.91 1.02 0.13 ZZZ 

67340 .... ............ A ........ Revise eye muscle add-on ................. 6.00 NA NA 2.18 2.21 0.25 ZZZ 

67343 .... ............ A ........ Release eye tissue ............................. 8.29 NA NA 6.11 6.34 0.37 090 

67345 .... ............ A ........ Destroy nerve of eye muscle ............. 2.98 2.18 2.40 1.71 1.88 0.17 010 

67346 .... ............ A ........ Biopsy, eye muscle ............................ 2.87 NA NA 1.64 1.80 0.15 000 

67399 .... ............ C ........ Eye muscle surgery procedure .......... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

mstockstill on PROD1PC66 with PROPOSALS2

38308 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

67400 .... ............ A ........ Explore/biopsy eye socket .................. 10.97 NA NA 9.46 10.41 0.56 090 

67405 .... ............ A ........ Explore/drain eye socket .................... 9.00 NA NA 8.36 9.09 0.44 090 

67412 .... ............ A ........ Explore/treat eye socket ..................... 10.17 NA NA 8.58 9.81 0.48 090 

67413 .... ............ A ........ Explore/treat eye socket ..................... 10.09 NA NA 8.73 9.80 0.50 090 

67414 .... ............ A ........ Explr/decompress eye socket ............ 17.78 NA NA 11.73 11.95 0.65 090 

67415 .... ............ A ........ Aspiration, orbital contents ................. 1.76 NA NA 0.63 0.70 0.09 000 

67420 .... ............ A ........ Explore/treat eye socket ..................... 21.62 NA NA 14.36 15.94 1.15 090 

67430 .... ............ A ........ Explore/treat eye socket ..................... 14.99 NA NA 11.92 13.55 0.86 090 

67440 .... ............ A ........ Explore/drain eye socket .................... 14.56 NA NA 11.94 13.15 0.70 090 

67445 .... ............ A ........ Explr/decompress eye socket ............ 18.96 NA NA 12.26 13.16 0.90 090 

67450 .... ............ A ........ Explore/biopsy eye socket .................. 15.11 NA NA 12.37 13.59 0.68 090 

67500 .... ............ A ........ Inject/treat eye socket ........................ 1.44 0.58 0.63 0.45 0.38 0.05 000 

67505 .... ............ A ........ Inject/treat eye socket ........................ 1.27 0.66 0.65 0.51 0.40 0.05 000 

67515 .... ............ A ........ Inject/treat eye socket ........................ 1.40 0.78 0.69 0.62 0.51 0.03 000 

67550 .... ............ A ........ Insert eye socket implant ................... 11.52 NA NA 9.88 10.63 0.72 090 

67560 .... ............ A ........ Revise eye socket implant ................. 11.93 NA NA 9.84 10.66 0.60 090 

67570 .... ............ A ........ Decompress optic nerve ..................... 14.21 NA NA 11.10 12.39 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 4.29 5.18 1.18 1.23 0.07 010 

67710 .... ............ A ........ Incision of eyelid ................................. 1.04 3.69 4.54 1.08 1.15 0.05 010 

67715 .... ............ A ........ Incision of eyelid fold .......................... 1.24 3.82 4.61 1.16 1.23 0.06 010 

67800 .... ............ A ........ Remove eyelid lesion ......................... 1.39 1.40 1.52 0.91 0.98 0.07 010 

67801 .... ............ A ........ Remove eyelid lesions ....................... 1.89 1.68 1.83 1.09 1.18 0.09 010 

67805 .... ............ A ........ Remove eyelid lesions ....................... 2.24 2.19 2.37 1.42 1.55 0.11 010 

67808 .... ............ A ........ Remove eyelid lesion(s) ..................... 4.47 NA NA 3.62 3.71 0.19 090 

67810 .... ............ A ........ Biopsy of eyelid .................................. 1.48 3.93 3.64 0.69 0.69 0.06 000 

67820 .... ............ A ........ Revise eyelashes ............................... 0.71 0.44 0.53 0.51 0.53 0.04 000 

67825 .... ............ A ........ Revise eyelashes ............................... 1.40 1.40 1.57 1.26 1.35 0.07 010 

67830 .... ............ A ........ Revise eyelashes ............................... 1.72 3.99 4.78 1.33 1.42 0.08 010 

67835 .... ............ A ........ Revise eyelashes ............................... 5.61 NA NA 4.15 4.40 0.28 090 

67840 .... ............ A ........ Remove eyelid lesion ......................... 2.06 3.90 4.70 1.46 1.57 0.10 010 

67850 .... ............ A ........ Treat eyelid lesion .............................. 1.71 3.28 3.33 1.45 1.46 0.07 010 

67875 .... ............ A ........ Closure of eyelid by suture ................ 1.35 2.38 2.85 0.84 0.89 0.07 000 

67880 .... ............ A ........ Revision of eyelid ............................... 4.47 5.44 6.05 3.59 3.72 0.19 090 

67882 .... ............ A ........ Revision of eyelid ............................... 5.87 6.37 7.04 4.49 4.68 0.25 090 

67900 .... ............ A ........ Repair brow defect ............................. 6.69 7.38 8.25 4.64 4.97 0.38 090 

67901 .... ............ A ........ Repair eyelid defect ............................ 7.47 9.00 7.25 5.32 5.39 0.54 090 

67902 .... ............ A ........ Repair eyelid defect ............................ 9.68 NA NA 6.39 5.97 0.60 090 

67903 .... ............ A ........ Repair eyelid defect ............................ 6.42 6.65 8.14 4.37 4.97 0.47 090 

67904 .... ............ A ........ Repair eyelid defect ............................ 7.83 8.19 8.96 5.41 5.36 0.41 090 

67906 .... ............ A ........ Repair eyelid defect ............................ 6.84 NA NA 4.51 4.80 0.46 090 

67908 .... ............ A ........ Repair eyelid defect ............................ 5.19 5.57 6.13 4.15 4.77 0.28 090 

67909 .... ............ A ........ Revise eyelid defect ........................... 5.46 6.19 7.15 4.19 4.60 0.31 090 

67911 .... ............ A ........ Revise eyelid defect ........................... 7.38 NA NA 5.09 4.97 0.31 090 

67912 .... ............ A ........ Correction eyelid w/implant ................ 6.23 13.10 16.03 4.76 5.15 0.28 090 

67914 .... ............ A ........ Repair eyelid defect ............................ 3.70 4.75 5.57 2.69 2.89 0.19 090 

67915 .... ............ A ........ Repair eyelid defect ............................ 3.21 4.32 5.19 2.44 2.65 0.16 090 

67916 .... ............ A ........ Repair eyelid defect ............................ 5.37 6.38 7.25 4.17 4.49 0.28 090 

67917 .... ............ A ........ Repair eyelid defect ............................ 6.08 6.74 7.63 4.44 4.78 0.36 090 

67921 .... ............ A ........ Repair eyelid defect ............................ 3.42 4.63 5.43 2.58 2.75 0.17 090 

67922 .... ............ A ........ Repair eyelid defect ............................ 3.09 4.16 5.09 2.34 2.58 0.15 090 

67923 .... ............ A ........ Repair eyelid defect ............................ 5.94 6.46 7.33 4.36 4.69 0.30 090 

67924 .... ............ A ........ Repair eyelid defect ............................ 5.84 6.93 7.96 4.09 4.41 0.30 090 

67930 .... ............ A ........ Repair eyelid wound ........................... 3.62 4.37 5.06 1.80 2.00 0.19 010 

67935 .... ............ A ........ Repair eyelid wound ........................... 6.27 6.78 7.69 3.62 4.04 0.39 090 

67938 .... ............ A ........ Remove eyelid foreign body ............... 1.35 3.81 4.62 1.22 1.25 0.06 010 

67950 .... ............ A ........ Revision of eyelid ............................... 5.88 6.67 7.68 4.40 4.83 0.36 090 

67961 .... ............ A ........ Revision of eyelid ............................... 5.75 6.83 7.79 4.33 4.71 0.33 090 

67966 .... ............ A ........ Revision of eyelid ............................... 8.83 8.08 8.65 5.79 5.71 0.37 090 

67971 .... ............ A ........ Reconstruction of eyelid ..................... 9.87 NA NA 6.23 6.80 0.53 090 

67973 .... ............ A ........ Reconstruction of eyelid ..................... 12.96 NA NA 7.79 8.61 0.75 090 

67974 .... ............ A ........ Reconstruction of eyelid ..................... 12.93 NA NA 7.77 8.56 0.75 090 

67975 .... ............ A ........ Reconstruction of eyelid ..................... 9.21 NA NA 6.00 6.52 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 1.24 1.33 1.06 1.14 0.06 010 

68040 .... ............ A ........ Treatment of eyelid lesions ................ 0.85 0.61 0.66 0.36 0.40 0.04 000 

68100 .... ............ A ........ Biopsy of eyelid lining ......................... 1.35 2.36 2.81 0.87 0.92 0.07 000 

68110 .... ............ A ........ Remove eyelid lining lesion ................ 1.79 3.07 3.60 1.49 1.58 0.09 010 

68115 .... ............ A ........ Remove eyelid lining lesion ................ 2.38 4.33 5.16 1.70 1.81 0.12 010 

68130 .... ............ A ........ Remove eyelid lining lesion ................ 4.99 6.65 7.72 4.05 4.35 0.24 090 

68135 .... ............ A ........ Remove eyelid lining lesion ................ 1.86 1.59 1.71 1.48 1.57 0.09 010 

68200 .... ............ A ........ Treat eyelid by injection ..................... 0.49 0.45 0.50 0.29 0.31 0.02 000 

mstockstill on PROD1PC66 with PROPOSALS2

38309 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

68320 .... ............ A ........ Revise/graft eyelid lining .................... 6.44 9.17 10.27 5.34 5.46 0.27 090 

68325 .... ............ A ........ Revise/graft eyelid lining .................... 8.43 NA NA 6.15 6.36 0.44 090 

68326 .... ............ A ........ Revise/graft eyelid lining .................... 8.22 NA NA 5.96 6.22 0.35 090 

68328 .... ............ A ........ Revise/graft eyelid lining .................... 9.25 NA NA 6.42 6.91 0.54 090 

68330 .... ............ A ........ Revise eyelid lining ............................. 5.63 7.42 8.45 4.47 4.62 0.24 090 

68335 .... ............ A ........ Revise/graft eyelid lining .................... 8.26 NA NA 5.96 6.21 0.36 090 

68340 .... ............ A ........ Separate eyelid adhesions ................. 4.84 6.88 7.91 3.89 4.02 0.21 090 

68360 .... ............ A ........ Revise eyelid lining ............................. 5.04 6.44 7.27 3.98 4.10 0.22 090 

68362 .... ............ A ........ Revise eyelid lining ............................. 8.41 NA NA 6.02 6.25 0.36 090 

68371 .... ............ A ........ Harvest eye tissue, alograft ................ 4.97 NA NA 4.08 4.43 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 4.41 5.16 1.22 1.53 0.08 010 

68420 .... ............ A ........ Incise/drain tear sac ........................... 2.32 4.59 5.41 1.43 1.78 0.11 010 

68440 .... ............ A ........ Incise tear duct opening ..................... 0.96 1.25 1.67 1.19 1.24 0.05 010 

68500 .... ............ A ........ Removal of tear gland ........................ 12.49 NA NA 9.55 9.56 0.55 090 

68505 .... ............ A ........ Partial removal, tear gland ................. 12.41 NA NA 8.97 9.85 0.55 090 

68510 .... ............ A ........ Biopsy of tear gland ........................... 4.60 5.23 6.30 2.06 2.09 0.23 000 

68520 .... ............ A ........ Removal of tear sac ........................... 8.58 NA NA 6.53 7.01 0.37 090 

68525 .... ............ A ........ Biopsy of tear sac ............................... 4.42 NA NA 1.60 1.83 0.22 000 

68530 .... ............ A ........ Clearance of tear duct ........................ 3.67 5.60 6.91 2.10 2.38 0.18 010 

68540 .... ............ A ........ Remove tear gland lesion .................. 11.93 NA NA 8.55 9.02 0.52 090 

68550 .... ............ A ........ Remove tear gland lesion .................. 14.86 NA NA 9.74 10.69 0.80 090 

68700 .... ............ A ........ Repair tear ducts ................................ 7.67 NA NA 5.60 5.83 0.32 090 

68705 .... ............ A ........ Revise tear duct opening ................... 2.08 3.04 3.62 1.59 1.70 0.10 010 

68720 .... ............ A ........ Create tear sac drain .......................... 9.78 NA NA 6.93 7.44 0.44 090 

68745 .... ............ A ........ Create tear duct drain ........................ 9.70 NA NA 7.03 7.53 0.52 090 

68750 .... ............ A ........ Create tear duct drain ........................ 9.87 NA NA 7.48 7.91 0.43 090 

68760 .... ............ A ........ Close tear duct opening ..................... 1.75 2.59 3.08 1.46 1.55 0.09 010 

68761 .... ............ A ........ Close tear duct opening ..................... 1.38 1.83 2.06 1.25 1.29 0.06 010 

68770 .... ............ A ........ Close tear system fistula .................... 8.09 NA NA 5.79 4.51 0.35 090 

68801 .... ............ A ........ Dilate tear duct opening ..................... 0.96 1.77 1.86 1.41 1.46 0.05 010 

68810 .... ............ A ........ Probe nasolacrimal duct ..................... 2.63 3.39 3.54 2.69 2.70 0.10 010 

68811 .... ............ A ........ Probe nasolacrimal duct ..................... 2.39 NA NA 2.13 2.28 0.13 010 

68815 .... ............ A ........ Probe nasolacrimal duct ..................... 3.24 6.41 7.35 2.45 2.64 0.17 010 

68840 .... ............ A ........ Explore/irrigate tear ducts .................. 1.27 1.51 1.56 1.28 1.21 0.06 010 

68850 .... ............ A ........ Injection for tear sac x-ray .................. 0.80 0.72 0.79 0.60 0.63 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 2.87 2.85 1.34 1.34 0.12 010 

69005 .... ............ A ........ Drain external ear lesion .................... 2.13 2.98 2.92 1.61 1.70 0.17 010 

69020 .... ............ A ........ Drain outer ear canal lesion ............... 1.50 4.07 4.00 1.90 1.96 0.12 010 

69100 .... ............ A ........ Biopsy of external ear ........................ 0.81 1.84 1.78 0.40 0.40 0.03 000 

69105 .... ............ A ........ Biopsy of external ear canal ............... 0.85 2.62 2.46 0.71 0.73 0.07 000 

69110 .... ............ A ........ Remove external ear, partial .............. 3.47 7.80 7.24 4.44 4.43 0.30 090 

69120 .... ............ A ........ Removal of external ear ..................... 4.08 NA NA 5.34 5.72 0.38 090 

69140 .... ............ A ........ Remove ear canal lesion(s) ............... 8.03 NA NA 13.17 13.10 0.65 090 

69145 .... ............ A ........ Remove ear canal lesion(s) ............... 2.65 6.99 6.31 3.36 3.29 0.21 090 

69150 .... ............ A ........ Extensive ear canal surgery ............... 13.49 NA NA 11.45 12.30 1.22 090 

69155 .... ............ A ........ Extensive ear/neck surgery ................ 23.06 NA NA 16.99 17.94 1.93 090 

69200 .... ............ A ........ Clear outer ear canal .......................... 0.77 2.14 2.24 0.61 0.58 0.06 000 

69205 .... ............ A ........ Clear outer ear canal .......................... 1.20 NA NA 1.24 1.29 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 2.55 2.43 0.68 0.69 0.07 000 

69222 .... ............ A ........ Clean out mastoid cavity .................... 1.42 3.95 3.86 1.89 1.95 0.12 010 

69300 .... ............ R ........ Revise external ear ............................ 6.69 10.69 7.30 5.20 4.63 0.72 YYY 

69310 .... ............ A ........ Rebuild outer ear canal ...................... 10.85 NA NA 15.45 15.68 0.85 090 

69320 .... ............ A ........ Rebuild outer ear canal ...................... 17.03 NA NA 20.02 20.65 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 2.80 2.45 0.68 0.67 0.07 000 

69401 .... ............ A ........ Inflate middle ear canal ...................... 0.63 1.52 1.37 0.60 0.62 0.05 000 

69405 .... ............ A ........ Catheterize middle ear canal ............. 2.65 3.65 3.54 1.97 2.12 0.21 010 

69420 .... ............ A ........ Incision of eardrum ............................. 1.35 3.30 3.19 1.55 1.55 0.11 010 

69421 .... ............ A ........ Incision of eardrum ............................. 1.75 NA NA 1.85 1.98 0.15 010 

69424 .... ............ A ........ Remove ventilating tube ..................... 0.85 2.32 2.23 0.68 0.67 0.07 000 

69433 .... ............ A ........ Create eardrum opening .................... 1.54 3.30 3.16 1.59 1.60 0.13 010 

69436 .... ............ A ........ Create eardrum opening .................... 1.98 NA NA 1.90 2.07 0.19 010 

69440 .... ............ A ........ Exploration of middle ear ................... 7.62 NA NA 9.10 8.82 0.61 090 

69450 .... ............ A ........ Eardrum revision ................................ 5.61 NA NA 7.59 7.22 0.45 090 

69501 .... ............ A ........ Mastoidectomy .................................... 9.12 NA NA 8.65 8.70 0.73 090 

69502 .... ............ A ........ Mastoidectomy .................................... 12.44 NA NA 11.04 11.17 1.00 090 

69505 .... ............ A ........ Remove mastoid structures ................ 13.05 NA NA 16.10 16.45 1.05 090 

69511 .... ............ A ........ Extensive mastoid surgery ................. 13.58 NA NA 16.29 16.67 1.09 090 

69530 .... ............ A ........ Extensive mastoid surgery ................. 20.24 NA NA 19.65 20.40 1.54 090 

mstockstill on PROD1PC66 with PROPOSALS2

38310 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

69535 .... ............ A ........ Remove part of temporal bone .......... 37.27 NA NA 26.82 29.01 2.93 090 

69540 .... ............ A ........ Remove ear lesion ............................. 1.22 3.88 3.77 1.85 1.89 0.10 010 

69550 .... ............ A ........ Remove ear lesion ............................. 11.04 NA NA 14.24 14.37 0.89 090 

69552 .... ............ A ........ Remove ear lesion ............................. 19.69 NA NA 18.18 19.19 1.59 090 

69554 .... ............ A ........ Remove ear lesion ............................. 35.71 NA NA 24.04 26.97 2.92 090 

69601 .... ............ A ........ Mastoid surgery revision .................... 13.31 NA NA 11.92 12.14 1.07 090 

69602 .... ............ A ........ Mastoid surgery revision .................... 13.64 NA NA 12.80 12.83 1.10 090 

69603 .... ............ A ........ Mastoid surgery revision .................... 14.08 NA NA 16.41 17.18 1.14 090 

69604 .... ............ A ........ Mastoid surgery revision .................... 14.08 NA NA 12.77 13.07 1.14 090 

69605 .... ............ A ........ Mastoid surgery revision .................... 18.55 NA NA 19.27 19.85 1.50 090 

69610 .... ............ A ........ Repair of eardrum .............................. 4.44 4.90 5.16 2.59 2.89 0.36 010 

69620 .... ............ A ........ Repair of eardrum .............................. 5.94 10.87 10.87 5.83 5.98 0.48 090 

69631 .... ............ A ........ Repair eardrum structures .................. 9.93 NA NA 11.50 11.20 0.80 090 

69632 .... ............ A ........ Rebuild eardrum structures ................ 12.82 NA NA 13.30 13.21 1.03 090 

69633 .... ............ A ........ Rebuild eardrum structures ................ 12.17 NA NA 13.07 12.89 0.98 090 

69635 .... ............ A ........ Repair eardrum structures .................. 13.39 NA NA 16.26 16.29 1.08 090 

69636 .... ............ A ........ Rebuild eardrum structures ................ 15.29 NA NA 18.16 18.50 1.23 090 

69637 .... ............ A ........ Rebuild eardrum structures ................ 15.18 NA NA 18.07 18.42 1.22 090 

69641 .... ............ A ........ Revise middle ear & mastoid ............. 12.77 NA NA 12.47 12.46 1.03 090 

69642 .... ............ A ........ Revise middle ear & mastoid ............. 16.91 NA NA 15.53 15.69 1.36 090 

69643 .... ............ A ........ Revise middle ear & mastoid ............. 15.45 NA NA 14.16 14.29 1.24 090 

69644 .... ............ A ........ Revise middle ear & mastoid ............. 17.09 NA NA 18.71 19.32 1.37 090 

69645 .... ............ A ........ Revise middle ear & mastoid ............. 16.57 NA NA 18.57 19.06 1.33 090 

69646 .... ............ A ........ Revise middle ear & mastoid ............. 18.23 NA NA 19.09 19.68 1.46 090 

69650 .... ............ A ........ Release middle ear bone ................... 9.71 NA NA 9.52 9.59 0.78 090 

69660 .... ............ A ........ Revise middle ear bone ..................... 11.94 NA NA 10.50 10.70 0.96 090 

69661 .... ............ A ........ Revise middle ear bone ..................... 15.80 NA NA 13.47 13.90 1.27 090 

69662 .... ............ A ........ Revise middle ear bone ..................... 15.49 NA NA 12.52 12.96 1.25 090 

69666 .... ............ A ........ Repair middle ear structures .............. 9.80 NA NA 9.79 9.75 0.79 090 

69667 .... ............ A ........ Repair middle ear structures .............. 9.81 NA NA 9.83 9.76 0.79 090 

69670 .... ............ A ........ Remove mastoid air cells ................... 11.62 NA NA 11.24 11.31 0.93 090 

69676 .... ............ A ........ Remove middle ear nerve .................. 9.58 NA NA 10.60 10.53 0.81 090 

69700 .... ............ A ........ Close mastoid fistula .......................... 8.28 NA NA 8.67 8.80 0.67 090 

69711 .... ............ A ........ Remove/repair hearing aid ................. 10.50 NA NA 10.40 10.45 0.83 090 

69714 .... ............ A ........ Implant temple bone w/stimul ............. 14.31 NA NA 11.81 12.06 1.13 090 

69715 .... ............ A ........ Temple bne implnt w/stimulat ............. 18.80 NA NA 13.36 13.99 1.48 090 

69717 .... ............ A ........ Temple bone implant revision ............ 15.29 NA NA 11.98 13.13 0.90 090 

69718 .... ............ A ........ Revise temple bone implant ............... 19.05 NA NA 13.44 15.53 3.22 090 

69720 .... ............ A ........ Release facial nerve ........................... 14.57 NA NA 14.02 14.09 1.16 090 

69725 .... ............ A ........ Release facial nerve ........................... 27.44 NA NA 18.08 18.86 2.45 090 

69740 .... ............ A ........ Repair facial nerve ............................. 16.18 NA NA 11.56 12.45 1.27 090 

69745 .... ............ A ........ Repair facial nerve ............................. 16.91 NA NA 9.87 12.78 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 9.60 9.41 0.69 090 

69802 .... ............ A ........ Incise inner ear ................................... 13.39 NA NA 11.86 11.89 1.06 090 

69805 .... ............ A ........ Explore inner ear ................................ 14.55 NA NA 10.92 11.24 1.12 090 

69806 .... ............ A ........ Explore inner ear ................................ 12.52 NA NA 10.40 10.57 1.00 090 

69820 .... ............ A ........ Establish inner ear window ................ 10.40 NA NA 10.25 10.68 0.90 090 

69840 .... ............ A ........ Revise inner ear window .................... 10.32 NA NA 11.39 12.34 0.79 090 

69905 .... ............ A ........ Remove inner ear ............................... 11.15 NA NA 11.03 11.05 0.90 090 

69910 .... ............ A ........ Remove inner ear & mastoid ............. 13.80 NA NA 10.90 11.25 1.07 090 

69915 .... ............ A ........ Incise inner ear nerve ......................... 22.65 NA NA 14.86 15.45 1.70 090 

69930 .... ............ A ........ Implant cochlear device ...................... 17.60 NA NA 13.13 13.75 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 16.94 17.69 2.29 090 

69955 .... ............ A ........ Release facial nerve ........................... 29.22 NA NA 19.51 20.12 2.49 090 

69960 .... ............ A ........ Release inner ear canal ..................... 29.22 NA NA 17.99 18.64 2.18 090 

69970 .... ............ A ........ Remove inner ear lesion .................... 32.21 NA NA 19.60 21.18 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 1.29 1.54 0.89 ZZZ 

70010 .... ............ A ........ Contrast x-ray of brain ........................ 1.19 2.80 3.73 NA NA 0.27 XXX 

70010 .... 26 ....... A ........ Contrast x-ray of brain ........................ 1.19 0.42 0.39 0.42 0.39 0.05 XXX 

70010 .... TC ...... A ........ Contrast x-ray of brain ........................ 0.00 2.37 3.34 NA NA 0.22 XXX 

70015 .... ............ A ........ Contrast x-ray of brain ........................ 1.19 2.90 2.29 NA NA 0.16 XXX 

70015 .... 26 ....... A ........ Contrast x-ray of brain ........................ 1.19 0.43 0.40 0.43 0.40 0.08 XXX 

70015 .... TC ...... A ........ Contrast x-ray of brain ........................ 0.00 2.47 1.89 NA NA 0.08 XXX 

70030 .... ............ A ........ X-ray eye for foreign body .................. 0.17 0.60 0.54 NA NA 0.03 XXX 

70030 .... 26 ....... A ........ X-ray eye for foreign body .................. 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

70030 .... TC ...... A ........ X-ray eye for foreign body .................. 0.00 0.54 0.48 NA NA 0.02 XXX 

70100 .... ............ A ........ X-ray exam of jaw .............................. 0.18 0.63 0.60 NA NA 0.03 XXX 

70100 .... 26 ....... A ........ X-ray exam of jaw .............................. 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

70100 .... TC ...... A ........ X-ray exam of jaw .............................. 0.00 0.58 0.55 NA NA 0.02 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38311 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

70110 .... ............ A ........ X-ray exam of jaw .............................. 0.25 0.80 0.75 NA NA 0.05 XXX 

70110 .... 26 ....... A ........ X-ray exam of jaw .............................. 0.25 0.09 0.08 0.09 0.08 0.01 XXX 

70110 .... TC ...... A ........ X-ray exam of jaw .............................. 0.00 0.71 0.66 NA NA 0.04 XXX 

70120 .... ............ A ........ X-ray exam of mastoids ..................... 0.18 0.69 0.68 NA NA 0.05 XXX 

70120 .... 26 ....... A ........ X-ray exam of mastoids ..................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

70120 .... TC ...... A ........ X-ray exam of mastoids ..................... 0.00 0.63 0.62 NA NA 0.04 XXX 

70130 .... ............ A ........ X-ray exam of mastoids ..................... 0.34 1.14 1.01 NA NA 0.07 XXX 

70130 .... 26 ....... A ........ X-ray exam of mastoids ..................... 0.34 0.11 0.11 0.11 0.11 0.02 XXX 

70130 .... TC ...... A ........ X-ray exam of mastoids ..................... 0.00 1.03 0.90 NA NA 0.05 XXX 

70134 .... ............ A ........ X-ray exam of middle ear ................... 0.34 0.91 0.87 NA NA 0.07 XXX 

70134 .... 26 ....... A ........ X-ray exam of middle ear ................... 0.34 0.12 0.11 0.12 0.11 0.02 XXX 

70134 .... TC ...... A ........ X-ray exam of middle ear ................... 0.00 0.79 0.76 NA NA 0.05 XXX 

70140 .... ............ A ........ X-ray exam of facial bones ................ 0.19 0.54 0.61 NA NA 0.05 XXX 

70140 .... 26 ....... A ........ X-ray exam of facial bones ................ 0.19 0.05 0.06 0.05 0.06 0.01 XXX 

70140 .... TC ...... A ........ X-ray exam of facial bones ................ 0.00 0.49 0.55 NA NA 0.04 XXX 

70150 .... ............ A ........ X-ray exam of facial bones ................ 0.26 0.85 0.85 NA NA 0.06 XXX 

70150 .... 26 ....... A ........ X-ray exam of facial bones ................ 0.26 0.08 0.08 0.08 0.08 0.01 XXX 

70150 .... TC ...... A ........ X-ray exam of facial bones ................ 0.00 0.76 0.77 NA NA 0.05 XXX 

70160 .... ............ A ........ X-ray exam of nasal bones ................ 0.17 0.70 0.63 NA NA 0.03 XXX 

70160 .... 26 ....... A ........ X-ray exam of nasal bones ................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

70160 .... TC ...... A ........ X-ray exam of nasal bones ................ 0.00 0.64 0.57 NA NA 0.02 XXX 

70170 .... ............ C ........ X-ray exam of tear duct ...................... 0.30 NA NA NA NA 0.07 XXX 

70170 .... 26 ....... A ........ X-ray exam of tear duct ...................... 0.30 0.11 0.10 0.11 0.10 0.01 XXX 

70170 .... TC ...... C ........ X-ray exam of tear duct ...................... 0.00 NA NA NA NA 0.06 XXX 

70190 .... ............ A ........ X-ray exam of eye sockets ................. 0.21 0.72 0.70 NA NA 0.05 XXX 

70190 .... 26 ....... A ........ X-ray exam of eye sockets ................. 0.21 0.07 0.07 0.07 0.07 0.01 XXX 

70190 .... TC ...... A ........ X-ray exam of eye sockets ................. 0.00 0.65 0.63 NA NA 0.04 XXX 

70200 .... ............ A ........ X-ray exam of eye sockets ................. 0.28 0.87 0.86 NA NA 0.06 XXX 

70200 .... 26 ....... A ........ X-ray exam of eye sockets ................. 0.28 0.10 0.09 0.10 0.09 0.01 XXX 

70200 .... TC ...... A ........ X-ray exam of eye sockets ................. 0.00 0.78 0.77 NA NA 0.05 XXX 

70210 .... ............ A ........ X-ray exam of sinuses ........................ 0.17 0.58 0.63 NA NA 0.05 XXX 

70210 .... 26 ....... A ........ X-ray exam of sinuses ........................ 0.17 0.05 0.06 0.05 0.06 0.01 XXX 

70210 .... TC ...... A ........ X-ray exam of sinuses ........................ 0.00 0.52 0.57 NA NA 0.04 XXX 

70220 .... ............ A ........ X-ray exam of sinuses ........................ 0.25 0.72 0.79 NA NA 0.06 XXX 

70220 .... 26 ....... A ........ X-ray exam of sinuses ........................ 0.25 0.08 0.08 0.08 0.08 0.01 XXX 

70220 .... TC ...... A ........ X-ray exam of sinuses ........................ 0.00 0.65 0.71 NA NA 0.05 XXX 

70240 .... ............ A ........ X-ray exam, pituitary saddle ............... 0.19 0.60 0.54 NA NA 0.03 XXX 

70240 .... 26 ....... A ........ X-ray exam, pituitary saddle ............... 0.19 0.06 0.06 0.06 0.06 0.01 XXX 

70240 .... TC ...... A ........ X-ray exam, pituitary saddle ............... 0.00 0.54 0.48 NA NA 0.02 XXX 

70250 .... ............ A ........ X-ray exam of skull ............................. 0.24 0.69 0.70 NA NA 0.05 XXX 

70250 .... 26 ....... A ........ X-ray exam of skull ............................. 0.24 0.07 0.08 0.07 0.08 0.01 XXX 

70250 .... TC ...... A ........ X-ray exam of skull ............................. 0.00 0.62 0.62 NA NA 0.04 XXX 

70260 .... ............ A ........ X-ray exam of skull ............................. 0.34 0.87 0.93 NA NA 0.08 XXX 

70260 .... 26 ....... A ........ X-ray exam of skull ............................. 0.34 0.11 0.11 0.11 0.11 0.02 XXX 

70260 .... TC ...... A ........ X-ray exam of skull ............................. 0.00 0.77 0.82 NA NA 0.06 XXX 

70300 .... ............ A ........ X-ray exam of teeth ............................ 0.10 0.24 0.28 NA NA 0.03 XXX 

70300 .... 26 ....... A ........ X-ray exam of teeth ............................ 0.10 0.03 0.04 0.03 0.04 0.01 XXX 

70300 .... TC ...... A ........ X-ray exam of teeth ............................ 0.00 0.21 0.24 NA NA 0.02 XXX 

70310 .... ............ A ........ X-ray exam of teeth ............................ 0.16 0.81 0.66 NA NA 0.03 XXX 

70310 .... 26 ....... A ........ X-ray exam of teeth ............................ 0.16 0.05 0.06 0.05 0.06 0.01 XXX 

70310 .... TC ...... A ........ X-ray exam of teeth ............................ 0.00 0.76 0.59 NA NA 0.02 XXX 

70320 .... ............ A ........ Full mouth x-ray of teeth .................... 0.22 1.06 0.95 NA NA 0.06 XXX 

70320 .... 26 ....... A ........ Full mouth x-ray of teeth .................... 0.22 0.07 0.08 0.07 0.08 0.01 XXX 

70320 .... TC ...... A ........ Full mouth x-ray of teeth .................... 0.00 0.99 0.87 NA NA 0.05 XXX 

70328 .... ............ A ........ X-ray exam of jaw joint ....................... 0.18 0.62 0.58 NA NA 0.03 XXX 

70328 .... 26 ....... A ........ X-ray exam of jaw joint ....................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

70328 .... TC ...... A ........ X-ray exam of jaw joint ....................... 0.00 0.56 0.52 NA NA 0.02 XXX 

70330 .... ............ A ........ X-ray exam of jaw joints ..................... 0.24 1.00 0.95 NA NA 0.06 XXX 

70330 .... 26 ....... A ........ X-ray exam of jaw joints ..................... 0.24 0.08 0.08 0.08 0.08 0.01 XXX 

70330 .... TC ...... A ........ X-ray exam of jaw joints ..................... 0.00 0.92 0.87 NA NA 0.05 XXX 

70332 .... ............ A ........ X-ray exam of jaw joint ....................... 0.54 1.45 1.87 NA NA 0.14 XXX 

70332 .... 26 ....... A ........ X-ray exam of jaw joint ....................... 0.54 0.17 0.18 0.17 0.18 0.02 XXX 

70332 .... TC ...... A ........ X-ray exam of jaw joint ....................... 0.00 1.28 1.69 NA NA 0.12 XXX 

70336 .... ............ A ........ Magnetic image, jaw joint ................... 1.48 12.06 11.80 NA NA 0.66 XXX 

70336 .... 26 ....... A ........ Magnetic image, jaw joint ................... 1.48 0.51 0.48 0.51 0.48 0.07 XXX 

70336 .... TC ...... A ........ Magnetic image, jaw joint ................... 0.00 11.55 11.32 NA NA 0.59 XXX 

70350 .... ............ A ........ X-ray head for orthodontia ................. 0.17 0.33 0.39 NA NA 0.03 XXX 

70350 .... 26 ....... A ........ X-ray head for orthodontia ................. 0.17 0.06 0.07 0.06 0.07 0.01 XXX 

70350 .... TC ...... A ........ X-ray head for orthodontia ................. 0.00 0.27 0.32 NA NA 0.02 XXX 

70355 .... ............ A ........ Panoramic x-ray of jaws ..................... 0.20 0.30 0.47 NA NA 0.05 XXX 

70355 .... 26 ....... A ........ Panoramic x-ray of jaws ..................... 0.20 0.07 0.07 0.07 0.07 0.01 XXX 

70355 .... TC ...... A ........ Panoramic x-ray of jaws ..................... 0.00 0.23 0.40 NA NA 0.04 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38312 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

70360 .... ............ A ........ X-ray exam of neck ............................ 0.17 0.56 0.52 NA NA 0.03 XXX 

70360 .... 26 ....... A ........ X-ray exam of neck ............................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

70360 .... TC ...... A ........ X-ray exam of neck ............................ 0.00 0.50 0.46 NA NA 0.02 XXX 

70370 .... ............ A ........ Throat x-ray & fluoroscopy ................. 0.32 1.63 1.52 NA NA 0.08 XXX 

70370 .... 26 ....... A ........ Throat x-ray & fluoroscopy ................. 0.32 0.10 0.10 0.10 0.10 0.01 XXX 

70370 .... TC ...... A ........ Throat x-ray & fluoroscopy ................. 0.00 1.53 1.42 NA NA 0.07 XXX 

70371 .... ............ A ........ Speech evaluation, complex .............. 0.84 1.46 1.91 NA NA 0.16 XXX 

70371 .... 26 ....... A ........ Speech evaluation, complex .............. 0.84 0.26 0.27 0.26 0.27 0.04 XXX 

70371 .... TC ...... A ........ Speech evaluation, complex .............. 0.00 1.20 1.65 NA NA 0.12 XXX 

70373 .... ............ A ........ Contrast x-ray of larynx ...................... 0.44 1.56 1.74 NA NA 0.13 XXX 

70373 .... 26 ....... A ........ Contrast x-ray of larynx ...................... 0.44 0.11 0.12 0.11 0.12 0.02 XXX 

70373 .... TC ...... A ........ Contrast x-ray of larynx ...................... 0.00 1.45 1.62 NA NA 0.11 XXX 

70380 .... ............ A ........ X-ray exam of salivary gland .............. 0.17 0.82 0.77 NA NA 0.05 XXX 

70380 .... 26 ....... A ........ X-ray exam of salivary gland .............. 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

70380 .... TC ...... A ........ X-ray exam of salivary gland .............. 0.00 0.76 0.71 NA NA 0.04 XXX 

70390 .... ............ A ........ X-ray exam of salivary duct ................ 0.38 2.32 2.09 NA NA 0.13 XXX 

70390 .... 26 ....... A ........ X-ray exam of salivary duct ................ 0.38 0.14 0.13 0.14 0.13 0.02 XXX 

70390 .... TC ...... A ........ X-ray exam of salivary duct ................ 0.00 2.18 1.97 NA NA 0.11 XXX 

70450 .... ............ A ........ Ct head/brain w/o dye ........................ 0.85 4.88 4.90 NA NA 0.29 XXX 

70450 .... 26 ....... A ........ Ct head/brain w/o dye ........................ 0.85 0.31 0.28 0.31 0.28 0.04 XXX 

70450 .... TC ...... A ........ Ct head/brain w/o dye ........................ 0.00 4.57 4.62 NA NA 0.25 XXX 

70460 .... ............ A ........ Ct head/brain w/dye ........................... 1.13 6.46 6.19 NA NA 0.35 XXX 

70460 .... 26 ....... A ........ Ct head/brain w/dye ........................... 1.13 0.41 0.38 0.41 0.38 0.05 XXX 

70460 .... TC ...... A ........ Ct head/brain w/dye ........................... 0.00 6.05 5.82 NA NA 0.30 XXX 

70470 .... ............ A ........ Ct head/brain w/o & w/dye ................. 1.27 7.86 7.61 NA NA 0.43 XXX 

70470 .... 26 ....... A ........ Ct head/brain w/o & w/dye ................. 1.27 0.45 0.42 0.45 0.42 0.06 XXX 

70470 .... TC ...... A ........ Ct head/brain w/o & w/dye ................. 0.00 7.41 7.19 NA NA 0.37 XXX 

70480 .... ............ A ........ Ct orbit/ear/fossa w/o dye .................. 1.28 8.41 6.71 NA NA 0.31 XXX 

70480 .... 26 ....... A ........ Ct orbit/ear/fossa w/o dye .................. 1.28 0.45 0.42 0.45 0.42 0.06 XXX 

70480 .... TC ...... A ........ Ct orbit/ear/fossa w/o dye .................. 0.00 7.96 6.29 NA NA 0.25 XXX 

70481 .... ............ A ........ Ct orbit/ear/fossa w/dye ...................... 1.38 9.88 7.93 NA NA 0.36 XXX 

70481 .... 26 ....... A ........ Ct orbit/ear/fossa w/dye ...................... 1.38 0.49 0.46 0.49 0.46 0.06 XXX 

70481 .... TC ...... A ........ Ct orbit/ear/fossa w/dye ...................... 0.00 9.39 7.47 NA NA 0.30 XXX 

70482 .... ............ A ........ Ct orbit/ear/fossa w/o&w/dye .............. 1.45 11.30 9.34 NA NA 0.43 XXX 

70482 .... 26 ....... A ........ Ct orbit/ear/fossa w/o&w/dye .............. 1.45 0.51 0.48 0.51 0.48 0.06 XXX 

70482 .... TC ...... A ........ Ct orbit/ear/fossa w/o&w/dye .............. 0.00 10.79 8.86 NA NA 0.37 XXX 

70486 .... ............ A ........ Ct maxillofacial w/o dye ...................... 1.14 6.74 5.86 NA NA 0.30 XXX 

70486 .... 26 ....... A ........ Ct maxillofacial w/o dye ...................... 1.14 0.40 0.37 0.40 0.37 0.05 XXX 

70486 .... TC ...... A ........ Ct maxillofacial w/o dye ...................... 0.00 6.33 5.48 NA NA 0.25 XXX 

70487 .... ............ A ........ Ct maxillofacial w/dye ......................... 1.30 8.28 7.13 NA NA 0.36 XXX 

70487 .... 26 ....... A ........ Ct maxillofacial w/dye ......................... 1.30 0.47 0.44 0.47 0.44 0.06 XXX 

70487 .... TC ...... A ........ Ct maxillofacial w/dye ......................... 0.00 7.81 6.69 NA NA 0.30 XXX 

70488 .... ............ A ........ Ct maxillofacial w/o & w/dye .............. 1.42 10.31 8.84 NA NA 0.43 XXX 

70488 .... 26 ....... A ........ Ct maxillofacial w/o & w/dye .............. 1.42 0.50 0.47 0.50 0.47 0.06 XXX 

70488 .... TC ...... A ........ Ct maxillofacial w/o & w/dye .............. 0.00 9.81 8.38 NA NA 0.37 XXX 

70490 .... ............ A ........ Ct soft tissue neck w/o dye ................ 1.28 6.44 5.74 NA NA 0.31 XXX 

70490 .... 26 ....... A ........ Ct soft tissue neck w/o dye ................ 1.28 0.46 0.43 0.46 0.43 0.06 XXX 

70490 .... TC ...... A ........ Ct soft tissue neck w/o dye ................ 0.00 5.98 5.31 NA NA 0.25 XXX 

70491 .... ............ A ........ Ct soft tissue neck w/dye ................... 1.38 7.97 6.98 NA NA 0.36 XXX 

70491 .... 26 ....... A ........ Ct soft tissue neck w/dye ................... 1.38 0.50 0.46 0.50 0.46 0.06 XXX 

70491 .... TC ...... A ........ Ct soft tissue neck w/dye ................... 0.00 7.48 6.52 NA NA 0.30 XXX 

70492 .... ............ A ........ Ct sft tsue nck w/o & w/dye ............... 1.45 9.94 8.67 NA NA 0.43 XXX 

70492 .... 26 ....... A ........ Ct sft tsue nck w/o & w/dye ............... 1.45 0.51 0.48 0.51 0.48 0.06 XXX 

70492 .... TC ...... A ........ Ct sft tsue nck w/o & w/dye ............... 0.00 9.43 8.20 NA NA 0.37 XXX 

70496 .... ............ A ........ Ct angiography, head ......................... 1.75 16.92 13.93 NA NA 0.66 XXX 

70496 .... 26 ....... A ........ Ct angiography, head ......................... 1.75 0.64 0.59 0.64 0.59 0.08 XXX 

70496 .... TC ...... A ........ Ct angiography, head ......................... 0.00 16.28 13.34 NA NA 0.58 XXX 

70498 .... ............ A ........ Ct angiography, neck ......................... 1.75 17.03 13.98 NA NA 0.66 XXX 

70498 .... 26 ....... A ........ Ct angiography, neck ......................... 1.75 0.65 0.59 0.65 0.59 0.08 XXX 

70498 .... TC ...... A ........ Ct angiography, neck ......................... 0.00 16.38 13.39 NA NA 0.58 XXX 

70540 .... ............ A ........ Mri orbit/face/neck w/o dye ................ 1.35 14.05 12.76 NA NA 0.45 XXX 

70540 .... 26 ....... A ........ Mri orbit/face/neck w/o dye ................ 1.35 0.47 0.44 0.47 0.44 0.06 XXX 

70540 .... TC ...... A ........ Mri orbit/face/neck w/o dye ................ 0.00 13.58 12.31 NA NA 0.39 XXX 

70542 .... ............ A ........ Mri orbit/face/neck w/dye .................... 1.62 15.16 14.45 NA NA 0.54 XXX 

70542 .... 26 ....... A ........ Mri orbit/face/neck w/dye .................... 1.62 0.57 0.53 0.57 0.53 0.07 XXX 

70542 .... TC ...... A ........ Mri orbit/face/neck w/dye .................... 0.00 14.59 13.92 NA NA 0.47 XXX 

70543 .... ............ A ........ Mri orbt/fac/nck w/o & w/dye .............. 2.15 18.60 21.97 NA NA 0.94 XXX 

70543 .... 26 ....... A ........ Mri orbt/fac/nck w/o & w/dye .............. 2.15 0.75 0.71 0.75 0.71 0.10 XXX 

70543 .... TC ...... A ........ Mri orbt/fac/nck w/o & w/dye .............. 0.00 17.85 21.26 NA NA 0.84 XXX 

70544 .... ............ A ........ Mr angiography head w/o dye ............ 1.20 15.70 13.54 NA NA 0.64 XXX 

70544 .... 26 ....... A ........ Mr angiography head w/o dye ............ 1.20 0.42 0.40 0.42 0.40 0.05 XXX 

70544 .... TC ...... A ........ Mr angiography head w/o dye ............ 0.00 15.28 13.14 NA NA 0.59 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38313 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

70545 .... ............ A ........ Mr angiography head w/dye ............... 1.20 15.58 13.49 NA NA 0.64 XXX 

70545 .... 26 ....... A ........ Mr angiography head w/dye ............... 1.20 0.42 0.39 0.42 0.39 0.05 XXX 

70545 .... TC ...... A ........ Mr angiography head w/dye ............... 0.00 15.15 13.09 NA NA 0.59 XXX 

70546 .... ............ A ........ Mr angiograph head w/o&w/dye ......... 1.80 23.80 23.25 NA NA 0.67 XXX 

70546 .... 26 ....... A ........ Mr angiograph head w/o&w/dye ......... 1.80 0.63 0.59 0.63 0.59 0.08 XXX 

70546 .... TC ...... A ........ Mr angiograph head w/o&w/dye ......... 0.00 23.17 22.66 NA NA 0.59 XXX 

70547 .... ............ A ........ Mr angiography neck w/o dye ............ 1.20 15.64 13.51 NA NA 0.64 XXX 

70547 .... 26 ....... A ........ Mr angiography neck w/o dye ............ 1.20 0.42 0.39 0.42 0.39 0.05 XXX 

70547 .... TC ...... A ........ Mr angiography neck w/o dye ............ 0.00 15.22 13.12 NA NA 0.59 XXX 

70548 .... ............ A ........ Mr angiography neck w/dye ............... 1.20 16.49 13.93 NA NA 0.64 XXX 

70548 .... 26 ....... A ........ Mr angiography neck w/dye ............... 1.20 0.43 0.40 0.43 0.40 0.05 XXX 

70548 .... TC ...... A ........ Mr angiography neck w/dye ............... 0.00 16.06 13.53 NA NA 0.59 XXX 

70549 .... ............ A ........ Mr angiograph neck w/o&w/dye ......... 1.80 23.81 23.24 NA NA 0.67 XXX 

70549 .... 26 ....... A ........ Mr angiograph neck w/o&w/dye ......... 1.80 0.64 0.59 0.64 0.59 0.08 XXX 

70549 .... TC ...... A ........ Mr angiograph neck w/o&w/dye ......... 0.00 23.18 22.65 NA NA 0.59 XXX 

70551 .... ............ A ........ Mri brain w/o dye ................................ 1.48 14.30 12.90 NA NA 0.66 XXX 

70551 .... 26 ....... A ........ Mri brain w/o dye ................................ 1.48 0.52 0.49 0.52 0.49 0.07 XXX 

70551 .... TC ...... A ........ Mri brain w/o dye ................................ 0.00 13.79 12.42 NA NA 0.59 XXX 

70552 .... ............ A ........ Mri brain w/dye ................................... 1.78 15.45 14.63 NA NA 0.78 XXX 

70552 .... 26 ....... A ........ Mri brain w/dye ................................... 1.78 0.63 0.59 0.63 0.59 0.08 XXX 

70552 .... TC ...... A ........ Mri brain w/dye ................................... 0.00 14.82 14.04 NA NA 0.70 XXX 

70553 .... ............ A ........ Mri brain w/o & w/dye ......................... 2.36 17.92 21.66 NA NA 1.41 XXX 

70553 .... 26 ....... A ........ Mri brain w/o & w/dye ......................... 2.36 0.83 0.78 0.83 0.78 0.10 XXX 

70553 .... TC ...... A ........ Mri brain w/o & w/dye ......................... 0.00 17.09 20.88 NA NA 1.31 XXX 

70554 .... ............ A ........ Fmri brain by tech .............................. 2.11 15.22 14.07 NA NA 0.92 XXX 

70554 .... 26 ....... A ........ Fmri brain by tech .............................. 2.11 0.70 0.63 0.70 0.63 0.10 XXX 

70554 .... TC ...... A ........ Fmri brain by tech .............................. 0.00 14.53 13.44 NA NA 0.82 XXX 

70555 .... ............ C ........ Fmri brain by phys/psych ................... 0.00 NA NA NA NA 0.11 XXX 

70555 .... 26 ....... A ........ Fmri brain by phys/psych ................... 2.54 0.89 0.78 0.89 0.78 0.11 XXX 

70555 .... TC ...... C ........ Fmri brain by phys/psych ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70557 .... ............ C ........ Mri brain w/o dye ................................ 2.90 0.00 0.71 0.00 0.71 0.08 XXX 

70557 .... 26 ....... A ........ Mri brain w/o dye ................................ 2.90 1.05 1.06 1.05 1.06 0.08 XXX 

70557 .... TC ...... C ........ Mri brain w/o dye ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70558 .... ............ C ........ Mri brain w/dye ................................... 3.20 0.00 0.79 0.00 0.79 0.10 XXX 

70558 .... 26 ....... A ........ Mri brain w/dye ................................... 3.20 1.11 1.16 1.11 1.16 0.10 XXX 

70558 .... TC ...... C ........ Mri brain w/dye ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70559 .... ............ C ........ Mri brain w/o & w/dye ......................... 3.20 0.00 0.78 0.00 0.78 0.12 XXX 

70559 .... 26 ....... A ........ Mri brain w/o & w/dye ......................... 3.20 1.15 1.16 1.15 1.16 0.12 XXX 

70559 .... TC ...... C ........ Mri brain w/o & w/dye ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

71010 .... ............ A ........ Chest x-ray ......................................... 0.18 0.43 0.48 NA NA 0.03 XXX 

71010 .... 26 ....... A ........ Chest x-ray ......................................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

71010 .... TC ...... A ........ Chest x-ray ......................................... 0.00 0.37 0.42 NA NA 0.02 XXX 

71015 .... ............ A ........ Chest x-ray ......................................... 0.21 0.57 0.58 NA NA 0.03 XXX 

71015 .... 26 ....... A ........ Chest x-ray ......................................... 0.21 0.07 0.07 0.07 0.07 0.01 XXX 

71015 .... TC ...... A ........ Chest x-ray ......................................... 0.00 0.50 0.51 NA NA 0.02 XXX 

71020 .... ............ A ........ Chest x-ray ......................................... 0.22 0.57 0.63 NA NA 0.05 XXX 

71020 .... 26 ....... A ........ Chest x-ray ......................................... 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

71020 .... TC ...... A ........ Chest x-ray ......................................... 0.00 0.50 0.56 NA NA 0.04 XXX 

71021 .... ............ A ........ Chest x-ray ......................................... 0.27 0.70 0.76 NA NA 0.06 XXX 

71021 .... 26 ....... A ........ Chest x-ray ......................................... 0.27 0.09 0.09 0.09 0.09 0.01 XXX 

71021 .... TC ...... A ........ Chest x-ray ......................................... 0.00 0.62 0.67 NA NA 0.05 XXX 

71022 .... ............ A ........ Chest x-ray ......................................... 0.31 0.89 0.86 NA NA 0.06 XXX 

71022 .... 26 ....... A ........ Chest x-ray ......................................... 0.31 0.10 0.10 0.10 0.10 0.01 XXX 

71022 .... TC ...... A ........ Chest x-ray ......................................... 0.00 0.79 0.76 NA NA 0.05 XXX 

71023 .... ............ A ........ Chest x-ray and fluoroscopy .............. 0.38 1.52 1.21 NA NA 0.06 XXX 

71023 .... 26 ....... A ........ Chest x-ray and fluoroscopy .............. 0.38 0.14 0.13 0.14 0.13 0.01 XXX 

71023 .... TC ...... A ........ Chest x-ray and fluoroscopy .............. 0.00 1.37 1.08 NA NA 0.05 XXX 

71030 .... ............ A ........ Chest x-ray ......................................... 0.31 0.92 0.89 NA NA 0.06 XXX 

71030 .... 26 ....... A ........ Chest x-ray ......................................... 0.31 0.10 0.10 0.10 0.10 0.01 XXX 

71030 .... TC ...... A ........ Chest x-ray ......................................... 0.00 0.81 0.79 NA NA 0.05 XXX 

71034 .... ............ A ........ Chest x-ray and fluoroscopy .............. 0.46 2.07 1.82 NA NA 0.10 XXX 

71034 .... 26 ....... A ........ Chest x-ray and fluoroscopy .............. 0.46 0.20 0.17 0.20 0.17 0.02 XXX 

71034 .... TC ...... A ........ Chest x-ray and fluoroscopy .............. 0.00 1.86 1.64 NA NA 0.08 XXX 

71035 .... ............ A ........ Chest x-ray ......................................... 0.18 0.78 0.67 NA NA 0.03 XXX 

71035 .... 26 ....... A ........ Chest x-ray ......................................... 0.18 0.07 0.06 0.07 0.06 0.01 XXX 

71035 .... TC ...... A ........ Chest x-ray ......................................... 0.00 0.71 0.61 NA NA 0.02 XXX 

71040 .... ............ A ........ Contrast x-ray of bronchi .................... 0.58 2.04 1.84 NA NA 0.11 XXX 

71040 .... 26 ....... A ........ Contrast x-ray of bronchi .................... 0.58 0.18 0.18 0.18 0.18 0.03 XXX 

71040 .... TC ...... A ........ Contrast x-ray of bronchi .................... 0.00 1.86 1.66 NA NA 0.08 XXX 

71060 .... ............ A ........ Contrast x-ray of bronchi .................... 0.74 3.07 2.73 NA NA 0.16 XXX 

71060 .... 26 ....... A ........ Contrast x-ray of bronchi .................... 0.74 0.26 0.24 0.26 0.24 0.03 XXX 

71060 .... TC ...... A ........ Contrast x-ray of bronchi .................... 0.00 2.81 2.49 NA NA 0.13 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38314 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

71090 .... ............ C ........ X-ray & pacemaker insertion .............. 0.54 NA NA NA NA 0.13 XXX 

71090 .... 26 ....... A ........ X-ray & pacemaker insertion .............. 0.54 0.27 0.24 0.27 0.24 0.02 XXX 

71090 .... TC ...... C ........ X-ray & pacemaker insertion .............. 0.00 NA NA NA NA 0.11 XXX 

71100 .... ............ A ........ X-ray exam of ribs .............................. 0.22 0.61 0.62 NA NA 0.05 XXX 

71100 .... 26 ....... A ........ X-ray exam of ribs .............................. 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

71100 .... TC ...... A ........ X-ray exam of ribs .............................. 0.00 0.54 0.55 NA NA 0.04 XXX 

71101 .... ............ A ........ X-ray exam of ribs/chest .................... 0.27 0.76 0.75 NA NA 0.05 XXX 

71101 .... 26 ....... A ........ X-ray exam of ribs/chest .................... 0.27 0.09 0.09 0.09 0.09 0.01 XXX 

71101 .... TC ...... A ........ X-ray exam of ribs/chest .................... 0.00 0.67 0.66 NA NA 0.04 XXX 

71110 .... ............ A ........ X-ray exam of ribs .............................. 0.27 0.77 0.82 NA NA 0.06 XXX 

71110 .... 26 ....... A ........ X-ray exam of ribs .............................. 0.27 0.08 0.09 0.08 0.09 0.01 XXX 

71110 .... TC ...... A ........ X-ray exam of ribs .............................. 0.00 0.68 0.73 NA NA 0.05 XXX 

71111 .... ............ A ........ X-ray exam of ribs/chest .................... 0.32 1.05 1.02 NA NA 0.07 XXX 

71111 .... 26 ....... A ........ X-ray exam of ribs/chest .................... 0.32 0.10 0.10 0.10 0.10 0.01 XXX 

71111 .... TC ...... A ........ X-ray exam of ribs/chest .................... 0.00 0.95 0.92 NA NA 0.06 XXX 

71120 .... ............ A ........ X-ray exam of breastbone .................. 0.20 0.63 0.67 NA NA 0.05 XXX 

71120 .... 26 ....... A ........ X-ray exam of breastbone .................. 0.20 0.07 0.07 0.07 0.07 0.01 XXX 

71120 .... TC ...... A ........ X-ray exam of breastbone .................. 0.00 0.56 0.60 NA NA 0.04 XXX 

71130 .... ............ A ........ X-ray exam of breastbone .................. 0.22 0.75 0.76 NA NA 0.05 XXX 

71130 .... 26 ....... A ........ X-ray exam of breastbone .................. 0.22 0.08 0.07 0.08 0.07 0.01 XXX 

71130 .... TC ...... A ........ X-ray exam of breastbone .................. 0.00 0.67 0.69 NA NA 0.04 XXX 

71250 .... ............ A ........ Ct thorax w/o dye ............................... 1.16 6.39 6.29 NA NA 0.36 XXX 

71250 .... 26 ....... A ........ Ct thorax w/o dye ............................... 1.16 0.41 0.38 0.41 0.38 0.05 XXX 

71250 .... TC ...... A ........ Ct thorax w/o dye ............................... 0.00 5.98 5.91 NA NA 0.31 XXX 

71260 .... ............ A ........ Ct thorax w/dye .................................. 1.24 7.93 7.64 NA NA 0.42 XXX 

71260 .... 26 ....... A ........ Ct thorax w/dye .................................. 1.24 0.44 0.41 0.44 0.41 0.05 XXX 

71260 .... TC ...... A ........ Ct thorax w/dye .................................. 0.00 7.48 7.23 NA NA 0.37 XXX 

71270 .... ............ A ........ Ct thorax w/o & w/dye ........................ 1.38 9.95 9.56 NA NA 0.52 XXX 

71270 .... 26 ....... A ........ Ct thorax w/o & w/dye ........................ 1.38 0.49 0.46 0.49 0.46 0.06 XXX 

71270 .... TC ...... A ........ Ct thorax w/o & w/dye ........................ 0.00 9.47 9.10 NA NA 0.46 XXX 

71275 .... ............ A ........ Ct angiography, chest ........................ 1.92 11.65 12.24 NA NA 0.48 XXX 

71275 .... 26 ....... A ........ Ct angiography, chest ........................ 1.92 0.70 0.64 0.70 0.64 0.09 XXX 

71275 .... TC ...... A ........ Ct angiography, chest ........................ 0.00 10.95 11.60 NA NA 0.39 XXX 

71550 .... ............ A ........ Mri chest w/o dye ............................... 1.46 16.21 13.84 NA NA 0.51 XXX 

71550 .... 26 ....... A ........ Mri chest w/o dye ............................... 1.46 0.51 0.48 0.51 0.48 0.06 XXX 

71550 .... TC ...... A ........ Mri chest w/o dye ............................... 0.00 15.70 13.36 NA NA 0.45 XXX 

71551 .... ............ A ........ Mri chest w/dye .................................. 1.73 17.75 15.76 NA NA 0.60 XXX 

71551 .... 26 ....... A ........ Mri chest w/dye .................................. 1.73 0.61 0.57 0.61 0.57 0.08 XXX 

71551 .... TC ...... A ........ Mri chest w/dye .................................. 0.00 17.15 15.19 NA NA 0.52 XXX 

71552 .... ............ A ........ Mri chest w/o & w/dye ........................ 2.26 22.34 23.82 NA NA 0.78 XXX 

71552 .... 26 ....... A ........ Mri chest w/o & w/dye ........................ 2.26 0.81 0.75 0.81 0.75 0.10 XXX 

71552 .... TC ...... A ........ Mri chest w/o & w/dye ........................ 0.00 21.52 23.07 NA NA 0.68 XXX 

71555 .... ............ R ........ Mri angio chest w or w/o dye ............. 1.81 15.13 13.39 NA NA 0.67 XXX 

71555 .... 26 ....... R ........ Mri angio chest w or w/o dye ............. 1.81 0.66 0.61 0.66 0.61 0.08 XXX 

71555 .... TC ...... R ........ Mri angio chest w or w/o dye ............. 0.00 14.47 12.78 NA NA 0.59 XXX 

72010 .... ............ A ........ X-ray exam of spine ........................... 0.45 1.42 1.29 NA NA 0.08 XXX 

72010 .... 26 ....... A ........ X-ray exam of spine ........................... 0.45 0.13 0.14 0.13 0.14 0.02 XXX 

72010 .... TC ...... A ........ X-ray exam of spine ........................... 0.00 1.29 1.16 NA NA 0.06 XXX 

72020 .... ............ A ........ X-ray exam of spine ........................... 0.15 0.47 0.46 NA NA 0.03 XXX 

72020 .... 26 ....... A ........ X-ray exam of spine ........................... 0.15 0.05 0.05 0.05 0.05 0.01 XXX 

72020 .... TC ...... A ........ X-ray exam of spine ........................... 0.00 0.41 0.41 NA NA 0.02 XXX 

72040 .... ............ A ........ X-ray exam of neck spine .................. 0.22 0.76 0.71 NA NA 0.05 XXX 

72040 .... 26 ....... A ........ X-ray exam of neck spine .................. 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

72040 .... TC ...... A ........ X-ray exam of neck spine .................. 0.00 0.69 0.64 NA NA 0.04 XXX 

72050 .... ............ A ........ X-ray exam of neck spine .................. 0.31 1.07 1.02 NA NA 0.07 XXX 

72050 .... 26 ....... A ........ X-ray exam of neck spine .................. 0.31 0.11 0.10 0.11 0.10 0.01 XXX 

72050 .... TC ...... A ........ X-ray exam of neck spine .................. 0.00 0.96 0.92 NA NA 0.06 XXX 

72052 .... ............ A ........ X-ray exam of neck spine .................. 0.36 1.38 1.31 NA NA 0.08 XXX 

72052 .... 26 ....... A ........ X-ray exam of neck spine .................. 0.36 0.12 0.12 0.12 0.12 0.02 XXX 

72052 .... TC ...... A ........ X-ray exam of neck spine .................. 0.00 1.26 1.19 NA NA 0.06 XXX 

72069 .... ............ A ........ X-ray exam of trunk spine .................. 0.22 0.75 0.66 NA NA 0.03 XXX 

72069 .... 26 ....... A ........ X-ray exam of trunk spine .................. 0.22 0.08 0.08 0.08 0.08 0.01 XXX 

72069 .... TC ...... A ........ X-ray exam of trunk spine .................. 0.00 0.67 0.58 NA NA 0.02 XXX 

72070 .... ............ A ........ X-ray exam of thoracic spine ............. 0.22 0.63 0.67 NA NA 0.05 XXX 

72070 .... 26 ....... A ........ X-ray exam of thoracic spine ............. 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

72070 .... TC ...... A ........ X-ray exam of thoracic spine ............. 0.00 0.56 0.60 NA NA 0.04 XXX 

72072 .... ............ A ........ X-ray exam of thoracic spine ............. 0.22 0.77 0.78 NA NA 0.06 XXX 

72072 .... 26 ....... A ........ X-ray exam of thoracic spine ............. 0.22 0.08 0.07 0.08 0.07 0.01 XXX 

72072 .... TC ...... A ........ X-ray exam of thoracic spine ............. 0.00 0.69 0.70 NA NA 0.05 XXX 

72074 .... ............ A ........ X-ray exam of thoracic spine ............. 0.22 0.94 0.95 NA NA 0.07 XXX 

72074 .... 26 ....... A ........ X-ray exam of thoracic spine ............. 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

72074 .... TC ...... A ........ X-ray exam of thoracic spine ............. 0.00 0.87 0.88 NA NA 0.06 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38315 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

72080 .... ............ A ........ X-ray exam of trunk spine .................. 0.22 0.69 0.71 NA NA 0.05 XXX 

72080 .... 26 ....... A ........ X-ray exam of trunk spine .................. 0.22 0.08 0.07 0.08 0.07 0.01 XXX 

72080 .... TC ...... A ........ X-ray exam of trunk spine .................. 0.00 0.61 0.64 NA NA 0.04 XXX 

72090 .... ............ A ........ X-ray exam of trunk spine .................. 0.28 1.00 0.87 NA NA 0.05 XXX 

72090 .... 26 ....... A ........ X-ray exam of trunk spine .................. 0.28 0.10 0.09 0.10 0.09 0.01 XXX 

72090 .... TC ...... A ........ X-ray exam of trunk spine .................. 0.00 0.89 0.78 NA NA 0.04 XXX 

72100 .... ............ A ........ X-ray exam of lower spine ................. 0.22 0.80 0.77 NA NA 0.05 XXX 

72100 .... 26 ....... A ........ X-ray exam of lower spine ................. 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

72100 .... TC ...... A ........ X-ray exam of lower spine ................. 0.00 0.73 0.70 NA NA 0.04 XXX 

72110 .... ............ A ........ X-ray exam of lower spine ................. 0.31 1.13 1.06 NA NA 0.07 XXX 

72110 .... 26 ....... A ........ X-ray exam of lower spine ................. 0.31 0.11 0.10 0.11 0.10 0.01 XXX 

72110 .... TC ...... A ........ X-ray exam of lower spine ................. 0.00 1.03 0.96 NA NA 0.06 XXX 

72114 .... ............ A ........ X-ray exam of lower spine ................. 0.36 1.55 1.42 NA NA 0.08 XXX 

72114 .... 26 ....... A ........ X-ray exam of lower spine ................. 0.36 0.13 0.12 0.13 0.12 0.02 XXX 

72114 .... TC ...... A ........ X-ray exam of lower spine ................. 0.00 1.42 1.30 NA NA 0.06 XXX 

72120 .... ............ A ........ X-ray exam of lower spine ................. 0.22 1.06 1.01 NA NA 0.07 XXX 

72120 .... 26 ....... A ........ X-ray exam of lower spine ................. 0.22 0.08 0.07 0.08 0.07 0.01 XXX 

72120 .... TC ...... A ........ X-ray exam of lower spine ................. 0.00 0.99 0.94 NA NA 0.06 XXX 

72125 .... ............ A ........ Ct neck spine w/o dye ........................ 1.16 6.41 6.30 NA NA 0.36 XXX 

72125 .... 26 ....... A ........ Ct neck spine w/o dye ........................ 1.16 0.41 0.38 0.41 0.38 0.05 XXX 

72125 .... TC ...... A ........ Ct neck spine w/o dye ........................ 0.00 6.00 5.91 NA NA 0.31 XXX 

72126 .... ............ A ........ Ct neck spine w/dye ........................... 1.22 7.93 7.64 NA NA 0.42 XXX 

72126 .... 26 ....... A ........ Ct neck spine w/dye ........................... 1.22 0.44 0.41 0.44 0.41 0.05 XXX 

72126 .... TC ...... A ........ Ct neck spine w/dye ........................... 0.00 7.49 7.23 NA NA 0.37 XXX 

72127 .... ............ A ........ Ct neck spine w/o & w/dye ................. 1.27 9.95 9.52 NA NA 0.52 XXX 

72127 .... 26 ....... A ........ Ct neck spine w/o & w/dye ................. 1.27 0.44 0.42 0.44 0.42 0.06 XXX 

72127 .... TC ...... A ........ Ct neck spine w/o & w/dye ................. 0.00 9.51 9.10 NA NA 0.46 XXX 

72128 .... ............ A ........ Ct chest spine w/o dye ....................... 1.16 6.40 6.29 NA NA 0.36 XXX 

72128 .... 26 ....... A ........ Ct chest spine w/o dye ....................... 1.16 0.41 0.38 0.41 0.38 0.05 XXX 

72128 .... TC ...... A ........ Ct chest spine w/o dye ....................... 0.00 5.98 5.91 NA NA 0.31 XXX 

72129 .... ............ A ........ Ct chest spine w/dye .......................... 1.22 7.94 7.64 NA NA 0.42 XXX 

72129 .... 26 ....... A ........ Ct chest spine w/dye .......................... 1.22 0.44 0.41 0.44 0.41 0.05 XXX 

72129 .... TC ...... A ........ Ct chest spine w/dye .......................... 0.00 7.50 7.23 NA NA 0.37 XXX 

72130 .... ............ A ........ Ct chest spine w/o & w/dye ................ 1.27 9.89 9.49 NA NA 0.52 XXX 

72130 .... 26 ....... A ........ Ct chest spine w/o & w/dye ................ 1.27 0.45 0.42 0.45 0.42 0.06 XXX 

72130 .... TC ...... A ........ Ct chest spine w/o & w/dye ................ 0.00 9.44 9.07 NA NA 0.46 XXX 

72131 .... ............ A ........ Ct lumbar spine w/o dye .................... 1.16 6.38 6.29 NA NA 0.36 XXX 

72131 .... 26 ....... A ........ Ct lumbar spine w/o dye .................... 1.16 0.41 0.38 0.41 0.38 0.05 XXX 

72131 .... TC ...... A ........ Ct lumbar spine w/o dye .................... 0.00 5.97 5.90 NA NA 0.31 XXX 

72132 .... ............ A ........ Ct lumbar spine w/dye ........................ 1.22 7.91 7.63 NA NA 0.42 XXX 

72132 .... 26 ....... A ........ Ct lumbar spine w/dye ........................ 1.22 0.44 0.41 0.44 0.41 0.05 XXX 

72132 .... TC ...... A ........ Ct lumbar spine w/dye ........................ 0.00 7.47 7.22 NA NA 0.37 XXX 

72133 .... ............ A ........ Ct lumbar spine w/o & w/dye ............. 1.27 9.93 9.54 NA NA 0.52 XXX 

72133 .... 26 ....... A ........ Ct lumbar spine w/o & w/dye ............. 1.27 0.45 0.42 0.45 0.42 0.06 XXX 

72133 .... TC ...... A ........ Ct lumbar spine w/o & w/dye ............. 0.00 9.48 9.11 NA NA 0.46 XXX 

72141 .... ............ A ........ Mri neck spine w/o dye ...................... 1.60 12.35 11.96 NA NA 0.66 XXX 

72141 .... 26 ....... A ........ Mri neck spine w/o dye ...................... 1.60 0.56 0.53 0.56 0.53 0.07 XXX 

72141 .... TC ...... A ........ Mri neck spine w/o dye ...................... 0.00 11.79 11.43 NA NA 0.59 XXX 

72142 .... ............ A ........ Mri neck spine w/dye .......................... 1.92 15.48 14.67 NA NA 0.79 XXX 

72142 .... 26 ....... A ........ Mri neck spine w/dye .......................... 1.92 0.67 0.64 0.67 0.64 0.09 XXX 

72142 .... TC ...... A ........ Mri neck spine w/dye .......................... 0.00 14.81 14.03 NA NA 0.70 XXX 

72146 .... ............ A ........ Mri chest spine w/o dye ..................... 1.60 12.37 12.58 NA NA 0.71 XXX 

72146 .... 26 ....... A ........ Mri chest spine w/o dye ..................... 1.60 0.56 0.53 0.56 0.53 0.07 XXX 

72146 .... TC ...... A ........ Mri chest spine w/o dye ..................... 0.00 11.81 12.06 NA NA 0.64 XXX 

72147 .... ............ A ........ Mri chest spine w/dye ......................... 1.92 13.46 13.66 NA NA 0.79 XXX 

72147 .... 26 ....... A ........ Mri chest spine w/dye ......................... 1.92 0.68 0.63 0.68 0.63 0.09 XXX 

72147 .... TC ...... A ........ Mri chest spine w/dye ......................... 0.00 12.78 13.03 NA NA 0.70 XXX 

72148 .... ............ A ........ Mri lumbar spine w/o dye ................... 1.48 12.30 12.54 NA NA 0.71 XXX 

72148 .... 26 ....... A ........ Mri lumbar spine w/o dye ................... 1.48 0.51 0.49 0.51 0.49 0.07 XXX 

72148 .... TC ...... A ........ Mri lumbar spine w/o dye ................... 0.00 11.79 12.05 NA NA 0.64 XXX 

72149 .... ............ A ........ Mri lumbar spine w/dye ...................... 1.78 15.38 14.61 NA NA 0.78 XXX 

72149 .... 26 ....... A ........ Mri lumbar spine w/dye ...................... 1.78 0.63 0.60 0.63 0.60 0.08 XXX 

72149 .... TC ...... A ........ Mri lumbar spine w/dye ...................... 0.00 14.75 14.02 NA NA 0.70 XXX 

72156 .... ............ A ........ Mri neck spine w/o & w/dye ............... 2.57 17.62 21.55 NA NA 1.42 XXX 

72156 .... 26 ....... A ........ Mri neck spine w/o & w/dye ............... 2.57 0.90 0.85 0.90 0.85 0.11 XXX 

72156 .... TC ...... A ........ Mri neck spine w/o & w/dye ............... 0.00 16.72 20.71 NA NA 1.31 XXX 

72157 .... ............ A ........ Mri chest spine w/o & w/dye .............. 2.57 16.07 20.77 NA NA 1.42 XXX 

72157 .... 26 ....... A ........ Mri chest spine w/o & w/dye .............. 2.57 0.91 0.84 0.91 0.84 0.11 XXX 

72157 .... TC ...... A ........ Mri chest spine w/o & w/dye .............. 0.00 15.16 19.93 NA NA 1.31 XXX 

72158 .... ............ A ........ Mri lumbar spine w/o & w/dye ............ 2.36 17.54 21.48 NA NA 1.41 XXX 

72158 .... 26 ....... A ........ Mri lumbar spine w/o & w/dye ............ 2.36 0.83 0.78 0.83 0.78 0.10 XXX 

72158 .... TC ...... A ........ Mri lumbar spine w/o & w/dye ............ 0.00 16.71 20.70 NA NA 1.31 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38316 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

72159 .... ............ N ........ Mr angio spine w/o&w/dye ................. 1.80 14.47 13.70 NA NA 0.74 XXX 

72159 .... 26 ....... N ........ Mr angio spine w/o&w/dye ................. 1.80 0.42 0.55 0.42 0.55 0.10 XXX 

72159 .... TC ...... N ........ Mr angio spine w/o&w/dye ................. 0.00 14.06 13.15 NA NA 0.64 XXX 

72170 .... ............ A ........ X-ray exam of pelvis ........................... 0.17 0.49 0.54 NA NA 0.03 XXX 

72170 .... 26 ....... A ........ X-ray exam of pelvis ........................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

72170 .... TC ...... A ........ X-ray exam of pelvis ........................... 0.00 0.43 0.48 NA NA 0.02 XXX 

72190 .... ............ A ........ X-ray exam of pelvis ........................... 0.21 0.84 0.79 NA NA 0.05 XXX 

72190 .... 26 ....... A ........ X-ray exam of pelvis ........................... 0.21 0.08 0.07 0.08 0.07 0.01 XXX 

72190 .... TC ...... A ........ X-ray exam of pelvis ........................... 0.00 0.77 0.72 NA NA 0.04 XXX 

72191 .... ............ A ........ Ct angiograph pelv w/o&w/dye ........... 1.81 11.23 11.84 NA NA 0.47 XXX 

72191 .... 26 ....... A ........ Ct angiograph pelv w/o&w/dye ........... 1.81 0.66 0.61 0.66 0.61 0.08 XXX 

72191 .... TC ...... A ........ Ct angiograph pelv w/o&w/dye ........... 0.00 10.57 11.24 NA NA 0.39 XXX 

72192 .... ............ A ........ Ct pelvis w/o dye ................................ 1.09 5.98 6.07 NA NA 0.36 XXX 

72192 .... 26 ....... A ........ Ct pelvis w/o dye ................................ 1.09 0.39 0.36 0.39 0.36 0.05 XXX 

72192 .... TC ...... A ........ Ct pelvis w/o dye ................................ 0.00 5.59 5.71 NA NA 0.31 XXX 

72193 .... ............ A ........ Ct pelvis w/dye ................................... 1.16 7.49 7.30 NA NA 0.41 XXX 

72193 .... 26 ....... A ........ Ct pelvis w/dye ................................... 1.16 0.42 0.39 0.42 0.39 0.05 XXX 

72193 .... TC ...... A ........ Ct pelvis w/dye ................................... 0.00 7.07 6.91 NA NA 0.36 XXX 

72194 .... ............ A ........ Ct pelvis w/o & w/dye ......................... 1.22 10.04 9.39 NA NA 0.48 XXX 

72194 .... 26 ....... A ........ Ct pelvis w/o & w/dye ......................... 1.22 0.44 0.41 0.44 0.41 0.05 XXX 

72194 .... TC ...... A ........ Ct pelvis w/o & w/dye ......................... 0.00 9.60 8.98 NA NA 0.43 XXX 

72195 .... ............ A ........ Mri pelvis w/o dye ............................... 1.46 14.30 12.89 NA NA 0.51 XXX 

72195 .... 26 ....... A ........ Mri pelvis w/o dye ............................... 1.46 0.51 0.48 0.51 0.48 0.06 XXX 

72195 .... TC ...... A ........ Mri pelvis w/o dye ............................... 0.00 13.79 12.41 NA NA 0.45 XXX 

72196 .... ............ A ........ Mri pelvis w/dye .................................. 1.73 15.39 14.58 NA NA 0.60 XXX 

72196 .... 26 ....... A ........ Mri pelvis w/dye .................................. 1.73 0.62 0.57 0.62 0.57 0.08 XXX 

72196 .... TC ...... A ........ Mri pelvis w/dye .................................. 0.00 14.77 14.01 NA NA 0.52 XXX 

72197 .... ............ A ........ Mri pelvis w/o & w/dye ....................... 2.26 18.79 22.07 NA NA 1.02 XXX 

72197 .... 26 ....... A ........ Mri pelvis w/o & w/dye ....................... 2.26 0.80 0.75 0.80 0.75 0.10 XXX 

72197 .... TC ...... A ........ Mri pelvis w/o & w/dye ....................... 0.00 18.00 21.33 NA NA 0.92 XXX 

72198 .... ............ A ........ Mr angio pelvis w/o & w/dye .............. 1.80 14.94 13.25 NA NA 0.67 XXX 

72198 .... 26 ....... A ........ Mr angio pelvis w/o & w/dye .............. 1.80 0.65 0.60 0.65 0.60 0.08 XXX 

72198 .... TC ...... A ........ Mr angio pelvis w/o & w/dye .............. 0.00 14.30 12.66 NA NA 0.59 XXX 

72200 .... ............ A ........ X-ray exam sacroiliac joints ............... 0.17 0.59 0.58 NA NA 0.03 XXX 

72200 .... 26 ....... A ........ X-ray exam sacroiliac joints ............... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

72200 .... TC ...... A ........ X-ray exam sacroiliac joints ............... 0.00 0.54 0.53 NA NA 0.02 XXX 

72202 .... ............ A ........ X-ray exam sacroiliac joints ............... 0.19 0.73 0.70 NA NA 0.05 XXX 

72202 .... 26 ....... A ........ X-ray exam sacroiliac joints ............... 0.19 0.07 0.06 0.07 0.06 0.01 XXX 

72202 .... TC ...... A ........ X-ray exam sacroiliac joints ............... 0.00 0.67 0.64 NA NA 0.04 XXX 

72220 .... ............ A ........ X-ray exam of tailbone ....................... 0.17 0.57 0.60 NA NA 0.05 XXX 

72220 .... 26 ....... A ........ X-ray exam of tailbone ....................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

72220 .... TC ...... A ........ X-ray exam of tailbone ....................... 0.00 0.52 0.54 NA NA 0.04 XXX 

72240 .... ............ A ........ Contrast x-ray of neck spine .............. 0.91 2.55 3.76 NA NA 0.29 XXX 

72240 .... 26 ....... A ........ Contrast x-ray of neck spine .............. 0.91 0.32 0.29 0.32 0.29 0.04 XXX 

72240 .... TC ...... A ........ Contrast x-ray of neck spine .............. 0.00 2.24 3.47 NA NA 0.25 XXX 

72255 .... ............ A ........ Contrast x-ray, thorax spine ............... 0.91 2.23 3.40 NA NA 0.26 XXX 

72255 .... 26 ....... A ........ Contrast x-ray, thorax spine ............... 0.91 0.29 0.27 0.29 0.27 0.04 XXX 

72255 .... TC ...... A ........ Contrast x-ray, thorax spine ............... 0.00 1.94 3.13 NA NA 0.22 XXX 

72265 .... ............ A ........ Contrast x-ray, lower spine ................ 0.83 2.51 3.39 NA NA 0.26 XXX 

72265 .... 26 ....... A ........ Contrast x-ray, lower spine ................ 0.83 0.29 0.26 0.29 0.26 0.04 XXX 

72265 .... TC ...... A ........ Contrast x-ray, lower spine ................ 0.00 2.22 3.13 NA NA 0.22 XXX 

72270 .... ............ A ........ Contrast x-ray, spine .......................... 1.33 3.97 5.20 NA NA 0.39 XXX 

72270 .... 26 ....... A ........ Contrast x-ray, spine .......................... 1.33 0.48 0.43 0.48 0.43 0.06 XXX 

72270 .... TC ...... A ........ Contrast x-ray, spine .......................... 0.00 3.49 4.76 NA NA 0.33 XXX 

72275 .... ............ A ........ Epidurography .................................... 0.76 1.71 2.00 NA NA 0.26 XXX 

72275 .... 26 ....... A ........ Epidurography .................................... 0.76 0.20 0.20 0.20 0.20 0.04 XXX 

72275 .... TC ...... A ........ Epidurography .................................... 0.00 1.51 1.80 NA NA 0.22 XXX 

72285 .... ............ A ........ X-ray c/t spine disk ............................. 1.16 1.43 5.08 NA NA 0.50 XXX 

72285 .... 26 ....... A ........ X-ray c/t spine disk ............................. 1.16 0.30 0.33 0.30 0.33 0.07 XXX 

72285 .... TC ...... A ........ X-ray c/t spine disk ............................. 0.00 1.13 4.75 NA NA 0.43 XXX 

72291 .... ............ C ........ Perq vertebroplasty, fluor ................... 1.31 0.00 0.00 0.00 0.00 0.10 XXX 

72291 .... 26 ....... A ........ Perq vertebroplasty, fluor ................... 1.31 0.48 0.47 0.48 0.47 0.10 XXX 

72291 .... TC ...... C ........ Perq vertebroplasty, fluor ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

72292 .... ............ C ........ Perq vertebroplasty, ct ....................... 1.38 0.00 0.00 0.00 0.00 0.07 XXX 

72292 .... 26 ....... A ........ Perq vertebroplasty, ct ....................... 1.38 0.51 0.49 0.51 0.49 0.07 XXX 

72292 .... TC ...... C ........ Perq vertebroplasty, ct ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

72295 .... ............ A ........ X-ray of lower spine disk .................... 0.83 1.45 4.78 NA NA 0.46 XXX 

72295 .... 26 ....... A ........ X-ray of lower spine disk .................... 0.83 0.25 0.26 0.25 0.26 0.06 XXX 

72295 .... TC ...... A ........ X-ray of lower spine disk .................... 0.00 1.20 4.52 NA NA 0.40 XXX 

73000 .... ............ A ........ X-ray exam of collar bone .................. 0.16 0.55 0.56 NA NA 0.03 XXX 

73000 .... 26 ....... A ........ X-ray exam of collar bone .................. 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73000 .... TC ...... A ........ X-ray exam of collar bone .................. 0.00 0.50 0.51 NA NA 0.02 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38317 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

73010 .... ............ A ........ X-ray exam of shoulder blade ............ 0.17 0.58 0.58 NA NA 0.03 XXX 

73010 .... 26 ....... A ........ X-ray exam of shoulder blade ............ 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73010 .... TC ...... A ........ X-ray exam of shoulder blade ............ 0.00 0.52 0.52 NA NA 0.02 XXX 

73020 .... ............ A ........ X-ray exam of shoulder ...................... 0.15 0.44 0.48 NA NA 0.03 XXX 

73020 .... 26 ....... A ........ X-ray exam of shoulder ...................... 0.15 0.05 0.05 0.05 0.05 0.01 XXX 

73020 .... TC ...... A ........ X-ray exam of shoulder ...................... 0.00 0.39 0.43 NA NA 0.02 XXX 

73030 .... ............ A ........ X-ray exam of shoulder ...................... 0.18 0.57 0.60 NA NA 0.05 XXX 

73030 .... 26 ....... A ........ X-ray exam of shoulder ...................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

73030 .... TC ...... A ........ X-ray exam of shoulder ...................... 0.00 0.50 0.53 NA NA 0.04 XXX 

73040 .... ............ A ........ Contrast x-ray of shoulder .................. 0.54 2.23 2.24 NA NA 0.14 XXX 

73040 .... 26 ....... A ........ Contrast x-ray of shoulder .................. 0.54 0.19 0.18 0.19 0.18 0.02 XXX 

73040 .... TC ...... A ........ Contrast x-ray of shoulder .................. 0.00 2.04 2.05 NA NA 0.12 XXX 

73050 .... ............ A ........ X-ray exam of shoulders .................... 0.20 0.73 0.73 NA NA 0.05 XXX 

73050 .... 26 ....... A ........ X-ray exam of shoulders .................... 0.20 0.08 0.07 0.08 0.07 0.01 XXX 

73050 .... TC ...... A ........ X-ray exam of shoulders .................... 0.00 0.65 0.66 NA NA 0.04 XXX 

73060 .... ............ A ........ X-ray exam of humerus ...................... 0.17 0.57 0.60 NA NA 0.05 XXX 

73060 .... 26 ....... A ........ X-ray exam of humerus ...................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73060 .... TC ...... A ........ X-ray exam of humerus ...................... 0.00 0.51 0.54 NA NA 0.04 XXX 

73070 .... ............ A ........ X-ray exam of elbow .......................... 0.15 0.55 0.56 NA NA 0.03 XXX 

73070 .... 26 ....... A ........ X-ray exam of elbow .......................... 0.15 0.05 0.05 0.05 0.05 0.01 XXX 

73070 .... TC ...... A ........ X-ray exam of elbow .......................... 0.00 0.50 0.51 NA NA 0.02 XXX 

73080 .... ............ A ........ X-ray exam of elbow .......................... 0.17 0.75 0.69 NA NA 0.05 XXX 

73080 .... 26 ....... A ........ X-ray exam of elbow .......................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73080 .... TC ...... A ........ X-ray exam of elbow .......................... 0.00 0.69 0.63 NA NA 0.04 XXX 

73085 .... ............ A ........ Contrast x-ray of elbow ...................... 0.54 1.82 2.04 NA NA 0.14 XXX 

73085 .... 26 ....... A ........ Contrast x-ray of elbow ...................... 0.54 0.18 0.18 0.18 0.18 0.02 XXX 

73085 .... TC ...... A ........ Contrast x-ray of elbow ...................... 0.00 1.64 1.86 NA NA 0.12 XXX 

73090 .... ............ A ........ X-ray exam of forearm ....................... 0.16 0.55 0.56 NA NA 0.03 XXX 

73090 .... 26 ....... A ........ X-ray exam of forearm ....................... 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73090 .... TC ...... A ........ X-ray exam of forearm ....................... 0.00 0.50 0.51 NA NA 0.02 XXX 

73092 .... ............ A ........ X-ray exam of arm, infant ................... 0.16 0.57 0.56 NA NA 0.03 XXX 

73092 .... 26 ....... A ........ X-ray exam of arm, infant ................... 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73092 .... TC ...... A ........ X-ray exam of arm, infant ................... 0.00 0.52 0.51 NA NA 0.02 XXX 

73100 .... ............ A ........ X-ray exam of wrist ............................ 0.16 0.60 0.57 NA NA 0.03 XXX 

73100 .... 26 ....... A ........ X-ray exam of wrist ............................ 0.16 0.06 0.05 0.06 0.05 0.01 XXX 

73100 .... TC ...... A ........ X-ray exam of wrist ............................ 0.00 0.54 0.51 NA NA 0.02 XXX 

73110 .... ............ A ........ X-ray exam of wrist ............................ 0.17 0.77 0.68 NA NA 0.03 XXX 

73110 .... 26 ....... A ........ X-ray exam of wrist ............................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73110 .... TC ...... A ........ X-ray exam of wrist ............................ 0.00 0.71 0.62 NA NA 0.02 XXX 

73115 .... ............ A ........ Contrast x-ray of wrist ........................ 0.54 2.31 2.03 NA NA 0.12 XXX 

73115 .... 26 ....... A ........ Contrast x-ray of wrist ........................ 0.54 0.19 0.18 0.19 0.18 0.02 XXX 

73115 .... TC ...... A ........ Contrast x-ray of wrist ........................ 0.00 2.12 1.85 NA NA 0.10 XXX 

73120 .... ............ A ........ X-ray exam of hand ............................ 0.16 0.55 0.54 NA NA 0.03 XXX 

73120 .... 26 ....... A ........ X-ray exam of hand ............................ 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73120 .... TC ...... A ........ X-ray exam of hand ............................ 0.00 0.50 0.49 NA NA 0.02 XXX 

73130 .... ............ A ........ X-ray exam of hand ............................ 0.17 0.65 0.62 NA NA 0.03 XXX 

73130 .... 26 ....... A ........ X-ray exam of hand ............................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73130 .... TC ...... A ........ X-ray exam of hand ............................ 0.00 0.60 0.56 NA NA 0.02 XXX 

73140 .... ............ A ........ X-ray exam of finger(s) ....................... 0.13 0.67 0.56 NA NA 0.03 XXX 

73140 .... 26 ....... A ........ X-ray exam of finger(s) ....................... 0.13 0.04 0.04 0.04 0.04 0.01 XXX 

73140 .... TC ...... A ........ X-ray exam of finger(s) ....................... 0.00 0.63 0.52 NA NA 0.02 XXX 

73200 .... ............ A ........ Ct upper extremity w/o dye ................ 1.09 6.34 5.78 NA NA 0.30 XXX 

73200 .... 26 ....... A ........ Ct upper extremity w/o dye ................ 1.09 0.39 0.36 0.39 0.36 0.05 XXX 

73200 .... TC ...... A ........ Ct upper extremity w/o dye ................ 0.00 5.96 5.42 NA NA 0.25 XXX 

73201 .... ............ A ........ Ct upper extremity w/dye ................... 1.16 7.84 7.00 NA NA 0.36 XXX 

73201 .... 26 ....... A ........ Ct upper extremity w/dye ................... 1.16 0.41 0.38 0.41 0.38 0.05 XXX 

73201 .... TC ...... A ........ Ct upper extremity w/dye ................... 0.00 7.43 6.62 NA NA 0.31 XXX 

73202 .... ............ A ........ Ct uppr extremity w/o&w/dye ............. 1.22 10.46 9.07 NA NA 0.44 XXX 

73202 .... 26 ....... A ........ Ct uppr extremity w/o&w/dye ............. 1.22 0.43 0.40 0.43 0.40 0.05 XXX 

73202 .... TC ...... A ........ Ct uppr extremity w/o&w/dye ............. 0.00 10.03 8.67 NA NA 0.39 XXX 

73206 .... ............ A ........ Ct angio upr extrm w/o&w/dye ........... 1.81 10.81 11.08 NA NA 0.47 XXX 

73206 .... 26 ....... A ........ Ct angio upr extrm w/o&w/dye ........... 1.81 0.68 0.61 0.68 0.61 0.08 XXX 

73206 .... TC ...... A ........ Ct angio upr extrm w/o&w/dye ........... 0.00 10.13 10.47 NA NA 0.39 XXX 

73218 .... ............ A ........ Mri upper extremity w/o dye ............... 1.35 14.51 13.00 NA NA 0.45 XXX 

73218 .... 26 ....... A ........ Mri upper extremity w/o dye ............... 1.35 0.46 0.44 0.46 0.44 0.06 XXX 

73218 .... TC ...... A ........ Mri upper extremity w/o dye ............... 0.00 14.05 12.56 NA NA 0.39 XXX 

73219 .... ............ A ........ Mri upper extremity w/dye .................. 1.62 15.26 14.52 NA NA 0.54 XXX 

73219 .... 26 ....... A ........ Mri upper extremity w/dye .................. 1.62 0.57 0.54 0.57 0.54 0.07 XXX 

73219 .... TC ...... A ........ Mri upper extremity w/dye .................. 0.00 14.69 13.98 NA NA 0.47 XXX 

73220 .... ............ A ........ Mri uppr extremity w/o&w/dye ............ 2.15 18.88 22.11 NA NA 0.94 XXX 

73220 .... 26 ....... A ........ Mri uppr extremity w/o&w/dye ............ 2.15 0.76 0.71 0.76 0.71 0.10 XXX 

73220 .... TC ...... A ........ Mri uppr extremity w/o&w/dye ............ 0.00 18.13 21.40 NA NA 0.84 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38318 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

73221 .... ............ A ........ Mri joint upr extrem w/o dye ............... 1.35 13.43 12.46 NA NA 0.45 XXX 

73221 .... 26 ....... A ........ Mri joint upr extrem w/o dye ............... 1.35 0.47 0.44 0.47 0.44 0.06 XXX 

73221 .... TC ...... A ........ Mri joint upr extrem w/o dye ............... 0.00 12.96 12.02 NA NA 0.39 XXX 

73222 .... ............ A ........ Mri joint upr extrem w/dye .................. 1.62 14.17 13.98 NA NA 0.54 XXX 

73222 .... 26 ....... A ........ Mri joint upr extrem w/dye .................. 1.62 0.57 0.54 0.57 0.54 0.07 XXX 

73222 .... TC ...... A ........ Mri joint upr extrem w/dye .................. 0.00 13.61 13.45 NA NA 0.47 XXX 

73223 .... ............ A ........ Mri joint upr extr w/o&w/dye ............... 2.15 17.42 21.39 NA NA 0.94 XXX 

73223 .... 26 ....... A ........ Mri joint upr extr w/o&w/dye ............... 2.15 0.75 0.71 0.75 0.71 0.10 XXX 

73223 .... TC ...... A ........ Mri joint upr extr w/o&w/dye ............... 0.00 16.67 20.68 NA NA 0.84 XXX 

73225 .... ............ N ........ Mr angio upr extr w/o&w/dye ............. 1.73 14.46 13.07 NA NA 0.69 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 

73225 .... TC ...... N ........ Mr angio upr extr w/o&w/dye ............. 0.00 14.06 12.54 NA NA 0.59 XXX 

73500 .... ............ A ........ X-ray exam of hip ............................... 0.17 0.49 0.51 NA NA 0.03 XXX 

73500 .... 26 ....... A ........ X-ray exam of hip ............................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73500 .... TC ...... A ........ X-ray exam of hip ............................... 0.00 0.42 0.45 NA NA 0.02 XXX 

73510 .... ............ A ........ X-ray exam of hip ............................... 0.21 0.77 0.70 NA NA 0.05 XXX 

73510 .... 26 ....... A ........ X-ray exam of hip ............................... 0.21 0.07 0.07 0.07 0.07 0.01 XXX 

73510 .... TC ...... A ........ X-ray exam of hip ............................... 0.00 0.70 0.63 NA NA 0.04 XXX 

73520 .... ............ A ........ X-ray exam of hips ............................. 0.26 0.78 0.77 NA NA 0.05 XXX 

73520 .... 26 ....... A ........ X-ray exam of hips ............................. 0.26 0.09 0.09 0.09 0.09 0.01 XXX 

73520 .... TC ...... A ........ X-ray exam of hips ............................. 0.00 0.69 0.68 NA NA 0.04 XXX 

73525 .... ............ A ........ Contrast x-ray of hip ........................... 0.54 1.81 2.04 NA NA 0.15 XXX 

73525 .... 26 ....... A ........ Contrast x-ray of hip ........................... 0.54 0.18 0.18 0.18 0.18 0.03 XXX 

73525 .... TC ...... A ........ Contrast x-ray of hip ........................... 0.00 1.63 1.86 NA NA 0.12 XXX 

73530 .... ............ C ........ X-ray exam of hip ............................... 0.29 NA NA NA NA 0.03 XXX 

73530 .... 26 ....... A ........ X-ray exam of hip ............................... 0.29 0.11 0.10 0.11 0.10 0.01 XXX 

73530 .... TC ...... C ........ X-ray exam of hip ............................... 0.00 NA NA NA NA 0.02 XXX 

73540 .... ............ A ........ X-ray exam of pelvis & hips ............... 0.20 0.81 0.72 NA NA 0.05 XXX 

73540 .... 26 ....... A ........ X-ray exam of pelvis & hips ............... 0.20 0.07 0.07 0.07 0.07 0.01 XXX 

73540 .... TC ...... A ........ X-ray exam of pelvis & hips ............... 0.00 0.73 0.65 NA NA 0.04 XXX 

73542 .... ............ A ........ X-ray exam, sacroiliac joint ................ 0.59 1.12 1.69 NA NA 0.15 XXX 

73542 .... 26 ....... A ........ X-ray exam, sacroiliac joint ................ 0.59 0.14 0.15 0.14 0.15 0.03 XXX 

73542 .... TC ...... A ........ X-ray exam, sacroiliac joint ................ 0.00 0.98 1.54 NA NA 0.12 XXX 

73550 .... ............ A ........ X-ray exam of thigh ............................ 0.17 0.54 0.59 NA NA 0.05 XXX 

73550 .... 26 ....... A ........ X-ray exam of thigh ............................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73550 .... TC ...... A ........ X-ray exam of thigh ............................ 0.00 0.48 0.53 NA NA 0.04 XXX 

73560 .... ............ A ........ X-ray exam of knee, 1 or 2 ................ 0.17 0.58 0.58 NA NA 0.03 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 

73560 .... TC ...... A ........ X-ray exam of knee, 1 or 2 ................ 0.00 0.52 0.52 NA NA 0.02 XXX 

73562 .... ............ A ........ X-ray exam of knee, 3 ........................ 0.18 0.72 0.67 NA NA 0.05 XXX 

73562 .... 26 ....... A ........ X-ray exam of knee, 3 ........................ 0.18 0.07 0.06 0.07 0.06 0.01 XXX 

73562 .... TC ...... A ........ X-ray exam of knee, 3 ........................ 0.00 0.66 0.61 NA NA 0.04 XXX 

73564 .... ............ A ........ X-ray exam, knee, 4 or more ............. 0.22 0.86 0.77 NA NA 0.05 XXX 

73564 .... 26 ....... A ........ X-ray exam, knee, 4 or more ............. 0.22 0.08 0.07 0.08 0.07 0.01 XXX 

73564 .... TC ...... A ........ X-ray exam, knee, 4 or more ............. 0.00 0.78 0.70 NA NA 0.04 XXX 

73565 .... ............ A ........ X-ray exam of knees .......................... 0.17 0.65 0.60 NA NA 0.03 XXX 

73565 .... 26 ....... A ........ X-ray exam of knees .......................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73565 .... TC ...... A ........ X-ray exam of knees .......................... 0.00 0.58 0.53 NA NA 0.02 XXX 

73580 .... ............ A ........ Contrast x-ray of knee joint ................ 0.54 2.54 2.63 NA NA 0.17 XXX 

73580 .... 26 ....... A ........ Contrast x-ray of knee joint ................ 0.54 0.20 0.18 0.20 0.18 0.03 XXX 

73580 .... TC ...... A ........ Contrast x-ray of knee joint ................ 0.00 2.35 2.45 NA NA 0.14 XXX 

73590 .... ............ A ........ X-ray exam of lower leg ..................... 0.17 0.53 0.56 NA NA 0.03 XXX 

73590 .... 26 ....... A ........ X-ray exam of lower leg ..................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73590 .... TC ...... A ........ X-ray exam of lower leg ..................... 0.00 0.48 0.50 NA NA 0.02 XXX 

73592 .... ............ A ........ X-ray exam of leg, infant .................... 0.16 0.57 0.56 NA NA 0.03 XXX 

73592 .... 26 ....... A ........ X-ray exam of leg, infant .................... 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73592 .... TC ...... A ........ X-ray exam of leg, infant .................... 0.00 0.52 0.51 NA NA 0.02 XXX 

73600 .... ............ A ........ X-ray exam of ankle ........................... 0.16 0.55 0.54 NA NA 0.03 XXX 

73600 .... 26 ....... A ........ X-ray exam of ankle ........................... 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73600 .... TC ...... A ........ X-ray exam of ankle ........................... 0.00 0.50 0.49 NA NA 0.02 XXX 

73610 .... ............ A ........ X-ray exam of ankle ........................... 0.17 0.67 0.63 NA NA 0.03 XXX 

73610 .... 26 ....... A ........ X-ray exam of ankle ........................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73610 .... TC ...... A ........ X-ray exam of ankle ........................... 0.00 0.61 0.57 NA NA 0.02 XXX 

73615 .... ............ A ........ Contrast x-ray of ankle ....................... 0.54 1.98 2.11 NA NA 0.15 XXX 

73615 .... 26 ....... A ........ Contrast x-ray of ankle ....................... 0.54 0.18 0.18 0.18 0.18 0.03 XXX 

73615 .... TC ...... A ........ Contrast x-ray of ankle ....................... 0.00 1.80 1.93 NA NA 0.12 XXX 

73620 .... ............ A ........ X-ray exam of foot .............................. 0.16 0.52 0.53 NA NA 0.03 XXX 

73620 .... 26 ....... A ........ X-ray exam of foot .............................. 0.16 0.04 0.05 0.04 0.05 0.01 XXX 

73620 .... TC ...... A ........ X-ray exam of foot .............................. 0.00 0.47 0.48 NA NA 0.02 XXX 

73630 .... ............ A ........ X-ray exam of foot .............................. 0.17 0.65 0.62 NA NA 0.03 XXX 

73630 .... 26 ....... A ........ X-ray exam of foot .............................. 0.17 0.05 0.06 0.05 0.06 0.01 XXX 

73630 .... TC ...... A ........ X-ray exam of foot .............................. 0.00 0.59 0.56 NA NA 0.02 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38319 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

73650 .... ............ A ........ X-ray exam of heel ............................. 0.16 0.54 0.53 NA NA 0.03 XXX 

73650 .... 26 ....... A ........ X-ray exam of heel ............................. 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73650 .... TC ...... A ........ X-ray exam of heel ............................. 0.00 0.49 0.48 NA NA 0.02 XXX 

73660 .... ............ A ........ X-ray exam of toe(s) ........................... 0.13 0.63 0.54 NA NA 0.03 XXX 

73660 .... 26 ....... A ........ X-ray exam of toe(s) ........................... 0.13 0.04 0.04 0.04 0.04 0.01 XXX 

73660 .... TC ...... A ........ X-ray exam of toe(s) ........................... 0.00 0.59 0.50 NA NA 0.02 XXX 

73700 .... ............ A ........ Ct lower extremity w/o dye ................. 1.09 6.35 5.78 NA NA 0.30 XXX 

73700 .... 26 ....... A ........ Ct lower extremity w/o dye ................. 1.09 0.39 0.36 0.39 0.36 0.05 XXX 

73700 .... TC ...... A ........ Ct lower extremity w/o dye ................. 0.00 5.97 5.42 NA NA 0.25 XXX 

73701 .... ............ A ........ Ct lower extremity w/dye .................... 1.16 7.90 7.03 NA NA 0.36 XXX 

73701 .... 26 ....... A ........ Ct lower extremity w/dye .................... 1.16 0.42 0.39 0.42 0.39 0.05 XXX 

73701 .... TC ...... A ........ Ct lower extremity w/dye .................... 0.00 7.49 6.65 NA NA 0.31 XXX 

73702 .... ............ A ........ Ct lwr extremity w/o&w/dye ................ 1.22 10.62 9.14 NA NA 0.44 XXX 

73702 .... 26 ....... A ........ Ct lwr extremity w/o&w/dye ................ 1.22 0.45 0.41 0.45 0.41 0.05 XXX 

73702 .... TC ...... A ........ Ct lwr extremity w/o&w/dye ................ 0.00 10.17 8.73 NA NA 0.39 XXX 

73706 .... ............ A ........ Ct angio lwr extr w/o&w/dye ............... 1.90 12.19 11.80 NA NA 0.47 XXX 

73706 .... 26 ....... A ........ Ct angio lwr extr w/o&w/dye ............... 1.90 0.72 0.65 0.72 0.65 0.08 XXX 

73706 .... TC ...... A ........ Ct angio lwr extr w/o&w/dye ............... 0.00 11.47 11.15 NA NA 0.39 XXX 

73718 .... ............ A ........ Mri lower extremity w/o dye ............... 1.35 14.13 12.80 NA NA 0.45 XXX 

73718 .... 26 ....... A ........ Mri lower extremity w/o dye ............... 1.35 0.47 0.44 0.47 0.44 0.06 XXX 

73718 .... TC ...... A ........ Mri lower extremity w/o dye ............... 0.00 13.66 12.36 NA NA 0.39 XXX 

73719 .... ............ A ........ Mri lower extremity w/dye ................... 1.62 15.26 14.50 NA NA 0.54 XXX 

73719 .... 26 ....... A ........ Mri lower extremity w/dye ................... 1.62 0.57 0.53 0.57 0.53 0.07 XXX 

73719 .... TC ...... A ........ Mri lower extremity w/dye ................... 0.00 14.69 13.97 NA NA 0.47 XXX 

73720 .... ............ A ........ Mri lwr extremity w/o&w/dye ............... 2.15 18.82 22.07 NA NA 0.94 XXX 

73720 .... 26 ....... A ........ Mri lwr extremity w/o&w/dye ............... 2.15 0.76 0.71 0.76 0.71 0.10 XXX 

73720 .... TC ...... A ........ Mri lwr extremity w/o&w/dye ............... 0.00 18.06 21.37 NA NA 0.84 XXX 

73721 .... ............ A ........ Mri jnt of lwr extre w/o dye ................. 1.35 13.74 12.61 NA NA 0.45 XXX 

73721 .... 26 ....... A ........ Mri jnt of lwr extre w/o dye ................. 1.35 0.47 0.44 0.47 0.44 0.06 XXX 

73721 .... TC ...... A ........ Mri jnt of lwr extre w/o dye ................. 0.00 13.27 12.17 NA NA 0.39 XXX 

73722 .... ............ A ........ Mri joint of lwr extr w/dye ................... 1.62 14.36 14.09 NA NA 0.54 XXX 

73722 .... 26 ....... A ........ Mri joint of lwr extr w/dye ................... 1.62 0.57 0.54 0.57 0.54 0.07 XXX 

73722 .... TC ...... A ........ Mri joint of lwr extr w/dye ................... 0.00 13.79 13.55 NA NA 0.47 XXX 

73723 .... ............ A ........ Mri joint lwr extr w/o&w/dye ............... 2.15 17.40 21.38 NA NA 0.94 XXX 

73723 .... 26 ....... A ........ Mri joint lwr extr w/o&w/dye ............... 2.15 0.75 0.71 0.75 0.71 0.10 XXX 

73723 .... TC ...... A ........ Mri joint lwr extr w/o&w/dye ............... 0.00 16.64 20.67 NA NA 0.84 XXX 

73725 .... ............ R ........ Mr ang lwr ext w or w/o dye ............... 1.82 14.98 13.29 NA NA 0.67 XXX 

73725 .... 26 ....... R ........ Mr ang lwr ext w or w/o dye ............... 1.82 0.65 0.60 0.65 0.60 0.08 XXX 

73725 .... TC ...... R ........ Mr ang lwr ext w or w/o dye ............... 0.00 14.33 12.68 NA NA 0.59 XXX 

74000 .... ............ A ........ X-ray exam of abdomen ..................... 0.18 0.46 0.52 NA NA 0.03 XXX 

74000 .... 26 ....... A ........ X-ray exam of abdomen ..................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

74000 .... TC ...... A ........ X-ray exam of abdomen ..................... 0.00 0.40 0.46 NA NA 0.02 XXX 

74010 .... ............ A ........ X-ray exam of abdomen ..................... 0.23 0.78 0.71 NA NA 0.05 XXX 

74010 .... 26 ....... A ........ X-ray exam of abdomen ..................... 0.23 0.08 0.08 0.08 0.08 0.01 XXX 

74010 .... TC ...... A ........ X-ray exam of abdomen ..................... 0.00 0.71 0.64 NA NA 0.04 XXX 

74020 .... ............ A ........ X-ray exam of abdomen ..................... 0.27 0.81 0.75 NA NA 0.05 XXX 

74020 .... 26 ....... A ........ X-ray exam of abdomen ..................... 0.27 0.10 0.09 0.10 0.09 0.01 XXX 

74020 .... TC ...... A ........ X-ray exam of abdomen ..................... 0.00 0.71 0.66 NA NA 0.04 XXX 

74022 .... ............ A ........ X-ray exam series, abdomen ............. 0.32 0.98 0.89 NA NA 0.06 XXX 

74022 .... 26 ....... A ........ X-ray exam series, abdomen ............. 0.32 0.11 0.10 0.11 0.10 0.01 XXX 

74022 .... TC ...... A ........ X-ray exam series, abdomen ............. 0.00 0.87 0.79 NA NA 0.05 XXX 

74150 .... ............ A ........ Ct abdomen w/o dye .......................... 1.19 6.02 5.99 NA NA 0.35 XXX 

74150 .... 26 ....... A ........ Ct abdomen w/o dye .......................... 1.19 0.43 0.40 0.43 0.40 0.05 XXX 

74150 .... TC ...... A ........ Ct abdomen w/o dye .......................... 0.00 5.59 5.59 NA NA 0.30 XXX 

74160 .... ............ A ........ Ct abdomen w/dye ............................. 1.27 8.75 7.94 NA NA 0.42 XXX 

74160 .... 26 ....... A ........ Ct abdomen w/dye ............................. 1.27 0.46 0.43 0.46 0.43 0.06 XXX 

74160 .... TC ...... A ........ Ct abdomen w/dye ............................. 0.00 8.29 7.51 NA NA 0.36 XXX 

74170 .... ............ A ........ Ct abdomen w/o & w/dye ................... 1.40 12.08 10.43 NA NA 0.49 XXX 

74170 .... 26 ....... A ........ Ct abdomen w/o & w/dye ................... 1.40 0.50 0.47 0.50 0.47 0.06 XXX 

74170 .... TC ...... A ........ Ct abdomen w/o & w/dye ................... 0.00 11.58 9.96 NA NA 0.43 XXX 

74175 .... ............ A ........ Ct angio abdom w/o & w/dye ............. 1.90 12.15 12.31 NA NA 0.47 XXX 

74175 .... 26 ....... A ........ Ct angio abdom w/o & w/dye ............. 1.90 0.70 0.64 0.70 0.64 0.08 XXX 

74175 .... TC ...... A ........ Ct angio abdom w/o & w/dye ............. 0.00 11.46 11.67 NA NA 0.39 XXX 

74181 .... ............ A ........ Mri abdomen w/o dye ......................... 1.46 12.34 11.92 NA NA 0.51 XXX 

74181 .... 26 ....... A ........ Mri abdomen w/o dye ......................... 1.46 0.52 0.48 0.52 0.48 0.06 XXX 

74181 .... TC ...... A ........ Mri abdomen w/o dye ......................... 0.00 11.82 11.44 NA NA 0.45 XXX 

74182 .... ............ A ........ Mri abdomen w/dye ............................ 1.73 17.28 15.51 NA NA 0.60 XXX 

74182 .... 26 ....... A ........ Mri abdomen w/dye ............................ 1.73 0.62 0.57 0.62 0.57 0.08 XXX 

74182 .... TC ...... A ........ Mri abdomen w/dye ............................ 0.00 16.67 14.94 NA NA 0.52 XXX 

74183 .... ............ A ........ Mri abdomen w/o & w/dye .................. 2.26 18.82 22.09 NA NA 1.02 XXX 

74183 .... 26 ....... A ........ Mri abdomen w/o & w/dye .................. 2.26 0.80 0.75 0.80 0.75 0.10 XXX 

74183 .... TC ...... A ........ Mri abdomen w/o & w/dye .................. 0.00 18.02 21.34 NA NA 0.92 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38320 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

74185 .... ............ R ........ Mri angio, abdom w orw/o dye ........... 1.80 14.94 13.26 NA NA 0.67 XXX 

74185 .... 26 ....... R ........ Mri angio, abdom w orw/o dye ........... 1.80 0.64 0.59 0.64 0.59 0.08 XXX 

74185 .... TC ...... R ........ Mri angio, abdom w orw/o dye ........... 0.00 14.30 12.67 NA NA 0.59 XXX 

74190 .... ............ C ........ X-ray exam of peritoneum .................. 0.48 NA NA NA NA 0.09 XXX 

74190 .... 26 ....... A ........ X-ray exam of peritoneum .................. 0.48 0.17 0.16 0.17 0.16 0.02 XXX 

74190 .... TC ...... C ........ X-ray exam of peritoneum .................. 0.00 NA NA NA NA 0.07 XXX 

74210 .... ............ A ........ Contrst x-ray exam of throat .............. 0.36 1.76 1.52 NA NA 0.08 XXX 

74210 .... 26 ....... A ........ Contrst x-ray exam of throat .............. 0.36 0.13 0.12 0.13 0.12 0.02 XXX 

74210 .... TC ...... A ........ Contrst x-ray exam of throat .............. 0.00 1.63 1.40 NA NA 0.06 XXX 

74220 .... ............ A ........ Contrast x-ray, esophagus ................. 0.46 2.00 1.65 NA NA 0.08 XXX 

74220 .... 26 ....... A ........ Contrast x-ray, esophagus ................. 0.46 0.16 0.15 0.16 0.15 0.02 XXX 

74220 .... TC ...... A ........ Contrast x-ray, esophagus ................. 0.00 1.83 1.50 NA NA 0.06 XXX 

74230 .... ............ A ........ Cine/vid x-ray, throat/esoph ............... 0.53 1.94 1.69 NA NA 0.09 XXX 

74230 .... 26 ....... A ........ Cine/vid x-ray, throat/esoph ............... 0.53 0.19 0.18 0.19 0.18 0.02 XXX 

74230 .... TC ...... A ........ Cine/vid x-ray, throat/esoph ............... 0.00 1.75 1.52 NA NA 0.07 XXX 

74235 .... ............ C ........ Remove esophagus obstruction ......... 1.19 0.00 0.26 0.00 0.26 0.05 XXX 

74235 .... 26 ....... A ........ Remove esophagus obstruction ......... 1.19 0.46 0.41 0.46 0.41 0.05 XXX 

74235 .... TC ...... C ........ Remove esophagus obstruction ......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

74240 .... ............ A ........ X-ray exam, upper gi tract .................. 0.69 2.29 1.96 NA NA 0.11 XXX 

74240 .... 26 ....... A ........ X-ray exam, upper gi tract .................. 0.69 0.25 0.23 0.25 0.23 0.03 XXX 

74240 .... TC ...... A ........ X-ray exam, upper gi tract .................. 0.00 2.04 1.73 NA NA 0.08 XXX 

74241 .... ............ A ........ X-ray exam, upper gi tract .................. 0.69 2.54 2.11 NA NA 0.11 XXX 

74241 .... 26 ....... A ........ X-ray exam, upper gi tract .................. 0.69 0.24 0.23 0.24 0.23 0.03 XXX 

74241 .... TC ...... A ........ X-ray exam, upper gi tract .................. 0.00 2.30 1.88 NA NA 0.08 XXX 

74245 .... ............ A ........ X-ray exam, upper gi tract .................. 0.91 3.93 3.27 NA NA 0.17 XXX 

74245 .... 26 ....... A ........ X-ray exam, upper gi tract .................. 0.91 0.32 0.30 0.32 0.30 0.04 XXX 

74245 .... TC ...... A ........ X-ray exam, upper gi tract .................. 0.00 3.60 2.97 NA NA 0.13 XXX 

74246 .... ............ A ........ Contrst x-ray uppr gi tract .................. 0.69 2.78 2.30 NA NA 0.13 XXX 

74246 .... 26 ....... A ........ Contrst x-ray uppr gi tract .................. 0.69 0.25 0.23 0.25 0.23 0.03 XXX 

74246 .... TC ...... A ........ Contrst x-ray uppr gi tract .................. 0.00 2.53 2.07 NA NA 0.10 XXX 

74247 .... ............ A ........ Contrst x-ray uppr gi tract .................. 0.69 3.19 2.52 NA NA 0.14 XXX 

74247 .... 26 ....... A ........ Contrst x-ray uppr gi tract .................. 0.69 0.25 0.23 0.25 0.23 0.03 XXX 

74247 .... TC ...... A ........ Contrst x-ray uppr gi tract .................. 0.00 2.95 2.29 NA NA 0.11 XXX 

74249 .... ............ A ........ Contrst x-ray uppr gi tract .................. 0.91 4.32 3.55 NA NA 0.18 XXX 

74249 .... 26 ....... A ........ Contrst x-ray uppr gi tract .................. 0.91 0.32 0.30 0.32 0.30 0.04 XXX 

74249 .... TC ...... A ........ Contrst x-ray uppr gi tract .................. 0.00 3.99 3.25 NA NA 0.14 XXX 

74250 .... ............ A ........ X-ray exam of small bowel ................. 0.47 2.46 1.94 NA NA 0.09 XXX 

74250 .... 26 ....... A ........ X-ray exam of small bowel ................. 0.47 0.17 0.16 0.17 0.16 0.02 XXX 

74250 .... TC ...... A ........ X-ray exam of small bowel ................. 0.00 2.30 1.79 NA NA 0.07 XXX 

74251 .... ............ A ........ X-ray exam of small bowel ................. 0.69 9.92 5.65 NA NA 0.10 XXX 

74251 .... 26 ....... A ........ X-ray exam of small bowel ................. 0.69 0.25 0.23 0.25 0.23 0.03 XXX 

74251 .... TC ...... A ........ X-ray exam of small bowel ................. 0.00 9.67 5.42 NA NA 0.07 XXX 

74260 .... ............ A ........ X-ray exam of small bowel ................. 0.50 8.23 4.88 NA NA 0.10 XXX 

74260 .... 26 ....... A ........ X-ray exam of small bowel ................. 0.50 0.18 0.17 0.18 0.17 0.02 XXX 

74260 .... TC ...... A ........ X-ray exam of small bowel ................. 0.00 8.05 4.72 NA NA 0.08 XXX 

74270 .... ............ A ........ Contrast x-ray exam of colon ............. 0.69 3.56 2.71 NA NA 0.14 XXX 

74270 .... 26 ....... A ........ Contrast x-ray exam of colon ............. 0.69 0.25 0.23 0.25 0.23 0.03 XXX 

74270 .... TC ...... A ........ Contrast x-ray exam of colon ............. 0.00 3.31 2.48 NA NA 0.11 XXX 

74280 .... ............ A ........ Contrast x-ray exam of colon ............. 0.99 4.91 3.68 NA NA 0.17 XXX 

74280 .... 26 ....... A ........ Contrast x-ray exam of colon ............. 0.99 0.35 0.32 0.35 0.32 0.04 XXX 

74280 .... TC ...... A ........ Contrast x-ray exam of colon ............. 0.00 4.55 3.36 NA NA 0.13 XXX 

74283 .... ............ A ........ Contrast x-ray exam of colon ............. 2.02 3.47 3.31 NA NA 0.23 XXX 

74283 .... 26 ....... A ........ Contrast x-ray exam of colon ............. 2.02 0.70 0.66 0.70 0.66 0.09 XXX 

74283 .... TC ...... A ........ Contrast x-ray exam of colon ............. 0.00 2.77 2.65 NA NA 0.14 XXX 

74290 .... ............ A ........ Contrast x-ray, gallbladder ................. 0.32 1.57 1.18 NA NA 0.06 XXX 

74290 .... 26 ....... A ........ Contrast x-ray, gallbladder ................. 0.32 0.11 0.10 0.11 0.10 0.01 XXX 

74290 .... TC ...... A ........ Contrast x-ray, gallbladder ................. 0.00 1.46 1.08 NA NA 0.05 XXX 

74291 .... ............ A ........ Contrast x-rays, gallbladder ............... 0.20 1.54 1.02 NA NA 0.03 XXX 

74291 .... 26 ....... A ........ Contrast x-rays, gallbladder ............... 0.20 0.07 0.07 0.07 0.07 0.01 XXX 

74291 .... TC ...... A ........ Contrast x-rays, gallbladder ............... 0.00 1.47 0.95 NA NA 0.02 XXX 

74300 .... ............ C ........ X-ray bile ducts/pancreas ................... 0.36 0.00 0.08 0.00 0.08 0.02 XXX 

74300 .... 26 ....... A ........ X-ray bile ducts/pancreas ................... 0.36 0.13 0.12 0.13 0.12 0.02 XXX 

74300 .... TC ...... C ........ X-ray bile ducts/pancreas ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

74301 .... ............ C ........ X-rays at surgery add-on .................... 0.21 0.00 0.05 0.00 0.05 0.01 ZZZ 

74301 .... 26 ....... A ........ X-rays at surgery add-on .................... 0.21 0.08 0.07 0.08 0.07 0.01 ZZZ 

74301 .... TC ...... C ........ X-rays at surgery add-on .................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

74305 .... ............ C ........ X-ray bile ducts/pancreas ................... 0.42 NA NA NA NA 0.07 XXX 

74305 .... 26 ....... A ........ X-ray bile ducts/pancreas ................... 0.42 0.15 0.14 0.15 0.14 0.02 XXX 

74305 .... TC ...... C ........ X-ray bile ducts/pancreas ................... 0.00 NA NA NA NA 0.05 XXX 

74320 .... ............ A ........ Contrast x-ray of bile ducts ................ 0.54 2.12 2.71 NA NA 0.19 XXX 

74320 .... 26 ....... A ........ Contrast x-ray of bile ducts ................ 0.54 0.20 0.19 0.20 0.19 0.02 XXX 

74320 .... TC ...... A ........ Contrast x-ray of bile ducts ................ 0.00 1.92 2.52 NA NA 0.17 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38321 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

74327 .... ............ A ........ X-ray bile stone removal .................... 0.70 2.95 2.44 NA NA 0.14 XXX 

74327 .... 26 ....... A ........ X-ray bile stone removal .................... 0.70 0.26 0.23 0.26 0.23 0.03 XXX 

74327 .... TC ...... A ........ X-ray bile stone removal .................... 0.00 2.69 2.21 NA NA 0.11 XXX 

74328 .... ............ C ........ X-ray bile duct endoscopy .................. 0.70 NA NA NA NA 0.20 XXX 

74328 .... 26 ....... A ........ X-ray bile duct endoscopy .................. 0.70 0.26 0.24 0.26 0.24 0.03 XXX 

74328 .... TC ...... C ........ X-ray bile duct endoscopy .................. 0.00 NA NA NA NA 0.17 XXX 

74329 .... ............ C ........ X-ray for pancreas endoscopy ........... 0.70 0.00 1.73 0.00 1.73 0.03 XXX 

74329 .... 26 ....... A ........ X-ray for pancreas endoscopy ........... 0.70 0.27 0.24 0.27 0.24 0.03 XXX 

74329 .... TC ...... C ........ X-ray for pancreas endoscopy ........... 0.00 0.00 1.58 0.00 1.58 0.00 XXX 

74330 .... ............ C ........ X-ray bile/panc endoscopy ................. 0.90 NA NA NA NA 0.21 XXX 

74330 .... 26 ....... A ........ X-ray bile/panc endoscopy ................. 0.90 0.33 0.30 0.33 0.30 0.04 XXX 

74330 .... TC ...... C ........ X-ray bile/panc endoscopy ................. 0.00 NA NA NA NA 0.17 XXX 

74340 .... ............ C ........ X-ray guide for GI tube ....................... 0.54 NA NA NA NA 0.16 XXX 

74340 .... 26 ....... A ........ X-ray guide for GI tube ....................... 0.54 0.20 0.19 0.20 0.19 0.02 XXX 

74340 .... TC ...... C ........ X-ray guide for GI tube ....................... 0.00 0.00 1.75 0.00 1.75 0.14 XXX 

74350 .... ............ A ........ X-ray guide, stomach tube ................. 0.76 2.21 2.78 NA NA 0.20 XXX 

74350 .... 26 ....... A ........ X-ray guide, stomach tube ................. 0.76 0.28 0.25 0.28 0.25 0.03 XXX 

74350 .... TC ...... A ........ X-ray guide, stomach tube ................. 0.00 1.93 2.53 NA NA 0.17 XXX 

74355 .... ............ C ........ X-ray guide, intestinal tube ................. 0.76 NA NA NA NA 0.17 XXX 

74355 .... 26 ....... A ........ X-ray guide, intestinal tube ................. 0.76 0.28 0.25 0.28 0.25 0.03 XXX 

74355 .... TC ...... C ........ X-ray guide, intestinal tube ................. 0.00 0.00 1.75 0.00 1.75 0.14 XXX 

74360 .... ............ C ........ X-ray guide, GI dilation ....................... 0.54 NA NA NA NA 0.19 XXX 

74360 .... 26 ....... A ........ X-ray guide, GI dilation ....................... 0.54 0.24 0.21 0.24 0.21 0.02 XXX 

74360 .... TC ...... C ........ X-ray guide, GI dilation ....................... 0.00 NA NA NA NA 0.17 XXX 

74363 .... ............ C ........ X-ray, bile duct dilation ....................... 0.88 0.00 0.19 0.00 0.19 0.04 XXX 

74363 .... 26 ....... A ........ X-ray, bile duct dilation ....................... 0.88 0.32 0.29 0.32 0.29 0.04 XXX 

74363 .... TC ...... C ........ X-ray, bile duct dilation ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

74400 .... ............ A ........ Contrst x-ray, urinary tract .................. 0.49 2.59 2.20 NA NA 0.13 XXX 

74400 .... 26 ....... A ........ Contrst x-ray, urinary tract .................. 0.49 0.18 0.17 0.18 0.17 0.02 XXX 

74400 .... TC ...... A ........ Contrst x-ray, urinary tract .................. 0.00 2.41 2.03 NA NA 0.11 XXX 

74410 .... ............ A ........ Contrst x-ray, urinary tract .................. 0.49 2.67 2.38 NA NA 0.13 XXX 

74410 .... 26 ....... A ........ Contrst x-ray, urinary tract .................. 0.49 0.18 0.17 0.18 0.17 0.02 XXX 

74410 .... TC ...... A ........ Contrst x-ray, urinary tract .................. 0.00 2.49 2.21 NA NA 0.11 XXX 

74415 .... ............ A ........ Contrst x-ray, urinary tract .................. 0.49 3.25 2.74 NA NA 0.14 XXX 

74415 .... 26 ....... A ........ Contrst x-ray, urinary tract .................. 0.49 0.18 0.17 0.18 0.17 0.02 XXX 

74415 .... TC ...... A ........ Contrst x-ray, urinary tract .................. 0.00 3.07 2.58 NA NA 0.12 XXX 

74420 .... ............ C ........ Contrst x-ray, urinary tract .................. 0.36 NA NA NA NA 0.16 XXX 

74420 .... 26 ....... A ........ Contrst x-ray, urinary tract .................. 0.36 0.14 0.13 0.14 0.13 0.02 XXX 

74420 .... TC ...... C ........ Contrst x-ray, urinary tract .................. 0.00 NA NA NA NA 0.14 XXX 

74425 .... ............ C ........ Contrst x-ray, urinary tract .................. 0.36 NA NA NA NA 0.09 XXX 

74425 .... 26 ....... A ........ Contrst x-ray, urinary tract .................. 0.36 0.13 0.12 0.13 0.12 0.02 XXX 

74425 .... TC ...... C ........ Contrst x-ray, urinary tract .................. 0.00 NA NA NA NA 0.07 XXX 

74430 .... ............ A ........ Contrast x-ray, bladder ....................... 0.32 1.94 1.53 NA NA 0.08 XXX 

74430 .... 26 ....... A ........ Contrast x-ray, bladder ....................... 0.32 0.12 0.11 0.12 0.11 0.02 XXX 

74430 .... TC ...... A ........ Contrast x-ray, bladder ....................... 0.00 1.83 1.43 NA NA 0.06 XXX 

74440 .... ............ A ........ X-ray, male genital tract ..................... 0.38 2.11 1.69 NA NA 0.08 XXX 

74440 .... 26 ....... A ........ X-ray, male genital tract ..................... 0.38 0.15 0.14 0.15 0.14 0.02 XXX 

74440 .... TC ...... A ........ X-ray, male genital tract ..................... 0.00 1.96 1.55 NA NA 0.06 XXX 

74445 .... ............ C ........ X-ray exam of penis ........................... 1.14 NA NA NA NA 0.13 XXX 

74445 .... 26 ....... A ........ X-ray exam of penis ........................... 1.14 0.46 0.41 0.46 0.41 0.07 XXX 

74445 .... TC ...... C ........ X-ray exam of penis ........................... 0.00 NA NA NA NA 0.06 XXX 

74450 .... ............ C ........ X-ray, urethra/bladder ......................... 0.33 NA NA NA NA 0.10 XXX 

74450 .... 26 ....... A ........ X-ray, urethra/bladder ......................... 0.33 0.12 0.11 0.12 0.11 0.02 XXX 

74450 .... TC ...... C ........ X-ray, urethra/bladder ......................... 0.00 NA NA NA NA 0.08 XXX 

74455 .... ............ A ........ X-ray, urethra/bladder ......................... 0.33 2.17 1.92 NA NA 0.12 XXX 

74455 .... 26 ....... A ........ X-ray, urethra/bladder ......................... 0.33 0.13 0.12 0.13 0.12 0.02 XXX 

74455 .... TC ...... A ........ X-ray, urethra/bladder ......................... 0.00 2.04 1.80 NA NA 0.10 XXX 

74470 .... ............ C ........ X-ray exam of kidney lesion ............... 0.54 NA NA NA NA 0.09 XXX 

74470 .... 26 ....... A ........ X-ray exam of kidney lesion ............... 0.54 0.17 0.17 0.17 0.17 0.02 XXX 

74470 .... TC ...... C ........ X-ray exam of kidney lesion ............... 0.00 NA NA NA NA 0.07 XXX 

74475 .... ............ A ........ X-ray control, cath insert .................... 0.54 2.10 3.16 NA NA 0.24 XXX 

74475 .... 26 ....... A ........ X-ray control, cath insert .................... 0.54 0.20 0.19 0.20 0.19 0.02 XXX 

74475 .... TC ...... A ........ X-ray control, cath insert .................... 0.00 1.90 2.97 NA NA 0.22 XXX 

74480 .... ............ A ........ X-ray control, cath insert .................... 0.54 2.11 3.16 NA NA 0.24 XXX 

74480 .... 26 ....... A ........ X-ray control, cath insert .................... 0.54 0.20 0.19 0.20 0.19 0.02 XXX 

74480 .... TC ...... A ........ X-ray control, cath insert .................... 0.00 1.91 2.98 NA NA 0.22 XXX 

74485 .... ............ A ........ X-ray guide, GU dilation ..................... 0.54 2.26 2.77 NA NA 0.20 XXX 

74485 .... 26 ....... A ........ X-ray guide, GU dilation ..................... 0.54 0.21 0.18 0.21 0.18 0.03 XXX 

74485 .... TC ...... A ........ X-ray guide, GU dilation ..................... 0.00 2.06 2.59 NA NA 0.17 XXX 

74710 .... ............ A ........ X-ray measurement of pelvis ............. 0.34 0.64 0.90 NA NA 0.08 XXX 

74710 .... 26 ....... A ........ X-ray measurement of pelvis ............. 0.34 0.12 0.11 0.12 0.11 0.02 XXX 

74710 .... TC ...... A ........ X-ray measurement of pelvis ............. 0.00 0.52 0.79 NA NA 0.06 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38322 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

74740 .... ............ A ........ X-ray, female genital tract .................. 0.38 1.75 1.58 NA NA 0.09 XXX 

74740 .... 26 ....... A ........ X-ray, female genital tract .................. 0.38 0.13 0.13 0.13 0.13 0.02 XXX 

74740 .... TC ...... A ........ X-ray, female genital tract .................. 0.00 1.62 1.45 NA NA 0.07 XXX 

74742 .... ............ C ........ X-ray, fallopian tube ........................... 0.61 0.00 0.13 0.00 0.13 0.03 XXX 

74742 .... 26 ....... A ........ X-ray, fallopian tube ........................... 0.61 0.19 0.19 0.19 0.19 0.03 XXX 

74742 .... TC ...... C ........ X-ray, fallopian tube ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

74775 .... ............ C ........ X-ray exam of perineum ..................... 0.62 NA NA NA NA 0.11 XXX 

74775 .... 26 ....... A ........ X-ray exam of perineum ..................... 0.62 0.23 0.21 0.23 0.21 0.03 XXX 

74775 .... TC ...... C ........ X-ray exam of perineum ..................... 0.00 0.00 0.97 0.00 0.97 0.08 XXX 

75552 .... ............ A ........ Heart mri for morph w/o dye .............. 1.60 18.93 15.23 NA NA 0.66 XXX 

75552 .... 26 ....... A ........ Heart mri for morph w/o dye .............. 1.60 0.62 0.56 0.62 0.56 0.07 XXX 

75552 .... TC ...... A ........ Heart mri for morph w/o dye .............. 0.00 18.31 14.67 NA NA 0.59 XXX 

75553 .... ............ A ........ Heart mri for morph w/dye ................. 2.00 23.11 17.57 NA NA 0.66 XXX 

75553 .... 26 ....... A ........ Heart mri for morph w/dye ................. 2.00 0.84 0.76 0.84 0.76 0.07 XXX 

75553 .... TC ...... A ........ Heart mri for morph w/dye ................. 0.00 22.27 16.81 NA NA 0.59 XXX 

75554 .... ............ A ........ Cardiac MRI/function .......................... 1.83 26.43 19.14 NA NA 0.66 XXX 

75554 .... 26 ....... A ........ Cardiac MRI/function .......................... 1.83 0.82 0.73 0.82 0.73 0.07 XXX 

75554 .... TC ...... A ........ Cardiac MRI/function .......................... 0.00 25.61 18.42 NA NA 0.59 XXX 

75555 .... ............ A ........ Cardiac MRI/limited study .................. 1.74 25.66 18.98 NA NA 0.66 XXX 

75555 .... 26 ....... A ........ Cardiac MRI/limited study .................. 1.74 0.76 0.71 0.76 0.71 0.07 XXX 

75555 .... TC ...... A ........ Cardiac MRI/limited study .................. 0.00 24.90 18.27 NA NA 0.59 XXX 

75600 .... ............ A ........ Contrast x-ray exam of aorta ............. 0.49 6.22 9.54 NA NA 0.67 XXX 

75600 .... 26 ....... A ........ Contrast x-ray exam of aorta ............. 0.49 0.23 0.22 0.23 0.22 0.02 XXX 

75600 .... TC ...... A ........ Contrast x-ray exam of aorta ............. 0.00 5.99 9.32 NA NA 0.65 XXX 

75605 .... ............ A ........ Contrast x-ray exam of aorta ............. 1.14 3.47 8.24 NA NA 0.70 XXX 

75605 .... 26 ....... A ........ Contrast x-ray exam of aorta ............. 1.14 0.48 0.44 0.48 0.44 0.05 XXX 

75605 .... TC ...... A ........ Contrast x-ray exam of aorta ............. 0.00 2.98 7.80 NA NA 0.65 XXX 

75625 .... ............ A ........ Contrast x-ray exam of aorta ............. 1.14 3.30 8.13 NA NA 0.71 XXX 

75625 .... 26 ....... A ........ Contrast x-ray exam of aorta ............. 1.14 0.42 0.40 0.42 0.40 0.06 XXX 

75625 .... TC ...... A ........ Contrast x-ray exam of aorta ............. 0.00 2.87 7.73 NA NA 0.65 XXX 

75630 .... ............ A ........ X-ray aorta, leg arteries ...................... 1.79 3.67 8.72 NA NA 0.80 XXX 

75630 .... 26 ....... A ........ X-ray aorta, leg arteries ...................... 1.79 0.70 0.66 0.70 0.66 0.11 XXX 

75630 .... TC ...... A ........ X-ray aorta, leg arteries ...................... 0.00 2.98 8.06 NA NA 0.69 XXX 

75635 .... ............ A ........ Ct angio abdominal arteries ............... 2.40 12.76 14.63 NA NA 0.50 XXX 

75635 .... 26 ....... A ........ Ct angio abdominal arteries ............... 2.40 0.92 0.83 0.92 0.83 0.11 XXX 

75635 .... TC ...... A ........ Ct angio abdominal arteries ............... 0.00 11.84 13.80 NA NA 0.39 XXX 

75650 .... ............ A ........ Artery x-rays, head & neck ................. 1.49 3.46 8.26 NA NA 0.72 XXX 

75650 .... 26 ....... A ........ Artery x-rays, head & neck ................. 1.49 0.57 0.52 0.57 0.52 0.07 XXX 

75650 .... TC ...... A ........ Artery x-rays, head & neck ................. 0.00 2.90 7.74 NA NA 0.65 XXX 

75658 .... ............ A ........ Artery x-rays, arm ............................... 1.31 3.67 8.38 NA NA 0.72 XXX 

75658 .... 26 ....... A ........ Artery x-rays, arm ............................... 1.31 0.44 0.46 0.44 0.46 0.07 XXX 

75658 .... TC ...... A ........ Artery x-rays, arm ............................... 0.00 3.23 7.92 NA NA 0.65 XXX 

75660 .... ............ A ........ Artery x-rays, head & neck ................. 1.31 3.83 8.43 NA NA 0.71 XXX 

75660 .... 26 ....... A ........ Artery x-rays, head & neck ................. 1.31 0.49 0.46 0.49 0.46 0.06 XXX 

75660 .... TC ...... A ........ Artery x-rays, head & neck ................. 0.00 3.33 7.96 NA NA 0.65 XXX 

75662 .... ............ A ........ Artery x-rays, head & neck ................. 1.66 4.91 9.06 NA NA 0.71 XXX 

75662 .... 26 ....... A ........ Artery x-rays, head & neck ................. 1.66 0.69 0.64 0.69 0.64 0.06 XXX 

75662 .... TC ...... A ........ Artery x-rays, head & neck ................. 0.00 4.22 8.42 NA NA 0.65 XXX 

75665 .... ............ A ........ Artery x-rays, head & neck ................. 1.31 4.04 8.52 NA NA 0.74 XXX 

75665 .... 26 ....... A ........ Artery x-rays, head & neck ................. 1.31 0.48 0.45 0.48 0.45 0.09 XXX 

75665 .... TC ...... A ........ Artery x-rays, head & neck ................. 0.00 3.56 8.07 NA NA 0.65 XXX 

75671 .... ............ A ........ Artery x-rays, head & neck ................. 1.66 5.02 9.06 NA NA 0.72 XXX 

75671 .... 26 ....... A ........ Artery x-rays, head & neck ................. 1.66 0.63 0.58 0.63 0.58 0.07 XXX 

75671 .... TC ...... A ........ Artery x-rays, head & neck ................. 0.00 4.38 8.47 NA NA 0.65 XXX 

75676 .... ............ A ........ Artery x-rays, neck ............................. 1.31 3.81 8.41 NA NA 0.72 XXX 

75676 .... 26 ....... A ........ Artery x-rays, neck ............................. 1.31 0.48 0.45 0.48 0.45 0.07 XXX 

75676 .... TC ...... A ........ Artery x-rays, neck ............................. 0.00 3.32 7.95 NA NA 0.65 XXX 

75680 .... ............ A ........ Artery x-rays, neck ............................. 1.66 4.53 8.82 NA NA 0.72 XXX 

75680 .... 26 ....... A ........ Artery x-rays, neck ............................. 1.66 0.65 0.59 0.65 0.59 0.07 XXX 

75680 .... TC ...... A ........ Artery x-rays, neck ............................. 0.00 3.88 8.23 NA NA 0.65 XXX 

75685 .... ............ A ........ Artery x-rays, spine ............................ 1.31 3.83 8.41 NA NA 0.71 XXX 

75685 .... 26 ....... A ........ Artery x-rays, spine ............................ 1.31 0.50 0.46 0.50 0.46 0.06 XXX 

75685 .... TC ...... A ........ Artery x-rays, spine ............................ 0.00 3.33 7.95 NA NA 0.65 XXX 

75705 .... ............ A ........ Artery x-rays, spine ............................ 2.18 4.15 8.68 NA NA 0.78 XXX 

75705 .... 26 ....... A ........ Artery x-rays, spine ............................ 2.18 0.81 0.74 0.81 0.74 0.13 XXX 

75705 .... TC ...... A ........ Artery x-rays, spine ............................ 0.00 3.35 7.94 NA NA 0.65 XXX 

75710 .... ............ A ........ Artery x-rays, arm/leg ......................... 1.14 3.88 8.44 NA NA 0.72 XXX 

75710 .... 26 ....... A ........ Artery x-rays, arm/leg ......................... 1.14 0.42 0.41 0.42 0.41 0.07 XXX 

75710 .... TC ...... A ........ Artery x-rays, arm/leg ......................... 0.00 3.45 8.03 NA NA 0.65 XXX 

75716 .... ............ A ........ Artery x-rays, arms/legs ..................... 1.31 4.82 8.91 NA NA 0.72 XXX 

75716 .... 26 ....... A ........ Artery x-rays, arms/legs ..................... 1.31 0.49 0.46 0.49 0.46 0.07 XXX 

75716 .... TC ...... A ........ Artery x-rays, arms/legs ..................... 0.00 4.33 8.46 NA NA 0.65 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38323 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

75722 .... ............ A ........ Artery x-rays, kidney ........................... 1.14 3.76 8.39 NA NA 0.70 XXX 

75722 .... 26 ....... A ........ Artery x-rays, kidney ........................... 1.14 0.47 0.44 0.47 0.44 0.05 XXX 

75722 .... TC ...... A ........ Artery x-rays, kidney ........................... 0.00 3.29 7.95 NA NA 0.65 XXX 

75724 .... ............ A ........ Artery x-rays, kidneys ......................... 1.49 4.96 9.09 NA NA 0.70 XXX 

75724 .... 26 ....... A ........ Artery x-rays, kidneys ......................... 1.49 0.71 0.64 0.71 0.64 0.05 XXX 

75724 .... TC ...... A ........ Artery x-rays, kidneys ......................... 0.00 4.25 8.44 NA NA 0.65 XXX 

75726 .... ............ A ........ Artery x-rays, abdomen ...................... 1.14 3.73 8.32 NA NA 0.70 XXX 

75726 .... 26 ....... A ........ Artery x-rays, abdomen ...................... 1.14 0.43 0.39 0.43 0.39 0.05 XXX 

75726 .... TC ...... A ........ Artery x-rays, abdomen ...................... 0.00 3.31 7.93 NA NA 0.65 XXX 

75731 .... ............ A ........ Artery x-rays, adrenal gland ............... 1.14 4.00 8.44 NA NA 0.71 XXX 

75731 .... 26 ....... A ........ Artery x-rays, adrenal gland ............... 1.14 0.50 0.42 0.50 0.42 0.06 XXX 

75731 .... TC ...... A ........ Artery x-rays, adrenal gland ............... 0.00 3.51 8.02 NA NA 0.65 XXX 

75733 .... ............ A ........ Artery x-rays, adrenals ....................... 1.31 5.30 9.14 NA NA 0.71 XXX 

75733 .... 26 ....... A ........ Artery x-rays, adrenals ....................... 1.31 0.63 0.53 0.63 0.53 0.06 XXX 

75733 .... TC ...... A ........ Artery x-rays, adrenals ....................... 0.00 4.66 8.61 NA NA 0.65 XXX 

75736 .... ............ A ........ Artery x-rays, pelvis ............................ 1.14 3.81 8.38 NA NA 0.71 XXX 

75736 .... 26 ....... A ........ Artery x-rays, pelvis ............................ 1.14 0.43 0.40 0.43 0.40 0.06 XXX 

75736 .... TC ...... A ........ Artery x-rays, pelvis ............................ 0.00 3.38 7.98 NA NA 0.65 XXX 

75741 .... ............ A ........ Artery x-rays, lung .............................. 1.31 3.14 8.06 NA NA 0.71 XXX 

75741 .... 26 ....... A ........ Artery x-rays, lung .............................. 1.31 0.49 0.45 0.49 0.45 0.06 XXX 

75741 .... TC ...... A ........ Artery x-rays, lung .............................. 0.00 2.65 7.61 NA NA 0.65 XXX 

75743 .... ............ A ........ Artery x-rays, lungs ............................ 1.66 3.53 8.30 NA NA 0.72 XXX 

75743 .... 26 ....... A ........ Artery x-rays, lungs ............................ 1.66 0.62 0.56 0.62 0.56 0.07 XXX 

75743 .... TC ...... A ........ Artery x-rays, lungs ............................ 0.00 2.90 7.73 NA NA 0.65 XXX 

75746 .... ............ A ........ Artery x-rays, lung .............................. 1.14 3.49 8.20 NA NA 0.70 XXX 

75746 .... 26 ....... A ........ Artery x-rays, lung .............................. 1.14 0.40 0.38 0.40 0.38 0.05 XXX 

75746 .... TC ...... A ........ Artery x-rays, lung .............................. 0.00 3.08 7.82 NA NA 0.65 XXX 

75756 .... ............ A ........ Artery x-rays, chest ............................ 1.14 4.21 8.66 NA NA 0.69 XXX 

75756 .... 26 ....... A ........ Artery x-rays, chest ............................ 1.14 0.56 0.51 0.56 0.51 0.04 XXX 

75756 .... TC ...... A ........ Artery x-rays, chest ............................ 0.00 3.65 8.14 NA NA 0.65 XXX 

75774 .... ............ A ........ Artery x-ray, each vessel .................... 0.36 2.46 7.59 2.46 7.59 0.67 ZZZ 

75774 .... 26 ....... A ........ Artery x-ray, each vessel .................... 0.36 0.14 0.13 0.14 0.13 0.02 ZZZ 

75774 .... TC ...... A ........ Artery x-ray, each vessel .................... 0.00 2.32 7.46 2.32 7.46 0.65 ZZZ 

75790 .... ............ A ........ Visualize A–V shunt ........................... 1.84 3.10 2.50 NA NA 0.17 XXX 

75790 .... 26 ....... A ........ Visualize A–V shunt ........................... 1.84 0.60 0.59 0.60 0.59 0.09 XXX 

75790 .... TC ...... A ........ Visualize A–V shunt ........................... 0.00 2.50 1.91 NA NA 0.08 XXX 

75801 .... ............ C ........ Lymph vessel x-ray, arm/leg .............. 0.81 0.00 0.17 0.00 0.17 0.37 XXX 

75801 .... 26 ....... A ........ Lymph vessel x-ray, arm/leg .............. 0.81 0.22 0.25 0.22 0.25 0.08 XXX 

75801 .... TC ...... C ........ Lymph vessel x-ray, arm/leg .............. 0.00 0.00 3.62 0.00 3.62 0.29 XXX 

75803 .... ............ C ........ Lymph vessel x-ray,arms/legs ............ 1.17 NA NA NA NA 0.34 XXX 

75803 .... 26 ....... A ........ Lymph vessel x-ray,arms/legs ............ 1.17 0.42 0.38 0.42 0.38 0.05 XXX 

75803 .... TC ...... C ........ Lymph vessel x-ray,arms/legs ............ 0.00 0.00 3.62 0.00 3.62 0.29 XXX 

75805 .... ............ C ........ Lymph vessel x-ray, trunk .................. 0.81 0.00 0.17 0.00 0.17 0.38 XXX 

75805 .... 26 ....... A ........ Lymph vessel x-ray, trunk .................. 0.81 0.28 0.27 0.28 0.27 0.05 XXX 

75805 .... TC ...... C ........ Lymph vessel x-ray, trunk .................. 0.00 0.00 4.08 0.00 4.08 0.33 XXX 

75807 .... ............ C ........ Lymph vessel x-ray, trunk .................. 1.17 0.00 0.25 0.00 0.25 0.05 XXX 

75807 .... 26 ....... A ........ Lymph vessel x-ray, trunk .................. 1.17 0.40 0.38 0.40 0.38 0.05 XXX 

75807 .... TC ...... C ........ Lymph vessel x-ray, trunk .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75809 .... ............ A ........ Nonvascular shunt, x-ray .................... 0.47 2.15 1.53 NA NA 0.07 XXX 

75809 .... 26 ....... A ........ Nonvascular shunt, x-ray .................... 0.47 0.16 0.15 0.16 0.15 0.02 XXX 

75809 .... TC ...... A ........ Nonvascular shunt, x-ray .................... 0.00 1.99 1.38 NA NA 0.05 XXX 

75810 .... ............ C ........ Vein x-ray, spleen/liver ....................... 1.14 NA NA NA NA 0.70 XXX 

75810 .... 26 ....... A ........ Vein x-ray, spleen/liver ....................... 1.14 0.41 0.38 0.41 0.38 0.05 XXX 

75810 .... TC ...... C ........ Vein x-ray, spleen/liver ....................... 0.00 0.00 8.43 0.00 8.43 0.65 XXX 

75820 .... ............ A ........ Vein x-ray, arm/leg ............................. 0.70 2.95 2.06 NA NA 0.09 XXX 

75820 .... 26 ....... A ........ Vein x-ray, arm/leg ............................. 0.70 0.28 0.25 0.28 0.25 0.03 XXX 

75820 .... TC ...... A ........ Vein x-ray, arm/leg ............................. 0.00 2.66 1.81 NA NA 0.06 XXX 

75822 .... ............ A ........ Vein x-ray, arms/legs .......................... 1.06 3.15 2.46 NA NA 0.13 XXX 

75822 .... 26 ....... A ........ Vein x-ray, arms/legs .......................... 1.06 0.38 0.35 0.38 0.35 0.05 XXX 

75822 .... TC ...... A ........ Vein x-ray, arms/legs .......................... 0.00 2.77 2.11 NA NA 0.08 XXX 

75825 .... ............ A ........ Vein x-ray, trunk ................................. 1.14 2.91 7.92 NA NA 0.72 XXX 

75825 .... 26 ....... A ........ Vein x-ray, trunk ................................. 1.14 0.39 0.37 0.39 0.37 0.07 XXX 

75825 .... TC ...... A ........ Vein x-ray, trunk ................................. 0.00 2.52 7.55 NA NA 0.65 XXX 

75827 .... ............ A ........ Vein x-ray, chest ................................. 1.14 2.93 7.93 NA NA 0.70 XXX 

75827 .... 26 ....... A ........ Vein x-ray, chest ................................. 1.14 0.38 0.37 0.38 0.37 0.05 XXX 

75827 .... TC ...... A ........ Vein x-ray, chest ................................. 0.00 2.56 7.57 NA NA 0.65 XXX 

75831 .... ............ A ........ Vein x-ray, kidney ............................... 1.14 3.03 7.98 NA NA 0.71 XXX 

75831 .... 26 ....... A ........ Vein x-ray, kidney ............................... 1.14 0.38 0.37 0.38 0.37 0.06 XXX 

75831 .... TC ...... A ........ Vein x-ray, kidney ............................... 0.00 2.64 7.61 NA NA 0.65 XXX 

75833 .... ............ A ........ Vein x-ray, kidneys ............................. 1.49 3.65 8.35 NA NA 0.74 XXX 

75833 .... 26 ....... A ........ Vein x-ray, kidneys ............................. 1.49 0.51 0.49 0.51 0.49 0.09 XXX 

75833 .... TC ...... A ........ Vein x-ray, kidneys ............................. 0.00 3.14 7.86 NA NA 0.65 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38324 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

75840 .... ............ A ........ Vein x-ray, adrenal gland ................... 1.14 2.92 7.99 NA NA 0.72 XXX 

75840 .... 26 ....... A ........ Vein x-ray, adrenal gland ................... 1.14 0.36 0.38 0.36 0.38 0.07 XXX 

75840 .... TC ...... A ........ Vein x-ray, adrenal gland ................... 0.00 2.56 7.61 NA NA 0.65 XXX 

75842 .... ............ A ........ Vein x-ray, adrenal glands ................. 1.49 3.73 8.36 NA NA 0.72 XXX 

75842 .... 26 ....... A ........ Vein x-ray, adrenal glands ................. 1.49 0.56 0.50 0.56 0.50 0.07 XXX 

75842 .... TC ...... A ........ Vein x-ray, adrenal glands ................. 0.00 3.17 7.86 NA NA 0.65 XXX 

75860 .... ............ A ........ Vein x-ray, neck .................................. 1.14 3.32 8.17 NA NA 0.69 XXX 

75860 .... 26 ....... A ........ Vein x-ray, neck .................................. 1.14 0.48 0.44 0.48 0.44 0.04 XXX 

75860 .... TC ...... A ........ Vein x-ray, neck .................................. 0.00 2.84 7.73 NA NA 0.65 XXX 

75870 .... ............ A ........ Vein x-ray, skull .................................. 1.14 3.27 8.10 NA NA 0.70 XXX 

75870 .... 26 ....... A ........ Vein x-ray, skull .................................. 1.14 0.41 0.40 0.41 0.40 0.05 XXX 

75870 .... TC ...... A ........ Vein x-ray, skull .................................. 0.00 2.86 7.71 NA NA 0.65 XXX 

75872 .... ............ A ........ Vein x-ray, skull .................................. 1.14 4.02 8.47 NA NA 0.79 XXX 

75872 .... 26 ....... A ........ Vein x-ray, skull .................................. 1.14 0.45 0.41 0.45 0.41 0.14 XXX 

75872 .... TC ...... A ........ Vein x-ray, skull .................................. 0.00 3.57 8.06 NA NA 0.65 XXX 

75880 .... ............ A ........ Vein x-ray, eye socket ........................ 0.70 3.16 2.13 NA NA 0.09 XXX 

75880 .... 26 ....... A ........ Vein x-ray, eye socket ........................ 0.70 0.27 0.24 0.27 0.24 0.03 XXX 

75880 .... TC ...... A ........ Vein x-ray, eye socket ........................ 0.00 2.89 1.88 NA NA 0.06 XXX 

75885 .... ............ A ........ Vein x-ray, liver ................................... 1.44 3.16 8.08 NA NA 0.71 XXX 

75885 .... 26 ....... A ........ Vein x-ray, liver ................................... 1.44 0.52 0.48 0.52 0.48 0.06 XXX 

75885 .... TC ...... A ........ Vein x-ray, liver ................................... 0.00 2.63 7.60 NA NA 0.65 XXX 

75887 .... ............ A ........ Vein x-ray, liver ................................... 1.44 3.40 8.20 NA NA 0.71 XXX 

75887 .... 26 ....... A ........ Vein x-ray, liver ................................... 1.44 0.57 0.50 0.57 0.50 0.06 XXX 

75887 .... TC ...... A ........ Vein x-ray, liver ................................... 0.00 2.83 7.70 NA NA 0.65 XXX 

75889 .... ............ A ........ Vein x-ray, liver ................................... 1.14 3.06 7.98 NA NA 0.70 XXX 

75889 .... 26 ....... A ........ Vein x-ray, liver ................................... 1.14 0.42 0.38 0.42 0.38 0.05 XXX 

75889 .... TC ...... A ........ Vein x-ray, liver ................................... 0.00 2.64 7.60 NA NA 0.65 XXX 

75891 .... ............ A ........ Vein x-ray, liver ................................... 1.14 3.05 7.98 NA NA 0.70 XXX 

75891 .... 26 ....... A ........ Vein x-ray, liver ................................... 1.14 0.42 0.38 0.42 0.38 0.05 XXX 

75891 .... TC ...... A ........ Vein x-ray, liver ................................... 0.00 2.63 7.60 NA NA 0.65 XXX 

75893 .... ............ A ........ Venous sampling by catheter ............. 0.54 2.83 7.79 NA NA 0.67 XXX 

75893 .... 26 ....... A ........ Venous sampling by catheter ............. 0.54 0.20 0.19 0.20 0.19 0.02 XXX 

75893 .... TC ...... A ........ Venous sampling by catheter ............. 0.00 2.64 7.61 NA NA 0.65 XXX 

75894 .... ............ C ........ X-rays, transcath therapy ................... 1.31 NA NA NA NA 1.35 XXX 

75894 .... 26 ....... A ........ X-rays, transcath therapy ................... 1.31 0.46 0.43 0.46 0.43 0.08 XXX 

75894 .... TC ...... C ........ X-rays, transcath therapy ................... 0.00 NA NA NA NA 1.27 XXX 

75896 .... ............ C ........ X-rays, transcath therapy ................... 1.31 NA NA NA NA 1.15 XXX 

75896 .... 26 ....... A ........ X-rays, transcath therapy ................... 1.31 0.51 0.48 0.51 0.48 0.05 XXX 

75896 .... TC ...... C ........ X-rays, transcath therapy ................... 0.00 NA NA NA NA 1.10 XXX 

75898 .... ............ C ........ Follow-up angiography ....................... 1.65 NA NA NA NA 0.13 XXX 

75898 .... 26 ....... A ........ Follow-up angiography ....................... 1.65 0.63 0.58 0.63 0.58 0.07 XXX 

75898 .... TC ...... C ........ Follow-up angiography ....................... 0.00 NA NA NA NA 0.06 XXX 

75900 .... ............ C ........ Intravascular cath exchange .............. 0.49 0.00 10.60 0.00 10.60 0.03 XXX 

75900 .... 26 ....... A ........ Intravascular cath exchange .............. 0.49 0.17 0.16 0.17 0.16 0.03 XXX 

75900 .... TC ...... C ........ Intravascular cath exchange .............. 0.00 0.00 10.49 0.00 10.49 0.00 XXX 

75901 .... ............ A ........ Remove cva device obstruct .............. 0.49 4.11 2.76 NA NA 0.85 XXX 

75901 .... 26 ....... A ........ Remove cva device obstruct .............. 0.49 0.17 0.16 0.17 0.16 0.02 XXX 

75901 .... TC ...... A ........ Remove cva device obstruct .............. 0.00 3.94 2.60 NA NA 0.83 XXX 

75902 .... ............ A ........ Remove cva lumen obstruct ............... 0.39 1.62 1.52 NA NA 0.85 XXX 

75902 .... 26 ....... A ........ Remove cva lumen obstruct ............... 0.39 0.14 0.13 0.14 0.13 0.02 XXX 

75902 .... TC ...... A ........ Remove cva lumen obstruct ............... 0.00 1.49 1.39 NA NA 0.83 XXX 

75940 .... ............ C ........ X-ray placement, vein filter ................. 0.54 NA NA NA NA 0.69 XXX 

75940 .... 26 ....... A ........ X-ray placement, vein filter ................. 0.54 0.19 0.18 0.19 0.18 0.04 XXX 

75940 .... TC ...... C ........ X-ray placement, vein filter ................. 0.00 NA NA NA NA 0.65 XXX 

75945 .... ............ C ........ Intravascular us .................................. 0.40 NA NA NA NA 0.28 XXX 

75945 .... 26 ....... A ........ Intravascular us .................................. 0.40 0.14 0.14 0.14 0.14 0.04 XXX 

75945 .... TC ...... C ........ Intravascular us .................................. 0.00 NA NA NA NA 0.24 XXX 

75946 .... ............ C ........ Intravascular us add-on ...................... 0.40 0.00 0.09 0.00 0.09 0.05 ZZZ 

75946 .... 26 ....... A ........ Intravascular us add-on ...................... 0.40 0.12 0.13 0.12 0.13 0.05 ZZZ 

75946 .... TC ...... C ........ Intravascular us add-on ...................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

75952 .... ............ C ........ Endovasc repair abdom aorta ............ 4.49 0.00 0.96 0.00 0.96 0.43 XXX 

75952 .... 26 ....... A ........ Endovasc repair abdom aorta ............ 4.49 1.30 1.39 1.30 1.39 0.43 XXX 

75952 .... TC ...... C ........ Endovasc repair abdom aorta ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75953 .... ............ C ........ Abdom aneurysm endovas rpr ........... 1.36 0.00 0.29 0.00 0.29 0.13 XXX 

75953 .... 26 ....... A ........ Abdom aneurysm endovas rpr ........... 1.36 0.40 0.43 0.40 0.43 0.13 XXX 

75953 .... TC ...... C ........ Abdom aneurysm endovas rpr ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75954 .... ............ C ........ Iliac aneurysm endovas rpr ................ 2.25 0.00 0.50 0.00 0.50 0.15 XXX 

75954 .... 26 ....... A ........ Iliac aneurysm endovas rpr ................ 2.25 0.63 0.71 0.63 0.71 0.15 XXX 

75954 .... TC ...... C ........ Iliac aneurysm endovas rpr ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75956 .... ............ C ........ Xray, endovasc thor ao repr ............... 7.00 0.00 1.65 0.00 1.65 0.69 XXX 

75956 .... 26 ....... A ........ Xray, endovasc thor ao repr ............... 7.00 1.87 2.27 1.87 2.27 0.69 XXX 

75956 .... TC ...... C ........ Xray, endovasc thor ao repr ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38325 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

75957 .... ............ C ........ Xray, endovasc thor ao repr ............... 6.00 0.00 1.41 0.00 1.41 0.59 XXX 

75957 .... 26 ....... A ........ Xray, endovasc thor ao repr ............... 6.00 1.64 1.96 1.64 1.96 0.59 XXX 

75957 .... TC ...... C ........ Xray, endovasc thor ao repr ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75958 .... ............ C ........ Xray, place prox ext thor ao ............... 4.00 0.00 0.94 0.00 0.94 0.39 XXX 

75958 .... 26 ....... A ........ Xray, place prox ext thor ao ............... 4.00 1.05 1.29 1.05 1.29 0.39 XXX 

75958 .... TC ...... C ........ Xray, place prox ext thor ao ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75959 .... ............ C ........ Xray, place dist ext thor ao ................ 3.50 0.00 0.83 0.00 0.83 0.34 XXX 

75959 .... 26 ....... A ........ Xray, place dist ext thor ao ................ 3.50 0.91 1.13 0.91 1.13 0.34 XXX 

75959 .... TC ...... C ........ Xray, place dist ext thor ao ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75960 .... ............ C ........ Transcath iv stent rs&i ........................ 0.82 0.00 0.19 0.00 0.19 0.82 XXX 

75960 .... 26 ....... A ........ Transcath iv stent rs&i ........................ 0.82 0.31 0.30 0.31 0.30 0.05 XXX 

75960 .... TC ...... C ........ Transcath iv stent rs&i ........................ 0.00 0.00 9.96 0.00 9.96 0.77 XXX 

75961 .... ............ A ........ Retrieval, broken catheter .................. 4.24 4.64 8.21 NA NA 0.73 XXX 

75961 .... 26 ....... A ........ Retrieval, broken catheter .................. 4.24 1.50 1.41 1.50 1.41 0.18 XXX 

75961 .... TC ...... A ........ Retrieval, broken catheter .................. 0.00 3.15 6.80 NA NA 0.55 XXX 

75962 .... ............ A ........ Repair arterial blockage ..................... 0.54 3.43 9.68 NA NA 0.86 XXX 

75962 .... 26 ....... A ........ Repair arterial blockage ..................... 0.54 0.20 0.19 0.20 0.19 0.03 XXX 

75962 .... TC ...... A ........ Repair arterial blockage ..................... 0.00 3.23 9.49 NA NA 0.83 XXX 

75964 .... ............ A ........ Repair artery blockage, each ............. 0.36 2.31 5.41 2.31 5.41 0.46 ZZZ 

75964 .... 26 ....... A ........ Repair artery blockage, each ............. 0.36 0.13 0.12 0.13 0.12 0.03 ZZZ 

75964 .... TC ...... A ........ Repair artery blockage, each ............. 0.00 2.18 5.29 2.18 5.29 0.43 ZZZ 

75966 .... ............ A ........ Repair arterial blockage ..................... 1.31 4.06 10.14 NA NA 0.89 XXX 

75966 .... 26 ....... A ........ Repair arterial blockage ..................... 1.31 0.55 0.51 0.55 0.51 0.06 XXX 

75966 .... TC ...... A ........ Repair arterial blockage ..................... 0.00 3.50 9.63 NA NA 0.83 XXX 

75968 .... ............ A ........ Repair artery blockage, each ............. 0.36 2.35 5.44 2.35 5.44 0.45 ZZZ 

75968 .... 26 ....... A ........ Repair artery blockage, each ............. 0.36 0.15 0.14 0.15 0.14 0.02 ZZZ 

75968 .... TC ...... A ........ Repair artery blockage, each ............. 0.00 2.19 5.30 2.19 5.30 0.43 ZZZ 

75970 .... ............ C ........ Vascular biopsy .................................. 0.83 NA NA NA NA 0.64 XXX 

75970 .... 26 ....... A ........ Vascular biopsy .................................. 0.83 0.31 0.29 0.31 0.29 0.04 XXX 

75970 .... TC ...... C ........ Vascular biopsy .................................. 0.00 NA NA NA NA 0.60 XXX 

75978 .... ............ A ........ Repair venous blockage ..................... 0.54 3.23 9.56 NA NA 0.85 XXX 

75978 .... 26 ....... A ........ Repair venous blockage ..................... 0.54 0.18 0.18 0.18 0.18 0.02 XXX 

75978 .... TC ...... A ........ Repair venous blockage ..................... 0.00 3.05 9.38 NA NA 0.83 XXX 

75980 .... ............ C ........ Contrast xray exam bile duct ............. 1.44 NA NA NA NA 0.35 XXX 

75980 .... 26 ....... A ........ Contrast xray exam bile duct ............. 1.44 0.53 0.48 0.53 0.48 0.06 XXX 

75980 .... TC ...... C ........ Contrast xray exam bile duct ............. 0.00 0.00 3.62 0.00 3.62 0.29 XXX 

75982 .... ............ C ........ Contrast xray exam bile duct ............. 1.44 0.00 0.31 0.00 0.31 0.06 XXX 

75982 .... 26 ....... A ........ Contrast xray exam bile duct ............. 1.44 0.53 0.48 0.53 0.48 0.06 XXX 

75982 .... TC ...... C ........ Contrast xray exam bile duct ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75984 .... ............ A ........ Xray control catheter change ............. 0.72 2.30 2.22 NA NA 0.14 XXX 

75984 .... 26 ....... A ........ Xray control catheter change ............. 0.72 0.26 0.24 0.26 0.24 0.03 XXX 

75984 .... TC ...... A ........ Xray control catheter change ............. 0.00 2.03 1.98 NA NA 0.11 XXX 

75989 .... ............ A ........ Abscess drainage under x-ray ........... 1.19 2.23 2.86 NA NA 0.22 XXX 

75989 .... 26 ....... A ........ Abscess drainage under x-ray ........... 1.19 0.43 0.40 0.43 0.40 0.05 XXX 

75989 .... TC ...... A ........ Abscess drainage under x-ray ........... 0.00 1.80 2.47 NA NA 0.17 XXX 

75992 .... ............ C ........ Atherectomy, x-ray exam ................... 0.54 NA NA NA NA 0.86 XXX 

75992 .... 26 ....... A ........ Atherectomy, x-ray exam ................... 0.54 0.22 0.21 0.22 0.21 0.03 XXX 

75992 .... TC ...... C ........ Atherectomy, x-ray exam ................... 0.00 0.00 10.53 0.00 10.53 0.83 XXX 

75993 .... ............ C ........ Atherectomy, x-ray exam ................... 0.36 0.00 4.29 0.00 4.29 0.02 ZZZ 

75993 .... 26 ....... A ........ Atherectomy, x-ray exam ................... 0.36 0.14 0.14 0.14 0.14 0.02 ZZZ 

75993 .... TC ...... C ........ Atherectomy, x-ray exam ................... 0.00 0.00 4.20 0.00 4.20 0.00 ZZZ 

75994 .... ............ C ........ Atherectomy, x-ray exam ................... 1.31 0.00 8.21 0.00 8.21 0.07 XXX 

75994 .... 26 ....... A ........ Atherectomy, x-ray exam ................... 1.31 0.52 0.51 0.52 0.51 0.07 XXX 

75994 .... TC ...... C ........ Atherectomy, x-ray exam ................... 0.00 0.00 7.87 0.00 7.87 0.00 XXX 

75995 .... ............ C ........ Atherectomy, x-ray exam ................... 1.31 0.00 8.19 0.00 8.19 0.05 XXX 

75995 .... 26 ....... A ........ Atherectomy, x-ray exam ................... 1.31 0.47 0.48 0.47 0.48 0.05 XXX 

75995 .... TC ...... C ........ Atherectomy, x-ray exam ................... 0.00 0.00 7.87 0.00 7.87 0.00 XXX 

75996 .... ............ C ........ Atherectomy, x-ray exam ................... 0.36 0.00 4.29 0.00 4.29 0.02 ZZZ 

75996 .... 26 ....... A ........ Atherectomy, x-ray exam ................... 0.36 0.12 0.13 0.12 0.13 0.02 ZZZ 

75996 .... TC ...... C ........ Atherectomy, x-ray exam ................... 0.00 0.00 4.20 0.00 4.20 0.00 ZZZ 

76000 .... ............ A ........ Fluoroscope examination ................... 0.17 2.74 2.03 NA NA 0.08 XXX 

76000 .... 26 ....... A ........ Fluoroscope examination ................... 0.17 0.06 0.05 0.06 0.05 0.01 XXX 

76000 .... TC ...... A ........ Fluoroscope examination ................... 0.00 2.68 1.98 NA NA 0.07 XXX 

76001 .... ............ C ........ Fluoroscope exam, extensive ............. 0.67 NA NA NA NA 0.19 XXX 

76001 .... 26 ....... A ........ Fluoroscope exam, extensive ............. 0.67 0.24 0.23 0.24 0.23 0.05 XXX 

76001 .... TC ...... C ........ Fluoroscope exam, extensive ............. 0.00 NA NA NA NA 0.14 XXX 

76010 .... ............ A ........ X-ray, nose to rectum ......................... 0.18 0.54 0.56 NA NA 0.03 XXX 

76010 .... 26 ....... A ........ X-ray, nose to rectum ......................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

76010 .... TC ...... A ........ X-ray, nose to rectum ......................... 0.00 0.47 0.50 NA NA 0.02 XXX 

76080 .... ............ A ........ X-ray exam of fistula .......................... 0.54 1.09 1.15 NA NA 0.08 XXX 

76080 .... 26 ....... A ........ X-ray exam of fistula .......................... 0.54 0.20 0.19 0.20 0.19 0.02 XXX 

76080 .... TC ...... A ........ X-ray exam of fistula .......................... 0.00 0.89 0.96 NA NA 0.06 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38326 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

76098 .... ............ A ........ X-ray exam, breast specimen ............ 0.16 0.32 0.39 NA NA 0.03 XXX 

76098 .... 26 ....... A ........ X-ray exam, breast specimen ............ 0.16 0.06 0.05 0.06 0.05 0.01 XXX 

76098 .... TC ...... A ........ X-ray exam, breast specimen ............ 0.00 0.27 0.34 NA NA 0.02 XXX 

76100 .... ............ A ........ X-ray exam of body section ............... 0.58 3.53 2.46 NA NA 0.10 XXX 

76100 .... 26 ....... A ........ X-ray exam of body section ............... 0.58 0.21 0.20 0.21 0.20 0.03 XXX 

76100 .... TC ...... A ........ X-ray exam of body section ............... 0.00 3.33 2.27 NA NA 0.07 XXX 

76101 .... ............ A ........ Complex body section x-ray ............... 0.58 5.44 3.48 NA NA 0.11 XXX 

76101 .... 26 ....... A ........ Complex body section x-ray ............... 0.58 0.19 0.19 0.19 0.19 0.03 XXX 

76101 .... TC ...... A ........ Complex body section x-ray ............... 0.00 5.25 3.29 NA NA 0.08 XXX 

76102 .... ............ A ........ Complex body section x-rays ............. 0.58 7.60 4.77 NA NA 0.14 XXX 

76102 .... 26 ....... A ........ Complex body section x-rays ............. 0.58 0.18 0.19 0.18 0.19 0.03 XXX 

76102 .... TC ...... A ........ Complex body section x-rays ............. 0.00 7.41 4.58 NA NA 0.11 XXX 

76120 .... ............ A ........ Cine/video x-rays ................................ 0.38 1.84 1.51 NA NA 0.08 XXX 

76120 .... 26 ....... A ........ Cine/video x-rays ................................ 0.38 0.13 0.13 0.13 0.13 0.02 XXX 

76120 .... TC ...... A ........ Cine/video x-rays ................................ 0.00 1.71 1.38 NA NA 0.06 XXX 

76125 .... ............ C ........ Cine/video x-rays add-on ................... 0.27 NA NA NA NA 0.06 ZZZ 

76125 .... 26 ....... A ........ Cine/video x-rays add-on ................... 0.27 0.11 0.10 0.11 0.10 0.01 ZZZ 

76125 .... TC ...... C ........ Cine/video x-rays add-on ................... 0.00 0.00 0.52 0.00 0.52 0.05 ZZZ 

76150 .... ............ A ........ X-ray exam, dry process .................... 0.00 0.67 0.54 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 1.39 2.43 NA NA 0.10 XXX 

76376 .... 26 ....... A ........ 3d render w/o postprocess ................. 0.20 0.07 0.07 0.07 0.07 0.02 XXX 

76376 .... TC ...... A ........ 3d render w/o postprocess ................. 0.00 1.32 2.36 NA NA 0.08 XXX 

76377 .... ............ A ........ 3d rendering w/postprocess ............... 0.79 1.40 2.53 NA NA 0.39 XXX 

76377 .... 26 ....... A ........ 3d rendering w/postprocess ............... 0.79 0.28 0.27 0.28 0.27 0.08 XXX 

76377 .... TC ...... A ........ 3d rendering w/postprocess ............... 0.00 1.11 2.26 NA NA 0.31 XXX 

76380 .... ............ A ........ CAT scan follow-up study .................. 0.98 4.68 4.21 NA NA 0.22 XXX 

76380 .... 26 ....... A ........ CAT scan follow-up study .................. 0.98 0.34 0.32 0.34 0.32 0.04 XXX 

76380 .... TC ...... A ........ CAT scan follow-up study .................. 0.00 4.33 3.89 NA NA 0.18 XXX 

76390 .... ............ N ........ Mr spectroscopy ................................. 1.40 9.31 10.40 NA NA 0.66 XXX 

76390 .... 26 ....... N ........ Mr spectroscopy ................................. 1.40 0.32 0.39 0.32 0.39 0.07 XXX 

76390 .... TC ...... N ........ Mr spectroscopy ................................. 0.00 8.99 10.00 NA NA 0.59 XXX 

76496 .... ............ C ........ Fluoroscopic procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76496 .... 26 ....... C ........ Fluoroscopic procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76496 .... TC ...... C ........ Fluoroscopic procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76497 .... ............ C ........ Ct procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76497 .... 26 ....... C ........ Ct procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76497 .... TC ...... C ........ Ct procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76498 .... ............ C ........ Mri procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76498 .... 26 ....... C ........ Mri procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76498 .... TC ...... C ........ Mri procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76499 .... ............ C ........ Radiographic procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76499 .... 26 ....... C ........ Radiographic procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76499 .... TC ...... C ........ Radiographic procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76506 .... ............ A ........ Echo exam of head ............................ 0.63 2.75 2.20 NA NA 0.14 XXX 

76506 .... 26 ....... A ........ Echo exam of head ............................ 0.63 0.21 0.22 0.21 0.22 0.06 XXX 

76506 .... TC ...... A ........ Echo exam of head ............................ 0.00 2.54 1.97 NA NA 0.08 XXX 

76510 .... ............ A ........ Ophth us, b & quant a ........................ 1.55 2.25 2.57 NA NA 0.10 XXX 

76510 .... 26 ....... A ........ Ophth us, b & quant a ........................ 1.55 0.56 0.63 0.56 0.63 0.03 XXX 

76510 .... TC ...... A ........ Ophth us, b & quant a ........................ 0.00 1.69 1.94 NA NA 0.07 XXX 

76511 .... ............ A ........ Ophth us, quant a only ....................... 0.94 1.35 1.90 NA NA 0.10 XXX 

76511 .... 26 ....... A ........ Ophth us, quant a only ....................... 0.94 0.33 0.37 0.33 0.37 0.03 XXX 

76511 .... TC ...... A ........ Ophth us, quant a only ....................... 0.00 1.01 1.52 NA NA 0.07 XXX 

76512 .... ............ A ........ Ophth us, b w/non-quant a ................. 0.94 1.16 1.70 NA NA 0.12 XXX 

76512 .... 26 ....... A ........ Ophth us, b w/non-quant a ................. 0.94 0.33 0.38 0.33 0.38 0.02 XXX 

76512 .... TC ...... A ........ Ophth us, b w/non-quant a ................. 0.00 0.82 1.32 NA NA 0.10 XXX 

76513 .... ............ A ........ Echo exam of eye, water bath ........... 0.66 1.52 1.67 NA NA 0.12 XXX 

76513 .... 26 ....... A ........ Echo exam of eye, water bath ........... 0.66 0.24 0.27 0.24 0.27 0.02 XXX 

76513 .... TC ...... A ........ Echo exam of eye, water bath ........... 0.00 1.29 1.41 NA NA 0.10 XXX 

76514 .... ............ A ........ Echo exam of eye, thickness ............. 0.17 0.16 0.15 NA NA 0.02 XXX 

76514 .... 26 ....... A ........ Echo exam of eye, thickness ............. 0.17 0.06 0.07 0.06 0.07 0.01 XXX 

76514 .... TC ...... A ........ Echo exam of eye, thickness ............. 0.00 0.10 0.08 NA NA 0.01 XXX 

76516 .... ............ A ........ Echo exam of eye .............................. 0.54 1.16 1.31 NA NA 0.08 XXX 

76516 .... 26 ....... A ........ Echo exam of eye .............................. 0.54 0.19 0.22 0.19 0.22 0.01 XXX 

76516 .... TC ...... A ........ Echo exam of eye .............................. 0.00 0.97 1.10 NA NA 0.07 XXX 

76519 .... ............ A ........ Echo exam of eye .............................. 0.54 1.29 1.42 NA NA 0.08 XXX 

76519 .... 26 ....... A ........ Echo exam of eye .............................. 0.54 0.20 0.22 0.20 0.22 0.01 XXX 

76519 .... TC ...... A ........ Echo exam of eye .............................. 0.00 1.09 1.20 NA NA 0.07 XXX 

76529 .... ............ A ........ Echo exam of eye .............................. 0.57 1.16 1.27 NA NA 0.10 XXX 

76529 .... 26 ....... A ........ Echo exam of eye .............................. 0.57 0.20 0.22 0.20 0.22 0.02 XXX 

76529 .... TC ...... A ........ Echo exam of eye .............................. 0.00 0.95 1.04 NA NA 0.08 XXX 

76536 .... ............ A ........ Us exam of head and neck ................ 0.56 2.65 2.10 NA NA 0.10 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38327 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

76536 .... 26 ....... A ........ Us exam of head and neck ................ 0.56 0.18 0.17 0.18 0.17 0.02 XXX 

76536 .... TC ...... A ........ Us exam of head and neck ................ 0.00 2.47 1.93 NA NA 0.08 XXX 

76604 .... ............ A ........ Us exam, chest ................................... 0.55 1.82 1.63 NA NA 0.09 XXX 

76604 .... 26 ....... A ........ Us exam, chest ................................... 0.55 0.19 0.18 0.19 0.18 0.02 XXX 

76604 .... TC ...... A ........ Us exam, chest ................................... 0.00 1.63 1.46 NA NA 0.07 XXX 

76645 .... ............ A ........ Us exam, breast(s) ............................. 0.54 2.10 1.64 NA NA 0.08 XXX 

76645 .... 26 ....... A ........ Us exam, breast(s) ............................. 0.54 0.19 0.18 0.19 0.18 0.02 XXX 

76645 .... TC ...... A ........ Us exam, breast(s) ............................. 0.00 1.91 1.46 NA NA 0.06 XXX 

76700 .... ............ A ........ Us exam, abdom, complete ............... 0.81 3.00 2.59 NA NA 0.15 XXX 

76700 .... 26 ....... A ........ Us exam, abdom, complete ............... 0.81 0.28 0.27 0.28 0.27 0.04 XXX 

76700 .... TC ...... A ........ Us exam, abdom, complete ............... 0.00 2.72 2.33 NA NA 0.11 XXX 

76705 .... ............ A ........ Echo exam of abdomen ..................... 0.59 2.33 1.96 NA NA 0.11 XXX 

76705 .... 26 ....... A ........ Echo exam of abdomen ..................... 0.59 0.21 0.20 0.21 0.20 0.03 XXX 

76705 .... TC ...... A ........ Echo exam of abdomen ..................... 0.00 2.13 1.76 NA NA 0.08 XXX 

76770 .... ............ A ........ Us exam abdo back wall, comp ......... 0.74 2.91 2.54 NA NA 0.14 XXX 

76770 .... 26 ....... A ........ Us exam abdo back wall, comp ......... 0.74 0.26 0.25 0.26 0.25 0.03 XXX 

76770 .... TC ...... A ........ Us exam abdo back wall, comp ......... 0.00 2.65 2.30 NA NA 0.11 XXX 

76775 .... ............ A ........ Us exam abdo back wall, lim ............. 0.58 2.40 1.98 NA NA 0.11 XXX 

76775 .... 26 ....... A ........ Us exam abdo back wall, lim ............. 0.58 0.21 0.20 0.21 0.20 0.03 XXX 

76775 .... TC ...... A ........ Us exam abdo back wall, lim ............. 0.00 2.19 1.78 NA NA 0.08 XXX 

76776 .... ............ A ........ Us exam k transpl w/doppler .............. 0.76 3.41 2.62 NA NA 0.14 XXX 

76776 .... 26 ....... A ........ Us exam k transpl w/doppler .............. 0.76 0.27 0.25 0.27 0.25 0.03 XXX 

76776 .... TC ...... A ........ Us exam k transpl w/doppler .............. 0.00 3.13 2.36 NA NA 0.11 XXX 

76800 .... ............ A ........ Us exam, spinal canal ........................ 1.13 2.30 2.03 NA NA 0.13 XXX 

76800 .... 26 ....... A ........ Us exam, spinal canal ........................ 1.13 0.29 0.32 0.29 0.32 0.05 XXX 

76800 .... TC ...... A ........ Us exam, spinal canal ........................ 0.00 2.01 1.71 NA NA 0.08 XXX 

76801 .... ............ A ........ Ob us < 14 wks, single fetus ............. 0.99 2.45 2.44 NA NA 0.16 XXX 

76801 .... 26 ....... A ........ Ob us < 14 wks, single fetus ............. 0.99 0.31 0.32 0.31 0.32 0.04 XXX 

76801 .... TC ...... A ........ Ob us < 14 wks, single fetus ............. 0.00 2.14 2.11 NA NA 0.12 XXX 

76802 .... ............ A ........ Ob us < 14 wks, addœl fetus .............. 0.83 0.97 1.15 0.97 1.15 0.16 ZZZ 

76802 .... 26 ....... A ........ Ob us < 14 wks, addœl fetus .............. 0.83 0.27 0.28 0.27 0.28 0.04 ZZZ 

76802 .... TC ...... A ........ Ob us < 14 wks, addœl fetus .............. 0.00 0.70 0.87 0.70 0.87 0.12 ZZZ 

76805 .... ............ A ........ Ob us >/= 14 wks, sngl fetus ............. 0.99 3.02 2.71 NA NA 0.16 XXX 

76805 .... 26 ....... A ........ Ob us >/= 14 wks, sngl fetus ............. 0.99 0.31 0.32 0.31 0.32 0.04 XXX 

76805 .... TC ...... A ........ Ob us >/= 14 wks, sngl fetus ............. 0.00 2.71 2.39 NA NA 0.12 XXX 

76810 .... ............ A ........ Ob us >/= 14 wks, addl fetus ............. 0.98 1.64 1.51 1.64 1.51 0.26 ZZZ 

76810 .... 26 ....... A ........ Ob us >/= 14 wks, addl fetus ............. 0.98 0.30 0.31 0.30 0.31 0.04 ZZZ 

76810 .... TC ...... A ........ Ob us >/= 14 wks, addl fetus ............. 0.00 1.34 1.19 1.34 1.19 0.22 ZZZ 

76811 .... ............ A ........ Ob us, detailed, sngl fetus ................. 1.90 3.04 3.63 NA NA 0.52 XXX 

76811 .... 26 ....... A ........ Ob us, detailed, sngl fetus ................. 1.90 0.55 0.63 0.55 0.63 0.09 XXX 

76811 .... TC ...... A ........ Ob us, detailed, sngl fetus ................. 0.00 2.49 3.00 NA NA 0.43 XXX 

76812 .... ............ A ........ Ob us, detailed, addl fetus ................. 1.78 3.96 2.82 3.96 2.82 0.49 ZZZ 

76812 .... 26 ....... A ........ Ob us, detailed, addl fetus ................. 1.78 0.51 0.58 0.51 0.58 0.08 ZZZ 

76812 .... TC ...... A ........ Ob us, detailed, addl fetus ................. 0.00 3.45 2.24 3.45 2.24 0.41 ZZZ 

76813 .... ............ A ........ Ob us nuchal meas, 1 gest ................ 1.18 2.20 2.11 NA NA 0.19 XXX 

76813 .... 26 ....... A ........ Ob us nuchal meas, 1 gest ................ 1.18 0.40 0.35 0.40 0.35 0.05 XXX 

76813 .... TC ...... A ........ Ob us nuchal meas, 1 gest ................ 0.00 1.80 1.75 NA NA 0.14 XXX 

76814 .... ............ A ........ Ob us nuchal meas, add-on ............... 0.99 1.15 1.12 NA NA 0.19 XXX 

76814 .... 26 ....... A ........ Ob us nuchal meas, add-on ............... 0.99 0.29 0.28 0.29 0.28 0.05 XXX 

76814 .... TC ...... A ........ Ob us nuchal meas, add-on ............... 0.00 0.85 0.84 NA NA 0.14 XXX 

76815 .... ............ A ........ Ob us, limited, fetus(s) ....................... 0.65 1.79 1.71 NA NA 0.11 XXX 

76815 .... 26 ....... A ........ Ob us, limited, fetus(s) ....................... 0.65 0.20 0.21 0.20 0.21 0.03 XXX 

76815 .... TC ...... A ........ Ob us, limited, fetus(s) ....................... 0.00 1.59 1.50 NA NA 0.08 XXX 

76816 .... ............ A ........ Ob us, follow-up, per fetus ................. 0.85 2.36 1.89 NA NA 0.10 XXX 

76816 .... 26 ....... A ........ Ob us, follow-up, per fetus ................. 0.85 0.25 0.28 0.25 0.28 0.04 XXX 

76816 .... TC ...... A ........ Ob us, follow-up, per fetus ................. 0.00 2.11 1.61 NA NA 0.06 XXX 

76817 .... ............ A ........ Transvaginal us, obstetric .................. 0.75 2.01 1.88 NA NA 0.09 XXX 

76817 .... 26 ....... A ........ Transvaginal us, obstetric .................. 0.75 0.23 0.24 0.23 0.24 0.03 XXX 

76817 .... TC ...... A ........ Transvaginal us, obstetric .................. 0.00 1.78 1.64 NA NA 0.06 XXX 

76818 .... ............ A ........ Fetal biophys profile w/nst .................. 1.05 2.21 2.10 NA NA 0.15 XXX 

76818 .... 26 ....... A ........ Fetal biophys profile w/nst .................. 1.05 0.31 0.35 0.31 0.35 0.05 XXX 

76818 .... TC ...... A ........ Fetal biophys profile w/nst .................. 0.00 1.90 1.75 NA NA 0.10 XXX 

76819 .... ............ A ........ Fetal biophys profil w/o nst ................ 0.77 1.62 1.75 NA NA 0.13 XXX 

76819 .... 26 ....... A ........ Fetal biophys profil w/o nst ................ 0.77 0.23 0.25 0.23 0.25 0.03 XXX 

76819 .... TC ...... A ........ Fetal biophys profil w/o nst ................ 0.00 1.39 1.50 NA NA 0.10 XXX 

76820 .... ............ A ........ Umbilical artery echo .......................... 0.50 0.56 1.18 NA NA 0.15 XXX 

76820 .... 26 ....... A ........ Umbilical artery echo .......................... 0.50 0.14 0.17 0.14 0.17 0.03 XXX 

76820 .... TC ...... A ........ Umbilical artery echo .......................... 0.00 0.42 1.01 NA NA 0.12 XXX 

76821 .... ............ A ........ Middle cerebral artery echo ................ 0.70 1.86 1.87 NA NA 0.15 XXX 

76821 .... 26 ....... A ........ Middle cerebral artery echo ................ 0.70 0.21 0.24 0.21 0.24 0.03 XXX 

76821 .... TC ...... A ........ Middle cerebral artery echo ................ 0.00 1.65 1.63 NA NA 0.12 XXX 

76825 .... ............ A ........ Echo exam of fetal heart .................... 1.67 4.31 3.44 NA NA 0.18 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38328 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

76825 .... 26 ....... A ........ Echo exam of fetal heart .................... 1.67 0.50 0.55 0.50 0.55 0.07 XXX 

76825 .... TC ...... A ........ Echo exam of fetal heart .................... 0.00 3.82 2.89 NA NA 0.11 XXX 

76826 .... ............ A ........ Echo exam of fetal heart .................... 0.83 2.73 1.86 NA NA 0.08 XXX 

76826 .... 26 ....... A ........ Echo exam of fetal heart .................... 0.83 0.24 0.27 0.24 0.27 0.03 XXX 

76826 .... TC ...... A ........ Echo exam of fetal heart .................... 0.00 2.48 1.59 NA NA 0.05 XXX 

76827 .... ............ A ........ Echo exam of fetal heart .................... 0.58 1.06 1.49 NA NA 0.14 XXX 

76827 .... 26 ....... A ........ Echo exam of fetal heart .................... 0.58 0.17 0.19 0.17 0.19 0.02 XXX 

76827 .... TC ...... A ........ Echo exam of fetal heart .................... 0.00 0.89 1.30 NA NA 0.12 XXX 

76828 .... ............ A ........ Echo exam of fetal heart .................... 0.56 0.63 0.98 NA NA 0.11 XXX 

76828 .... 26 ....... A ........ Echo exam of fetal heart .................... 0.56 0.16 0.19 0.16 0.19 0.03 XXX 

76828 .... TC ...... A ........ Echo exam of fetal heart .................... 0.00 0.47 0.79 NA NA 0.08 XXX 

76830 .... ............ A ........ Transvaginal us, non-ob ..................... 0.69 2.74 2.23 NA NA 0.13 XXX 

76830 .... 26 ....... A ........ Transvaginal us, non-ob ..................... 0.69 0.23 0.22 0.23 0.22 0.03 XXX 

76830 .... TC ...... A ........ Transvaginal us, non-ob ..................... 0.00 2.52 2.01 NA NA 0.10 XXX 

76831 .... ............ A ........ Echo exam, uterus ............................. 0.72 2.71 2.24 NA NA 0.13 XXX 

76831 .... 26 ....... A ........ Echo exam, uterus ............................. 0.72 0.21 0.23 0.21 0.23 0.03 XXX 

76831 .... TC ...... A ........ Echo exam, uterus ............................. 0.00 2.50 2.01 NA NA 0.10 XXX 

76856 .... ............ A ........ Us exam, pelvic, complete ................. 0.69 2.77 2.25 NA NA 0.13 XXX 

76856 .... 26 ....... A ........ Us exam, pelvic, complete ................. 0.69 0.24 0.23 0.24 0.23 0.03 XXX 

76856 .... TC ...... A ........ Us exam, pelvic, complete ................. 0.00 2.53 2.02 NA NA 0.10 XXX 

76857 .... ............ A ........ Us exam, pelvic, limited ..................... 0.38 2.48 2.15 NA NA 0.08 XXX 

76857 .... 26 ....... A ........ Us exam, pelvic, limited ..................... 0.38 0.15 0.14 0.15 0.14 0.02 XXX 

76857 .... TC ...... A ........ Us exam, pelvic, limited ..................... 0.00 2.33 2.02 NA NA 0.06 XXX 

76870 .... ............ A ........ Us exam, scrotum .............................. 0.64 2.80 2.25 NA NA 0.13 XXX 

76870 .... 26 ....... A ........ Us exam, scrotum .............................. 0.64 0.23 0.22 0.23 0.22 0.03 XXX 

76870 .... TC ...... A ........ Us exam, scrotum .............................. 0.00 2.57 2.03 NA NA 0.10 XXX 

76872 .... ............ A ........ Us, transrectal .................................... 0.69 3.39 2.81 NA NA 0.14 XXX 

76872 .... 26 ....... A ........ Us, transrectal .................................... 0.69 0.27 0.24 0.27 0.24 0.04 XXX 

76872 .... TC ...... A ........ Us, transrectal .................................... 0.00 3.12 2.57 NA NA 0.10 XXX 

76873 .... ............ A ........ Echograp trans r, pros study .............. 1.55 3.39 3.00 NA NA 0.25 XXX 

76873 .... 26 ....... A ........ Echograp trans r, pros study .............. 1.55 0.56 0.53 0.56 0.53 0.09 XXX 

76873 .... TC ...... A ........ Echograp trans r, pros study .............. 0.00 2.83 2.47 NA NA 0.16 XXX 

76880 .... ............ A ........ Us exam, extremity ............................. 0.59 3.14 2.36 NA NA 0.11 XXX 

76880 .... 26 ....... A ........ Us exam, extremity ............................. 0.59 0.18 0.18 0.18 0.18 0.03 XXX 

76880 .... TC ...... A ........ Us exam, extremity ............................. 0.00 2.96 2.18 NA NA 0.08 XXX 

76885 .... ............ A ........ Us exam infant hips, dynamic ............ 0.74 3.23 2.46 NA NA 0.13 XXX 

76885 .... 26 ....... A ........ Us exam infant hips, dynamic ............ 0.74 0.25 0.24 0.25 0.24 0.03 XXX 

76885 .... TC ...... A ........ Us exam infant hips, dynamic ............ 0.00 2.98 2.23 NA NA 0.10 XXX 

76886 .... ............ A ........ Us exam infant hips, static ................. 0.62 2.24 1.92 NA NA 0.11 XXX 

76886 .... 26 ....... A ........ Us exam infant hips, static ................. 0.62 0.22 0.20 0.22 0.20 0.03 XXX 

76886 .... TC ...... A ........ Us exam infant hips, static ................. 0.00 2.02 1.72 NA NA 0.08 XXX 

76930 .... ............ A ........ Echo guide, cardiocentesis ................ 0.67 2.01 1.90 NA NA 0.12 XXX 

76930 .... 26 ....... A ........ Echo guide, cardiocentesis ................ 0.67 0.33 0.29 0.33 0.29 0.02 XXX 

76930 .... TC ...... A ........ Echo guide, cardiocentesis ................ 0.00 1.68 1.61 NA NA 0.10 XXX 

76932 .... ............ C ........ Echo guide for heart biopsy ............... 0.67 NA NA NA NA 0.12 XXX 

76932 .... 26 ....... A ........ Echo guide for heart biopsy ............... 0.67 0.33 0.30 0.33 0.30 0.02 XXX 

76932 .... TC ...... C ........ Echo guide for heart biopsy ............... 0.00 NA NA NA NA 0.10 XXX 

76936 .... ............ A ........ Echo guide for artery repair ............... 1.99 6.03 6.46 NA NA 0.47 XXX 

76936 .... 26 ....... A ........ Echo guide for artery repair ............... 1.99 0.71 0.68 0.71 0.68 0.13 XXX 

76936 .... TC ...... A ........ Echo guide for artery repair ............... 0.00 5.33 5.78 NA NA 0.34 XXX 

76937 .... ............ A ........ Us guide, vascular access ................. 0.30 0.61 0.54 0.61 0.54 0.13 ZZZ 

76937 .... 26 ....... A ........ Us guide, vascular access ................. 0.30 0.10 0.10 0.10 0.10 0.03 ZZZ 

76937 .... TC ...... A ........ Us guide, vascular access ................. 0.00 0.51 0.44 0.51 0.44 0.10 ZZZ 

76940 .... ............ C ........ Us guide, tissue ablation .................... 2.00 NA NA NA NA 0.60 XXX 

76940 .... 26 ....... A ........ Us guide, tissue ablation .................... 2.00 0.65 0.64 0.65 0.64 0.31 XXX 

76940 .... TC ...... C ........ Us guide, tissue ablation .................... 0.00 NA NA NA NA 0.29 XXX 

76941 .... ............ C ........ Echo guide for transfusion ................. 1.34 NA NA NA NA 0.15 XXX 

76941 .... 26 ....... A ........ Echo guide for transfusion ................. 1.34 0.39 0.44 0.39 0.44 0.07 XXX 

76941 .... TC ...... C ........ Echo guide for transfusion ................. 0.00 0.00 1.02 0.00 1.02 0.08 XXX 

76942 .... ............ A ........ Echo guide for biopsy ......................... 0.67 4.76 3.87 NA NA 0.13 XXX 

76942 .... 26 ....... A ........ Echo guide for biopsy ......................... 0.67 0.24 0.23 0.24 0.23 0.03 XXX 

76942 .... TC ...... A ........ Echo guide for biopsy ......................... 0.00 4.52 3.65 NA NA 0.10 XXX 

76945 .... ............ C ........ Echo guide, villus sampling ................ 0.67 NA NA NA NA 0.11 XXX 

76945 .... 26 ....... A ........ Echo guide, villus sampling ................ 0.67 0.20 0.21 0.20 0.21 0.03 XXX 

76945 .... TC ...... C ........ Echo guide, villus sampling ................ 0.00 0.00 1.02 0.00 1.02 0.08 XXX 

76946 .... ............ A ........ Echo guide for amniocentesis ............ 0.38 0.45 1.05 NA NA 0.12 XXX 

76946 .... 26 ....... A ........ Echo guide for amniocentesis ............ 0.38 0.11 0.12 0.11 0.12 0.02 XXX 

76946 .... TC ...... A ........ Echo guide for amniocentesis ............ 0.00 0.34 0.93 NA NA 0.10 XXX 

76948 .... ............ A ........ Echo guide, ova aspiration ................. 0.38 0.44 1.04 NA NA 0.12 XXX 

76948 .... 26 ....... A ........ Echo guide, ova aspiration ................. 0.38 0.10 0.11 0.10 0.11 0.02 XXX 

76948 .... TC ...... A ........ Echo guide, ova aspiration ................. 0.00 0.34 0.93 NA NA 0.10 XXX 

76950 .... ............ A ........ Echo guidance radiotherapy ............... 0.58 1.21 1.36 NA NA 0.10 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38329 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

76950 .... 26 ....... A ........ Echo guidance radiotherapy ............... 0.58 0.19 0.19 0.19 0.19 0.03 XXX 

76950 .... TC ...... A ........ Echo guidance radiotherapy ............... 0.00 1.01 1.16 NA NA 0.07 XXX 

76965 .... ............ A ........ Echo guidance radiotherapy ............... 1.34 1.20 3.60 NA NA 0.37 XXX 

76965 .... 26 ....... A ........ Echo guidance radiotherapy ............... 1.34 0.50 0.47 0.50 0.47 0.08 XXX 

76965 .... TC ...... A ........ Echo guidance radiotherapy ............... 0.00 0.70 3.13 NA NA 0.29 XXX 

76970 .... ............ A ........ Ultrasound exam follow-up ................. 0.40 1.96 1.59 NA NA 0.08 XXX 

76970 .... 26 ....... A ........ Ultrasound exam follow-up ................. 0.40 0.11 0.12 0.11 0.12 0.02 XXX 

76970 .... TC ...... A ........ Ultrasound exam follow-up ................. 0.00 1.85 1.47 NA NA 0.06 XXX 

76975 .... ............ C ........ GI endoscopic ultrasound ................... 0.81 NA NA NA NA 0.14 XXX 

76975 .... 26 ....... A ........ GI endoscopic ultrasound ................... 0.81 0.31 0.29 0.31 0.29 0.04 XXX 

76975 .... TC ...... C ........ GI endoscopic ultrasound ................... 0.00 NA NA NA NA 0.10 XXX 

76977 .... ............ A ........ Us bone density measure .................. 0.05 0.10 0.47 NA NA 0.06 XXX 

76977 .... 26 ....... A ........ Us bone density measure .................. 0.05 0.01 0.02 0.01 0.02 0.01 XXX 

76977 .... TC ...... A ........ Us bone density measure .................. 0.00 0.09 0.46 NA NA 0.05 XXX 

76998 .... ............ C ........ Us guide, intraop ................................ 0.00 NA NA NA NA 0.13 XXX 

76998 .... 26 ....... A ........ Us guide, intraop ................................ 1.20 0.35 0.38 0.35 0.38 0.13 XXX 

76998 .... TC ...... C ........ Us guide, intraop ................................ 0.00 0.00 1.75 0.00 1.75 0.00 XXX 

76999 .... ............ C ........ Echo examination procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76999 .... 26 ....... C ........ Echo examination procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76999 .... TC ...... 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 2.70 1.86 NA NA 0.11 ZZZ 

77001 .... 26 ....... A ........ Fluoroguide for vein device ................ 0.38 0.13 0.13 0.13 0.13 0.01 ZZZ 

77001 .... TC ...... A ........ Fluoroguide for vein device ................ 0.00 2.57 1.73 NA NA 0.10 ZZZ 

77002 .... ............ A ........ Needle localization by xray ................ 0.54 1.21 1.39 NA NA 0.09 XXX 

77002 .... 26 ....... A ........ Needle localization by xray ................ 0.54 0.16 0.17 0.16 0.17 0.02 XXX 

77002 .... TC ...... A ........ Needle localization by xray ................ 0.00 1.06 1.23 NA NA 0.07 XXX 

77003 .... ............ A ........ Fluoroguide for spine inject ................ 0.60 0.75 1.22 NA NA 0.10 XXX 

77003 .... 26 ....... A ........ Fluoroguide for spine inject ................ 0.60 0.14 0.15 0.14 0.15 0.03 XXX 

77003 .... TC ...... A ........ Fluoroguide for spine inject ................ 0.00 0.61 1.08 NA NA 0.07 XXX 

77011 .... ............ A ........ Ct scan for localization ....................... 1.21 20.09 12.48 NA NA 0.47 XXX 

77011 .... 26 ....... A ........ Ct scan for localization ....................... 1.21 0.40 0.40 0.40 0.40 0.05 XXX 

77011 .... TC ...... A ........ Ct scan for localization ....................... 0.00 19.68 12.08 NA NA 0.42 XXX 

77012 .... ............ A ........ Ct scan for needle biopsy .................. 1.16 2.31 6.54 NA NA 0.47 XXX 

77012 .... 26 ....... A ........ Ct scan for needle biopsy .................. 1.16 0.42 0.39 0.42 0.39 0.05 XXX 

77012 .... TC ...... A ........ Ct scan for needle biopsy .................. 0.00 1.90 6.15 NA NA 0.42 XXX 

77013 .... ............ C ........ Ct guide for tissue ablation ................ 0.00 NA NA NA NA 0.18 XXX 

77013 .... 26 ....... A ........ Ct guide for tissue ablation ................ 3.99 1.43 1.34 1.43 1.34 0.18 XXX 

77013 .... TC ...... C ........ Ct guide for tissue ablation ................ 0.00 0.00 5.52 0.00 5.52 0.00 XXX 

77014 .... ............ A ........ Ct scan for therapy guide ................... 0.85 4.44 3.64 NA NA 0.20 XXX 

77014 .... 26 ....... A ........ Ct scan for therapy guide ................... 0.85 0.29 0.28 0.29 0.28 0.04 XXX 

77014 .... TC ...... A ........ Ct scan for therapy guide ................... 0.00 4.16 3.36 NA NA 0.16 XXX 

77021 .... ............ A ........ Mr guidance for needle place ............. 1.50 9.63 11.03 NA NA 0.64 XXX 

77021 .... 26 ....... A ........ Mr guidance for needle place ............. 1.50 0.53 0.51 0.53 0.51 0.09 XXX 

77021 .... TC ...... A ........ Mr guidance for needle place ............. 0.00 9.10 10.52 NA NA 0.55 XXX 

77022 .... ............ C ........ Mri for tissue ablation ......................... 0.00 NA NA NA NA 0.24 XXX 

77022 .... 26 ....... A ........ Mri for tissue ablation ......................... 4.24 1.61 1.46 1.61 1.46 0.24 XXX 

77022 .... TC ...... C ........ Mri for tissue ablation ......................... 0.00 0.00 7.49 0.00 7.49 0.00 XXX 

77031 .... ............ A ........ Stereotact guide for brst bx ................ 1.59 1.86 5.75 NA NA 0.46 XXX 

77031 .... 26 ....... A ........ Stereotact guide for brst bx ................ 1.59 0.54 0.53 0.54 0.53 0.09 XXX 

77031 .... TC ...... A ........ Stereotact guide for brst bx ................ 0.00 1.32 5.23 NA NA 0.37 XXX 

77032 .... ............ A ........ Guidance for needle, breast ............... 0.56 0.62 1.20 NA NA 0.09 XXX 

77032 .... 26 ....... A ........ Guidance for needle, breast ............... 0.56 0.20 0.19 0.20 0.19 0.02 XXX 

77032 .... TC ...... A ........ Guidance for needle, breast ............... 0.00 0.42 1.01 NA NA 0.07 XXX 

77051 .... ............ A ........ Computer dx mammogram add-on .... 0.06 0.20 0.36 0.20 0.36 0.02 ZZZ 

77051 .... 26 ....... A ........ Computer dx mammogram add-on .... 0.06 0.02 0.02 0.02 0.02 0.01 ZZZ 

77051 .... TC ...... A ........ Computer dx mammogram add-on .... 0.00 0.18 0.34 0.18 0.34 0.01 ZZZ 

77052 .... ............ A ........ Comp screen mammogram add-on ... 0.06 0.20 0.36 0.20 0.36 0.02 ZZZ 

77052 .... 26 ....... A ........ Comp screen mammogram add-on ... 0.06 0.02 0.02 0.02 0.02 0.01 ZZZ 

77052 .... TC ...... A ........ Comp screen mammogram add-on ... 0.00 0.18 0.34 0.18 0.34 0.01 ZZZ 

77053 .... ............ A ........ X-ray of mammary duct ...................... 0.36 0.65 2.05 NA NA 0.16 XXX 

77053 .... 26 ....... A ........ X-ray of mammary duct ...................... 0.36 0.13 0.12 0.13 0.12 0.02 XXX 

77053 .... TC ...... A ........ X-ray of mammary duct ...................... 0.00 0.52 1.93 NA NA 0.14 XXX 

77054 .... ............ A ........ X-ray of mammary ducts .................... 0.45 1.66 3.10 NA NA 0.21 XXX 

77054 .... 26 ....... A ........ X-ray of mammary ducts .................... 0.45 0.16 0.15 0.16 0.15 0.02 XXX 

77054 .... TC ...... A ........ X-ray of mammary ducts .................... 0.00 1.50 2.95 NA NA 0.19 XXX 

77055 .... ............ A ........ Mammogram, one breast ................... 0.70 1.64 1.40 NA NA 0.09 XXX 

77055 .... 26 ....... A ........ Mammogram, one breast ................... 0.70 0.25 0.24 0.25 0.24 0.03 XXX 

77055 .... TC ...... A ........ Mammogram, one breast ................... 0.00 1.39 1.16 NA NA 0.06 XXX 

77056 .... ............ A ........ Mammogram, both breasts ................ 0.87 2.13 1.77 NA NA 0.11 XXX 

77056 .... 26 ....... A ........ Mammogram, both breasts ................ 0.87 0.31 0.29 0.31 0.29 0.04 XXX 

77056 .... TC ...... A ........ Mammogram, both breasts ................ 0.00 1.82 1.48 NA NA 0.07 XXX 

77057 .... ............ A ........ Mammogram, screening ..................... 0.70 1.44 1.45 NA NA 0.10 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38330 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

77057 .... 26 ....... A ........ Mammogram, screening ..................... 0.70 0.25 0.24 0.25 0.24 0.03 XXX 

77057 .... TC ...... A ........ Mammogram, screening ..................... 0.00 1.19 1.22 NA NA 0.07 XXX 

77058 .... ............ A ........ Mri, one breast ................................... 1.63 21.44 19.28 NA NA 0.99 XXX 

77058 .... 26 ....... A ........ Mri, one breast ................................... 1.63 0.57 0.54 0.57 0.54 0.07 XXX 

77058 .... TC ...... A ........ Mri, one breast ................................... 0.00 20.87 18.74 NA NA 0.92 XXX 

77059 .... ............ A ........ Mri, both breasts ................................. 1.63 21.37 23.46 NA NA 1.31 XXX 

77059 .... 26 ....... A ........ Mri, both breasts ................................. 1.63 0.57 0.54 0.57 0.54 0.07 XXX 

77059 .... TC ...... A ........ Mri, both breasts ................................. 0.00 20.80 22.92 NA NA 1.24 XXX 

77071 .... ............ A ........ X-ray stress view ................................ 0.41 0.76 0.37 0.76 0.37 0.06 XXX 

77072 .... ............ A ........ X-rays for bone age ............................ 0.19 0.42 0.18 NA NA 0.03 XXX 

77072 .... 26 ....... A ........ X-rays for bone age ............................ 0.19 0.07 0.06 0.07 0.06 0.01 XXX 

77072 .... TC ...... A ........ X-rays for bone age ............................ 0.00 0.36 0.35 NA NA 0.02 XXX 

77073 .... ............ A ........ X-rays, bone length studies ................ 0.27 0.67 0.80 NA NA 0.06 XXX 

77073 .... 26 ....... A ........ X-rays, bone length studies ................ 0.27 0.10 0.09 0.10 0.09 0.01 XXX 

77073 .... TC ...... A ........ X-rays, bone length studies ................ 0.00 0.57 0.71 NA NA 0.05 XXX 

77074 .... ............ A ........ X-rays, bone survey, limited ............... 0.45 1.44 1.25 NA NA 0.08 XXX 

77074 .... 26 ....... A ........ X-rays, bone survey, limited ............... 0.45 0.16 0.15 0.16 0.15 0.02 XXX 

77074 .... TC ...... A ........ X-rays, bone survey, limited ............... 0.00 1.27 1.09 NA NA 0.06 XXX 

77075 .... ............ A ........ X-rays, bone survey complete ............ 0.54 2.28 1.84 NA NA 0.10 XXX 

77075 .... 26 ....... A ........ X-rays, bone survey complete ............ 0.54 0.20 0.19 0.20 0.19 0.02 XXX 

77075 .... TC ...... A ........ X-rays, bone survey complete ............ 0.00 2.08 1.65 NA NA 0.08 XXX 

77076 .... ............ A ........ X-rays, bone survey, infant ................ 0.70 2.12 1.35 NA NA 0.08 XXX 

77076 .... 26 ....... A ........ X-rays, bone survey, infant ................ 0.70 0.23 0.23 0.23 0.23 0.03 XXX 

77076 .... TC ...... A ........ X-rays, bone survey, infant ................ 0.00 1.89 1.12 NA NA 0.05 XXX 

77077 .... ............ A ........ Joint survey, single view .................... 0.31 0.65 1.02 NA NA 0.08 XXX 

77077 .... 26 ....... A ........ Joint survey, single view .................... 0.31 0.11 0.10 0.11 0.10 0.02 XXX 

77077 .... TC ...... A ........ Joint survey, single view .................... 0.00 0.54 0.92 NA NA 0.06 XXX 

77078 .... ............ A ........ Ct bone density, axial ......................... 0.25 4.69 3.59 NA NA 0.17 XXX 

77078 .... 26 ....... A ........ Ct bone density, axial ......................... 0.25 0.09 0.08 0.09 0.08 0.01 XXX 

77078 .... TC ...... A ........ Ct bone density, axial ......................... 0.00 4.61 3.51 NA NA 0.16 XXX 

77079 .... ............ A ........ Ct bone density, peripheral ................ 0.22 0.81 2.29 NA NA 0.06 XXX 

77079 .... 26 ....... A ........ Ct bone density, peripheral ................ 0.22 0.08 0.07 0.08 0.07 0.01 XXX 

77079 .... TC ...... A ........ Ct bone density, peripheral ................ 0.00 0.73 2.22 NA NA 0.05 XXX 

77080 .... ............ A ........ Dxa bone density, axial ...................... 0.20 0.87 2.42 NA NA 0.18 XXX 

77080 .... 26 ....... A ........ Dxa bone density, axial ...................... 0.20 0.06 0.09 0.06 0.09 0.01 XXX 

77080 .... TC ...... A ........ Dxa bone density, axial ...................... 0.00 0.81 2.34 NA NA 0.17 XXX 

77081 .... ............ A ........ Dxa bone density/peripheral ............... 0.22 0.47 0.71 NA NA 0.06 XXX 

77081 .... 26 ....... A ........ Dxa bone density/peripheral ............... 0.22 0.06 0.07 0.06 0.07 0.01 XXX 

77081 .... TC ...... A ........ Dxa bone density/peripheral ............... 0.00 0.40 0.63 NA NA 0.05 XXX 

77082 .... ............ A ........ Dxa bone density, vert fx ................... 0.17 0.52 0.71 NA NA 0.06 XXX 

77082 .... 26 ....... A ........ Dxa bone density, vert fx ................... 0.17 0.05 0.06 0.05 0.06 0.01 XXX 

77082 .... TC ...... A ........ Dxa bone density, vert fx ................... 0.00 0.47 0.66 NA NA 0.05 XXX 

77083 .... ............ A ........ Radiographic absorptiometry .............. 0.20 0.36 0.67 NA NA 0.06 XXX 

77083 .... 26 ....... A ........ Radiographic absorptiometry .............. 0.20 0.05 0.06 0.05 0.06 0.01 XXX 

77083 .... TC ...... A ........ Radiographic absorptiometry .............. 0.00 0.31 0.60 NA NA 0.05 XXX 

77084 .... ............ A ........ Magnetic image, bone marrow ........... 1.60 13.43 12.31 NA NA 0.66 XXX 

77084 .... 26 ....... A ........ Magnetic image, bone marrow ........... 1.60 0.53 0.52 0.53 0.52 0.07 XXX 

77084 .... TC ...... A ........ Magnetic image, bone marrow ........... 0.00 12.90 11.79 NA NA 0.59 XXX 

77261 .... ............ A ........ Radiation therapy planning ................. 1.39 0.49 0.50 0.49 0.50 0.07 XXX 

77262 .... ............ A ........ Radiation therapy planning ................. 2.11 0.70 0.73 0.70 0.73 0.11 XXX 

77263 .... ............ A ........ Radiation therapy planning ................. 3.14 1.05 1.08 1.05 1.08 0.16 XXX 

77280 .... ............ A ........ Set radiation therapy field .................. 0.70 4.40 4.06 NA NA 0.22 XXX 

77280 .... 26 ....... A ........ Set radiation therapy field .................. 0.70 0.23 0.23 0.23 0.23 0.04 XXX 

77280 .... TC ...... A ........ Set radiation therapy field .................. 0.00 4.16 3.83 NA NA 0.18 XXX 

77285 .... ............ A ........ Set radiation therapy field .................. 1.05 7.96 6.95 NA NA 0.35 XXX 

77285 .... 26 ....... A ........ Set radiation therapy field .................. 1.05 0.35 0.34 0.35 0.34 0.05 XXX 

77285 .... TC ...... A ........ Set radiation therapy field .................. 0.00 7.61 6.61 NA NA 0.30 XXX 

77290 .... ............ A ........ Set radiation therapy field .................. 1.56 13.31 10.19 NA NA 0.43 XXX 

77290 .... 26 ....... A ........ Set radiation therapy field .................. 1.56 0.52 0.51 0.52 0.51 0.08 XXX 

77290 .... TC ...... A ........ Set radiation therapy field .................. 0.00 12.79 9.68 NA NA 0.35 XXX 

77295 .... ............ A ........ Set radiation therapy field .................. 4.56 7.42 18.42 NA NA 1.71 XXX 

77295 .... 26 ....... A ........ Set radiation therapy field .................. 4.56 1.52 1.49 1.52 1.49 0.23 XXX 

77295 .... TC ...... A ........ Set radiation therapy field .................. 0.00 5.90 16.93 NA NA 1.48 XXX 

77299 .... ............ C ........ Radiation therapy planning ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77299 .... 26 ....... C ........ Radiation therapy planning ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77299 .... TC ...... 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 .... 26 ....... A ........ Radiation therapy dose plan .............. 0.62 0.21 0.20 0.21 0.20 0.03 XXX 

77300 .... TC ...... A ........ Radiation therapy dose plan .............. 0.00 0.97 1.16 NA NA 0.07 XXX 

77301 .... ............ A ........ Radiotherapy dose plan, imrt ............. 7.99 57.00 43.83 NA NA 1.88 XXX 

77301 .... 26 ....... A ........ Radiotherapy dose plan, imrt ............. 7.99 2.66 2.61 2.66 2.61 0.40 XXX 

77301 .... TC ...... A ........ Radiotherapy dose plan, imrt ............. 0.00 54.35 41.22 NA NA 1.48 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38331 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

77305 .... ............ A ........ Teletx isodose plan simple ................. 0.70 0.90 1.49 NA NA 0.15 XXX 

77305 .... 26 ....... A ........ Teletx isodose plan simple ................. 0.70 0.23 0.23 0.23 0.23 0.04 XXX 

77305 .... TC ...... A ........ Teletx isodose plan simple ................. 0.00 0.66 1.26 NA NA 0.11 XXX 

77310 .... ............ A ........ Teletx isodose plan intermed ............. 1.05 1.25 1.96 NA NA 0.18 XXX 

77310 .... 26 ....... A ........ Teletx isodose plan intermed ............. 1.05 0.35 0.34 0.35 0.34 0.05 XXX 

77310 .... TC ...... A ........ Teletx isodose plan intermed ............. 0.00 0.90 1.62 NA NA 0.13 XXX 

77315 .... ............ A ........ Teletx isodose plan complex .............. 1.56 2.08 2.63 NA NA 0.22 XXX 

77315 .... 26 ....... A ........ Teletx isodose plan complex .............. 1.56 0.52 0.51 0.52 0.51 0.08 XXX 

77315 .... TC ...... A ........ Teletx isodose plan complex .............. 0.00 1.56 2.11 NA NA 0.14 XXX 

77321 .... ............ A ........ Special teletx port plan ....................... 0.95 1.50 2.93 NA NA 0.26 XXX 

77321 .... 26 ....... A ........ Special teletx port plan ....................... 0.95 0.32 0.31 0.32 0.31 0.05 XXX 

77321 .... TC ...... A ........ Special teletx port plan ....................... 0.00 1.19 2.62 NA NA 0.21 XXX 

77326 .... ............ A ........ Brachytx isodose calc simp ................ 0.93 2.97 2.82 NA NA 0.18 XXX 

77326 .... 26 ....... A ........ Brachytx isodose calc simp ................ 0.93 0.31 0.31 0.31 0.31 0.05 XXX 

77326 .... TC ...... A ........ Brachytx isodose calc simp ................ 0.00 2.66 2.51 NA NA 0.13 XXX 

77327 .... ............ A ........ Brachytx isodose calc interm ............. 1.39 4.07 4.00 NA NA 0.25 XXX 

77327 .... 26 ....... A ........ Brachytx isodose calc interm ............. 1.39 0.46 0.45 0.46 0.45 0.07 XXX 

77327 .... TC ...... A ........ Brachytx isodose calc interm ............. 0.00 3.61 3.55 NA NA 0.18 XXX 

77328 .... ............ A ........ Brachytx isodose plan compl ............. 2.09 5.22 5.43 NA NA 0.36 XXX 

77328 .... 26 ....... A ........ Brachytx isodose plan compl ............. 2.09 0.70 0.69 0.70 0.69 0.11 XXX 

77328 .... TC ...... A ........ Brachytx isodose plan compl ............. 0.00 4.53 4.75 NA NA 0.25 XXX 

77331 .... ............ A ........ Special radiation dosimetry ................ 0.87 0.80 0.79 NA NA 0.06 XXX 

77331 .... 26 ....... A ........ Special radiation dosimetry ................ 0.87 0.29 0.28 0.29 0.28 0.04 XXX 

77331 .... TC ...... A ........ Special radiation dosimetry ................ 0.00 0.51 0.51 NA NA 0.02 XXX 

77332 .... ............ A ........ Radiation treatment aid(s) .................. 0.54 1.54 1.53 NA NA 0.10 XXX 

77332 .... 26 ....... A ........ Radiation treatment aid(s) .................. 0.54 0.18 0.18 0.18 0.18 0.03 XXX 

77332 .... TC ...... A ........ Radiation treatment aid(s) .................. 0.00 1.36 1.35 NA NA 0.07 XXX 

77333 .... ............ A ........ Radiation treatment aid(s) .................. 0.84 0.52 1.34 NA NA 0.15 XXX 

77333 .... 26 ....... A ........ Radiation treatment aid(s) .................. 0.84 0.28 0.27 0.28 0.27 0.04 XXX 

77333 .... TC ...... A ........ Radiation treatment aid(s) .................. 0.00 0.24 1.07 NA NA 0.11 XXX 

77334 .... ............ A ........ Radiation treatment aid(s) .................. 1.24 2.70 3.19 NA NA 0.23 XXX 

77334 .... 26 ....... A ........ Radiation treatment aid(s) .................. 1.24 0.41 0.41 0.41 0.41 0.06 XXX 

77334 .... TC ...... A ........ Radiation treatment aid(s) .................. 0.00 2.29 2.78 NA NA 0.17 XXX 

77336 .... ............ A ........ Radiation physics consult ................... 0.00 1.13 2.06 NA NA 0.16 XXX 

77370 .... ............ A ........ Radiation physics consult ................... 0.00 3.02 3.26 NA NA 0.18 XXX 

77371 .... ............ A ........ Srs, multisource .................................. 0.00 29.82 30.11 NA NA 0.13 XXX 

77372 .... ............ A ........ Srs, linear based ................................ 0.00 22.61 22.82 NA NA 0.13 XXX 

77373 .... ............ A ........ Sbrt delivery ........................................ 0.00 42.26 42.67 NA NA 0.13 XXX 

77399 .... ............ C ........ External radiation dosimetry ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77399 .... 26 ....... C ........ External radiation dosimetry ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77399 .... TC ...... 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 4.30 3.01 NA NA 0.11 XXX 

77403 .... ............ A ........ Radiation treatment delivery ............... 0.00 3.72 2.75 NA NA 0.11 XXX 

77404 .... ............ A ........ Radiation treatment delivery ............... 0.00 4.17 2.98 NA NA 0.11 XXX 

77406 .... ............ A ........ Radiation treatment delivery ............... 0.00 4.20 2.99 NA NA 0.11 XXX 

77407 .... ............ A ........ Radiation treatment delivery ............... 0.00 5.75 3.87 NA NA 0.12 XXX 

77408 .... ............ A ........ Radiation treatment delivery ............... 0.00 5.14 3.63 NA NA 0.12 XXX 

77409 .... ............ A ........ Radiation treatment delivery ............... 0.00 5.71 3.92 NA NA 0.12 XXX 

77411 .... ............ A ........ Radiation treatment delivery ............... 0.00 5.68 3.90 NA NA 0.12 XXX 

77412 .... ............ A ........ Radiation treatment delivery ............... 0.00 6.72 4.55 NA NA 0.13 XXX 

77413 .... ............ A ........ Radiation treatment delivery ............... 0.00 6.79 4.57 NA NA 0.13 XXX 

77414 .... ............ A ........ Radiation treatment delivery ............... 0.00 7.64 5.00 NA NA 0.13 XXX 

77416 .... ............ A ........ Radiation treatment delivery ............... 0.00 7.65 5.00 NA NA 0.13 XXX 

77417 .... ............ A ........ Radiology port film(s) ......................... 0.00 0.36 0.47 NA NA 0.04 XXX 

77418 .... ............ A ........ Radiation tx delivery, imrt ................... 0.00 13.04 15.55 NA NA 0.13 XXX 

77421 .... ............ A ........ Stereoscopic x-ray guidance .............. 0.39 1.98 2.73 NA NA 0.12 XXX 

77421 .... 26 ....... A ........ Stereoscopic x-ray guidance .............. 0.39 0.13 0.13 0.13 0.13 0.02 XXX 

77421 .... TC ...... A ........ Stereoscopic x-ray guidance .............. 0.00 1.85 2.60 NA NA 0.10 XXX 

77422 .... ............ A ........ Neutron beam tx, simple .................... 0.00 5.37 4.84 NA NA 0.13 XXX 

77423 .... ............ A ........ Neutron beam tx, complex ................. 0.00 7.41 5.03 NA NA 0.13 XXX 

77427 .... ............ A ........ Radiation tx management, x5 ............ 3.70 1.40 1.23 1.40 1.23 0.17 XXX 

77431 .... ............ A ........ Radiation therapy management ......... 1.81 0.79 0.74 0.79 0.74 0.09 XXX 

77432 .... ............ A ........ Stereotactic radiation trmt .................. 7.92 2.64 2.78 2.64 2.78 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 1.93 6.88 NA NA 0.70 XXX 

77470 .... 26 ....... A ........ Special radiation treatment ................. 2.09 0.69 0.68 0.69 0.68 0.11 XXX 

77470 .... TC ...... A ........ Special radiation treatment ................. 0.00 1.23 6.19 NA NA 0.59 XXX 

77499 .... ............ C ........ Radiation therapy management ......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77499 .... 26 ....... C ........ Radiation therapy management ......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77499 .... TC ...... 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 

mstockstill on PROD1PC66 with PROPOSALS2

38332 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

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 10.16 6.78 NA NA 0.24 XXX 

77600 .... 26 ....... R ........ Hyperthermia treatment ...................... 1.56 0.51 0.49 0.51 0.49 0.08 XXX 

77600 .... TC ...... R ........ Hyperthermia treatment ...................... 0.00 9.65 6.29 NA NA 0.16 XXX 

77605 .... ............ R ........ Hyperthermia treatment ...................... 2.09 18.23 11.32 NA NA 0.38 XXX 

77605 .... 26 ....... R ........ Hyperthermia treatment ...................... 2.09 0.55 0.62 0.55 0.62 0.16 XXX 

77605 .... TC ...... R ........ Hyperthermia treatment ...................... 0.00 17.68 10.71 NA NA 0.22 XXX 

77610 .... ............ R ........ Hyperthermia treatment ...................... 1.56 17.70 10.52 NA NA 0.24 XXX 

77610 .... 26 ....... R ........ Hyperthermia treatment ...................... 1.56 0.36 0.46 0.36 0.46 0.08 XXX 

77610 .... TC ...... R ........ Hyperthermia treatment ...................... 0.00 17.34 10.06 NA NA 0.16 XXX 

77615 .... ............ R ........ Hyperthermia treatment ...................... 2.09 25.69 15.24 NA NA 0.33 XXX 

77615 .... 26 ....... R ........ Hyperthermia treatment ...................... 2.09 0.65 0.66 0.65 0.66 0.11 XXX 

77615 .... TC ...... R ........ Hyperthermia treatment ...................... 0.00 25.04 14.58 NA NA 0.22 XXX 

77620 .... ............ R ........ Hyperthermia treatment ...................... 1.56 10.38 6.83 NA NA 0.36 XXX 

77620 .... 26 ....... R ........ Hyperthermia treatment ...................... 1.56 0.40 0.46 0.40 0.46 0.20 XXX 

77620 .... TC ...... R ........ Hyperthermia treatment ...................... 0.00 9.97 6.36 NA NA 0.16 XXX 

77750 .... ............ A ........ Infuse radioactive materials ................ 4.94 4.56 3.74 4.56 3.74 0.32 090 

77750 .... 26 ....... A ........ Infuse radioactive materials ................ 4.94 1.65 1.62 1.65 1.62 0.25 090 

77750 .... TC ...... A ........ Infuse radioactive materials ................ 0.00 2.91 2.12 2.91 2.12 0.07 090 

77761 .... ............ A ........ Apply intrcav radiat simple ................. 3.82 6.33 4.96 6.33 4.96 0.33 090 

77761 .... 26 ....... A ........ Apply intrcav radiat simple ................. 3.82 1.27 1.18 1.27 1.18 0.19 090 

77761 .... TC ...... A ........ Apply intrcav radiat simple ................. 0.00 5.06 3.78 5.06 3.78 0.14 090 

77762 .... ............ A ........ Apply intrcav radiat interm .................. 5.73 7.60 6.54 7.60 6.54 0.48 090 

77762 .... 26 ....... A ........ Apply intrcav radiat interm .................. 5.73 1.90 1.87 1.90 1.87 0.29 090 

77762 .... TC ...... A ........ Apply intrcav radiat interm .................. 0.00 5.70 4.67 5.70 4.67 0.19 090 

77763 .... ............ A ........ Apply intrcav radiat compl .................. 8.60 10.33 8.80 10.33 8.80 0.66 090 

77763 .... 26 ....... A ........ Apply intrcav radiat compl .................. 8.60 2.86 2.81 2.86 2.81 0.43 090 

77763 .... TC ...... A ........ Apply intrcav radiat compl .................. 0.00 7.46 5.99 7.46 5.99 0.23 090 

77776 .... ............ A ........ Apply interstit radiat simpl .................. 4.67 7.45 5.30 7.45 5.30 0.57 090 

77776 .... 26 ....... A ........ Apply interstit radiat simpl .................. 4.67 1.70 1.33 1.70 1.33 0.44 090 

77776 .... TC ...... A ........ Apply interstit radiat simpl .................. 0.00 5.75 3.98 5.75 3.98 0.13 090 

77777 .... ............ A ........ Apply interstit radiat inter .................... 7.49 7.91 7.25 7.91 7.25 0.61 090 

77777 .... 26 ....... A ........ Apply interstit radiat inter .................... 7.49 2.48 2.43 2.48 2.43 0.39 090 

77777 .... TC ...... A ........ Apply interstit radiat inter .................... 0.00 5.43 4.82 5.43 4.82 0.22 090 

77778 .... ............ A ........ Apply interstit radiat compl ................. 11.23 11.32 10.03 11.32 10.03 0.84 090 

77778 .... 26 ....... A ........ Apply interstit radiat compl ................. 11.23 3.75 3.67 3.75 3.67 0.57 090 

77778 .... TC ...... A ........ Apply interstit radiat compl ................. 0.00 7.57 6.36 7.57 6.36 0.27 090 

77781 .... ............ A ........ High intensity brachytherapy .............. 1.21 4.37 12.61 NA NA 1.14 XXX 

77781 .... 26 ....... A ........ High intensity brachytherapy .............. 1.21 0.40 0.47 0.40 0.47 0.08 XXX 

77781 .... TC ...... A ........ High intensity brachytherapy .............. 0.00 3.97 12.14 NA NA 1.06 XXX 

77782 .... ............ A ........ High intensity brachytherapy .............. 2.04 12.31 16.73 NA NA 1.19 XXX 

77782 .... 26 ....... A ........ High intensity brachytherapy .............. 2.04 0.68 0.74 0.68 0.74 0.13 XXX 

77782 .... TC ...... A ........ High intensity brachytherapy .............. 0.00 11.64 15.99 NA NA 1.06 XXX 

77783 .... ............ A ........ High intensity brachytherapy .............. 3.27 24.00 22.80 NA NA 1.25 XXX 

77783 .... 26 ....... A ........ High intensity brachytherapy .............. 3.27 1.08 1.14 1.08 1.14 0.19 XXX 

77783 .... TC ...... A ........ High intensity brachytherapy .............. 0.00 22.92 21.66 NA NA 1.06 XXX 

77784 .... ............ A ........ High intensity brachytherapy .............. 5.15 45.31 33.80 NA NA 1.35 XXX 

77784 .... 26 ....... A ........ High intensity brachytherapy .............. 5.15 1.71 1.76 1.71 1.76 0.29 XXX 

77784 .... TC ...... A ........ High intensity brachytherapy .............. 0.00 43.60 32.04 NA NA 1.06 XXX 

77789 .... ............ A ........ Apply surface radiation ....................... 1.14 2.02 1.43 2.02 1.43 0.08 000 

77789 .... 26 ....... A ........ Apply surface radiation ....................... 1.14 0.39 0.38 0.39 0.38 0.06 000 

77789 .... TC ...... A ........ Apply surface radiation ....................... 0.00 1.63 1.05 1.63 1.05 0.02 000 

77790 .... ............ A ........ Radiation handling .............................. 1.05 1.47 1.16 NA NA 0.07 XXX 

77790 .... 26 ....... A ........ Radiation handling .............................. 1.05 0.35 0.34 0.35 0.34 0.05 XXX 

77790 .... TC ...... A ........ Radiation handling .............................. 0.00 1.11 0.81 NA NA 0.02 XXX 

77799 .... ............ C ........ Radium/radioisotope therapy .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77799 .... 26 ....... C ........ Radium/radioisotope therapy .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77799 .... TC ...... C ........ Radium/radioisotope therapy .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78000 .... ............ A ........ Thyroid, single uptake ........................ 0.19 1.83 1.42 NA NA 0.07 XXX 

78000 .... 26 ....... A ........ Thyroid, single uptake ........................ 0.19 0.06 0.06 0.06 0.06 0.01 XXX 

78000 .... TC ...... A ........ Thyroid, single uptake ........................ 0.00 1.77 1.36 NA NA 0.06 XXX 

78001 .... ............ A ........ Thyroid, multiple uptakes ................... 0.26 2.28 1.82 NA NA 0.08 XXX 

78001 .... 26 ....... A ........ Thyroid, multiple uptakes ................... 0.26 0.09 0.09 0.09 0.09 0.01 XXX 

78001 .... TC ...... A ........ Thyroid, multiple uptakes ................... 0.00 2.19 1.73 NA NA 0.07 XXX 

78003 .... ............ A ........ Thyroid suppress/stimul ...................... 0.33 1.92 1.48 NA NA 0.07 XXX 

78003 .... 26 ....... A ........ Thyroid suppress/stimul ...................... 0.33 0.12 0.11 0.12 0.11 0.01 XXX 

78003 .... TC ...... A ........ Thyroid suppress/stimul ...................... 0.00 1.81 1.37 NA NA 0.06 XXX 

78006 .... ............ A ........ Thyroid imaging with uptake .............. 0.49 6.16 4.31 NA NA 0.15 XXX 

78006 .... 26 ....... A ........ Thyroid imaging with uptake .............. 0.49 0.17 0.16 0.17 0.16 0.02 XXX 

78006 .... TC ...... A ........ Thyroid imaging with uptake .............. 0.00 5.99 4.14 NA NA 0.13 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38333 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

78007 .... ............ A ........ Thyroid image, mult uptakes .............. 0.50 3.03 2.85 NA NA 0.16 XXX 

78007 .... 26 ....... A ........ Thyroid image, mult uptakes .............. 0.50 0.17 0.16 0.17 0.16 0.02 XXX 

78007 .... TC ...... A ........ Thyroid image, mult uptakes .............. 0.00 2.86 2.69 NA NA 0.14 XXX 

78010 .... ............ A ........ Thyroid imaging .................................. 0.39 4.14 3.01 NA NA 0.13 XXX 

78010 .... 26 ....... A ........ Thyroid imaging .................................. 0.39 0.13 0.13 0.13 0.13 0.02 XXX 

78010 .... TC ...... A ........ Thyroid imaging .................................. 0.00 4.01 2.88 NA NA 0.11 XXX 

78011 .... ............ A ........ Thyroid imaging with flow ................... 0.45 4.48 3.49 NA NA 0.15 XXX 

78011 .... 26 ....... A ........ Thyroid imaging with flow ................... 0.45 0.16 0.15 0.16 0.15 0.02 XXX 

78011 .... TC ...... A ........ Thyroid imaging with flow ................... 0.00 4.32 3.33 NA NA 0.13 XXX 

78015 .... ............ A ........ Thyroid met imaging ........................... 0.67 5.28 4.01 NA NA 0.17 XXX 

78015 .... 26 ....... A ........ Thyroid met imaging ........................... 0.67 0.23 0.22 0.23 0.22 0.03 XXX 

78015 .... TC ...... A ........ Thyroid met imaging ........................... 0.00 5.06 3.79 NA NA 0.14 XXX 

78016 .... ............ A ........ Thyroid met imaging/studies .............. 0.82 8.42 6.04 NA NA 0.21 XXX 

78016 .... 26 ....... A ........ Thyroid met imaging/studies .............. 0.82 0.28 0.27 0.28 0.27 0.03 XXX 

78016 .... TC ...... A ........ Thyroid met imaging/studies .............. 0.00 8.14 5.77 NA NA 0.18 XXX 

78018 .... ............ A ........ Thyroid met imaging, body ................. 0.86 7.84 6.72 NA NA 0.33 XXX 

78018 .... 26 ....... A ........ Thyroid met imaging, body ................. 0.86 0.30 0.29 0.30 0.29 0.04 XXX 

78018 .... TC ...... A ........ Thyroid met imaging, body ................. 0.00 7.54 6.43 NA NA 0.29 XXX 

78020 .... ............ A ........ Thyroid met uptake ............................. 0.60 1.78 1.63 1.78 1.63 0.16 ZZZ 

78020 .... 26 ....... A ........ Thyroid met uptake ............................. 0.60 0.20 0.20 0.20 0.20 0.02 ZZZ 

78020 .... TC ...... A ........ Thyroid met uptake ............................. 0.00 1.57 1.43 1.57 1.43 0.14 ZZZ 

78070 .... ............ A ........ Parathyroid nuclear imaging ............... 0.82 3.45 3.96 NA NA 0.15 XXX 

78070 .... 26 ....... A ........ Parathyroid nuclear imaging ............... 0.82 0.28 0.27 0.28 0.27 0.04 XXX 

78070 .... TC ...... A ........ Parathyroid nuclear imaging ............... 0.00 3.17 3.68 NA NA 0.11 XXX 

78075 .... ............ A ........ Adrenal nuclear imaging ..................... 0.74 11.47 8.50 NA NA 0.32 XXX 

78075 .... 26 ....... A ........ Adrenal nuclear imaging ..................... 0.74 0.25 0.25 0.25 0.25 0.03 XXX 

78075 .... TC ...... A ........ Adrenal nuclear imaging ..................... 0.00 11.22 8.25 NA NA 0.29 XXX 

78099 .... ............ C ........ Endocrine nuclear procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78099 .... 26 ....... C ........ Endocrine nuclear procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78099 .... TC ...... 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 4.13 3.14 NA NA 0.14 XXX 

78102 .... 26 ....... A ........ Bone marrow imaging, ltd .................. 0.55 0.19 0.18 0.19 0.18 0.02 XXX 

78102 .... TC ...... A ........ Bone marrow imaging, ltd .................. 0.00 3.94 2.96 NA NA 0.12 XXX 

78103 .... ............ A ........ Bone marrow imaging, mult ............... 0.75 5.37 4.36 NA NA 0.20 XXX 

78103 .... 26 ....... A ........ Bone marrow imaging, mult ............... 0.75 0.26 0.25 0.26 0.25 0.03 XXX 

78103 .... TC ...... A ........ Bone marrow imaging, mult ............... 0.00 5.11 4.10 NA NA 0.17 XXX 

78104 .... ............ A ........ Bone marrow imaging, body .............. 0.80 6.15 5.22 NA NA 0.25 XXX 

78104 .... 26 ....... A ........ Bone marrow imaging, body .............. 0.80 0.30 0.28 0.30 0.28 0.03 XXX 

78104 .... TC ...... A ........ Bone marrow imaging, body .............. 0.00 5.86 4.94 NA NA 0.22 XXX 

78110 .... ............ A ........ Plasma volume, single ....................... 0.19 2.10 1.55 NA NA 0.07 XXX 

78110 .... 26 ....... A ........ Plasma volume, single ....................... 0.19 0.07 0.07 0.07 0.07 0.01 XXX 

78110 .... TC ...... A ........ Plasma volume, single ....................... 0.00 2.04 1.49 NA NA 0.06 XXX 

78111 .... ............ A ........ Plasma volume, multiple .................... 0.22 2.11 2.37 NA NA 0.15 XXX 

78111 .... 26 ....... A ........ Plasma volume, multiple .................... 0.22 0.07 0.08 0.07 0.08 0.01 XXX 

78111 .... TC ...... A ........ Plasma volume, multiple .................... 0.00 2.04 2.29 NA NA 0.14 XXX 

78120 .... ............ A ........ Red cell mass, single ......................... 0.23 2.07 1.92 NA NA 0.12 XXX 

78120 .... 26 ....... A ........ Red cell mass, single ......................... 0.23 0.08 0.08 0.08 0.08 0.01 XXX 

78120 .... TC ...... A ........ Red cell mass, single ......................... 0.00 1.99 1.84 NA NA 0.11 XXX 

78121 .... ............ A ........ Red cell mass, multiple ...................... 0.32 2.17 2.58 NA NA 0.15 XXX 

78121 .... 26 ....... A ........ Red cell mass, multiple ...................... 0.32 0.10 0.11 0.10 0.11 0.01 XXX 

78121 .... TC ...... A ........ Red cell mass, multiple ...................... 0.00 2.07 2.48 NA NA 0.14 XXX 

78122 .... ............ A ........ Blood volume ...................................... 0.45 2.22 3.47 NA NA 0.26 XXX 

78122 .... 26 ....... A ........ Blood volume ...................................... 0.45 0.15 0.15 0.15 0.15 0.02 XXX 

78122 .... TC ...... A ........ Blood volume ...................................... 0.00 2.07 3.32 NA NA 0.24 XXX 

78130 .... ............ A ........ Red cell survival study ....................... 0.61 3.47 3.24 NA NA 0.17 XXX 

78130 .... 26 ....... A ........ Red cell survival study ....................... 0.61 0.21 0.20 0.21 0.20 0.03 XXX 

78130 .... TC ...... A ........ Red cell survival study ....................... 0.00 3.26 3.03 NA NA 0.14 XXX 

78135 .... ............ A ........ Red cell survival kinetics .................... 0.64 8.59 6.76 NA NA 0.28 XXX 

78135 .... 26 ....... A ........ Red cell survival kinetics .................... 0.64 0.22 0.21 0.22 0.21 0.03 XXX 

78135 .... TC ...... A ........ Red cell survival kinetics .................... 0.00 8.37 6.54 NA NA 0.25 XXX 

78140 .... ............ A ........ Red cell sequestration ........................ 0.61 2.92 3.49 NA NA 0.24 XXX 

78140 .... 26 ....... A ........ Red cell sequestration ........................ 0.61 0.22 0.20 0.22 0.20 0.03 XXX 

78140 .... TC ...... A ........ Red cell sequestration ........................ 0.00 2.70 3.29 NA NA 0.21 XXX 

78185 .... ............ A ........ Spleen imaging ................................... 0.40 5.13 3.78 NA NA 0.15 XXX 

78185 .... 26 ....... A ........ Spleen imaging ................................... 0.40 0.14 0.13 0.14 0.13 0.02 XXX 

78185 .... TC ...... A ........ Spleen imaging ................................... 0.00 4.99 3.64 NA NA 0.13 XXX 

78190 .... ............ A ........ Platelet survival, kinetics .................... 1.09 8.27 7.27 NA NA 0.38 XXX 

78190 .... 26 ....... A ........ Platelet survival, kinetics .................... 1.09 0.25 0.34 0.25 0.34 0.08 XXX 

78190 .... TC ...... A ........ Platelet survival, kinetics .................... 0.00 8.02 6.93 NA NA 0.30 XXX 

78191 .... ............ A ........ Platelet survival .................................. 0.61 3.49 5.47 NA NA 0.40 XXX 

78191 .... 26 ....... A ........ Platelet survival .................................. 0.61 0.22 0.20 0.22 0.20 0.03 XXX 

78191 .... TC ...... A ........ Platelet survival .................................. 0.00 3.27 5.27 NA NA 0.37 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38334 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

78195 .... ............ A ........ Lymph system imaging ....................... 1.20 8.60 6.47 NA NA 0.28 XXX 

78195 .... 26 ....... A ........ Lymph system imaging ....................... 1.20 0.42 0.40 0.42 0.40 0.06 XXX 

78195 .... TC ...... A ........ Lymph system imaging ....................... 0.00 8.18 6.07 NA NA 0.22 XXX 

78199 .... ............ C ........ Blood/lymph nuclear exam ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78199 .... 26 ....... C ........ Blood/lymph nuclear exam ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78199 .... TC ...... C ........ Blood/lymph nuclear exam ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78201 .... ............ A ........ Liver imaging ...................................... 0.44 4.55 3.52 NA NA 0.15 XXX 

78201 .... 26 ....... A ........ Liver imaging ...................................... 0.44 0.13 0.14 0.13 0.14 0.02 XXX 

78201 .... TC ...... A ........ Liver imaging ...................................... 0.00 4.42 3.38 NA NA 0.13 XXX 

78202 .... ............ A ........ Liver imaging with flow ....................... 0.51 5.28 4.13 NA NA 0.16 XXX 

78202 .... 26 ....... A ........ Liver imaging with flow ....................... 0.51 0.17 0.16 0.17 0.16 0.02 XXX 

78202 .... TC ...... A ........ Liver imaging with flow ....................... 0.00 5.10 3.96 NA NA 0.14 XXX 

78205 .... ............ A ........ Liver imaging (3D) .............................. 0.71 5.21 5.64 NA NA 0.34 XXX 

78205 .... 26 ....... A ........ Liver imaging (3D) .............................. 0.71 0.25 0.24 0.25 0.24 0.03 XXX 

78205 .... TC ...... A ........ Liver imaging (3D) .............................. 0.00 4.96 5.40 NA NA 0.31 XXX 

78206 .... ............ A ........ Liver image (3d) with flow .................. 0.96 8.52 8.25 NA NA 0.15 XXX 

78206 .... 26 ....... A ........ Liver image (3d) with flow .................. 0.96 0.34 0.33 0.34 0.33 0.04 XXX 

78206 .... TC ...... A ........ Liver image (3d) with flow .................. 0.00 8.18 7.93 NA NA 0.11 XXX 

78215 .... ............ A ........ Liver and spleen imaging ................... 0.49 4.78 3.90 NA NA 0.16 XXX 

78215 .... 26 ....... A ........ Liver and spleen imaging ................... 0.49 0.17 0.16 0.17 0.16 0.02 XXX 

78215 .... TC ...... A ........ Liver and spleen imaging ................... 0.00 4.60 3.73 NA NA 0.14 XXX 

78216 .... ............ A ........ Liver & spleen image/flow .................. 0.57 2.82 3.21 NA NA 0.20 XXX 

78216 .... 26 ....... A ........ Liver & spleen image/flow .................. 0.57 0.20 0.19 0.20 0.19 0.02 XXX 

78216 .... TC ...... A ........ Liver & spleen image/flow .................. 0.00 2.62 3.03 NA NA 0.18 XXX 

78220 .... ............ A ........ Liver function study ............................ 0.49 3.05 3.44 NA NA 0.21 XXX 

78220 .... 26 ....... A ........ Liver function study ............................ 0.49 0.17 0.16 0.17 0.16 0.02 XXX 

78220 .... TC ...... A ........ Liver function study ............................ 0.00 2.88 3.27 NA NA 0.19 XXX 

78223 .... ............ A ........ Hepatobiliary imaging ......................... 0.84 8.43 6.11 NA NA 0.23 XXX 

78223 .... 26 ....... A ........ Hepatobiliary imaging ......................... 0.84 0.30 0.28 0.30 0.28 0.04 XXX 

78223 .... TC ...... A ........ Hepatobiliary imaging ......................... 0.00 8.13 5.83 NA NA 0.19 XXX 

78230 .... ............ A ........ Salivary gland imaging ....................... 0.45 4.13 3.19 NA NA 0.15 XXX 

78230 .... 26 ....... A ........ Salivary gland imaging ....................... 0.45 0.16 0.15 0.16 0.15 0.02 XXX 

78230 .... TC ...... A ........ Salivary gland imaging ....................... 0.00 3.97 3.04 NA NA 0.13 XXX 

78231 .... ............ A ........ Serial salivary imaging ....................... 0.52 2.75 3.03 NA NA 0.19 XXX 

78231 .... 26 ....... A ........ Serial salivary imaging ....................... 0.52 0.16 0.17 0.16 0.17 0.02 XXX 

78231 .... TC ...... A ........ Serial salivary imaging ....................... 0.00 2.58 2.86 NA NA 0.17 XXX 

78232 .... ............ A ........ Salivary gland function exam ............. 0.47 2.74 3.19 NA NA 0.20 XXX 

78232 .... 26 ....... A ........ Salivary gland function exam ............. 0.47 0.15 0.15 0.15 0.15 0.02 XXX 

78232 .... TC ...... A ........ Salivary gland function exam ............. 0.00 2.59 3.04 NA NA 0.18 XXX 

78258 .... ............ A ........ Esophageal motility study ................... 0.74 5.48 4.32 NA NA 0.17 XXX 

78258 .... 26 ....... A ........ Esophageal motility study ................... 0.74 0.27 0.26 0.27 0.26 0.03 XXX 

78258 .... TC ...... A ........ Esophageal motility study ................... 0.00 5.21 4.06 NA NA 0.14 XXX 

78261 .... ............ A ........ Gastric mucosa imaging ..................... 0.69 5.94 5.10 NA NA 0.25 XXX 

78261 .... 26 ....... A ........ Gastric mucosa imaging ..................... 0.69 0.24 0.23 0.24 0.23 0.03 XXX 

78261 .... TC ...... A ........ Gastric mucosa imaging ..................... 0.00 5.70 4.87 NA NA 0.22 XXX 

78262 .... ............ A ........ Gastroesophageal reflux exam .......... 0.68 5.89 5.14 NA NA 0.25 XXX 

78262 .... 26 ....... A ........ Gastroesophageal reflux exam .......... 0.68 0.22 0.22 0.22 0.22 0.03 XXX 

78262 .... TC ...... A ........ Gastroesophageal reflux exam .......... 0.00 5.67 4.92 NA NA 0.22 XXX 

78264 .... ............ A ........ Gastric emptying study ....................... 0.78 7.10 5.69 NA NA 0.25 XXX 

78264 .... 26 ....... A ........ Gastric emptying study ....................... 0.78 0.28 0.26 0.28 0.26 0.03 XXX 

78264 .... TC ...... A ........ Gastric emptying study ....................... 0.00 6.82 5.43 NA NA 0.22 XXX 

78270 .... ............ A ........ Vit B–12 absorption exam .................. 0.20 1.92 1.75 NA NA 0.11 XXX 

78270 .... 26 ....... A ........ Vit B–12 absorption exam .................. 0.20 0.07 0.07 0.07 0.07 0.01 XXX 

78270 .... TC ...... A ........ Vit B–12 absorption exam .................. 0.00 1.85 1.68 NA NA 0.10 XXX 

78271 .... ............ A ........ Vit b–12 absrp exam, int fac .............. 0.20 1.87 1.79 NA NA 0.11 XXX 

78271 .... 26 ....... A ........ Vit b–12 absrp exam, int fac .............. 0.20 0.05 0.06 0.05 0.06 0.01 XXX 

78271 .... TC ...... A ........ Vit b–12 absrp exam, int fac .............. 0.00 1.81 1.72 NA NA 0.10 XXX 

78272 .... ............ A ........ Vit B–12 absorp, combined ................ 0.27 2.04 2.21 NA NA 0.14 XXX 

78272 .... 26 ....... A ........ Vit B–12 absorp, combined ................ 0.27 0.07 0.08 0.07 0.08 0.01 XXX 

78272 .... TC ...... A ........ Vit B–12 absorp, combined ................ 0.00 1.96 2.13 NA NA 0.13 XXX 

78278 .... ............ A ........ Acute GI blood loss imaging .............. 0.99 8.52 6.79 NA NA 0.29 XXX 

78278 .... 26 ....... A ........ Acute GI blood loss imaging .............. 0.99 0.35 0.33 0.35 0.33 0.04 XXX 

78278 .... TC ...... A ........ Acute GI blood loss imaging .............. 0.00 8.17 6.46 NA NA 0.25 XXX 

78282 .... ............ C ........ GI protein loss exam .......................... 0.38 0.00 0.08 NA NA 0.02 XXX 

78282 .... 26 ....... A ........ GI protein loss exam .......................... 0.38 0.13 0.12 0.13 0.12 0.02 XXX 

78282 .... TC ...... C ........ GI protein loss exam .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78290 .... ............ A ........ Meckelœs divert exam ........................ 0.68 8.44 5.78 NA NA 0.19 XXX 

78290 .... 26 ....... A ........ Meckelœs divert exam ........................ 0.68 0.24 0.23 0.24 0.23 0.03 XXX 

78290 .... TC ...... A ........ Meckelœs divert exam ........................ 0.00 8.19 5.55 NA NA 0.16 XXX 

78291 .... ............ A ........ Leveen/shunt patency exam .............. 0.88 6.09 4.68 NA NA 0.20 XXX 

78291 .... 26 ....... A ........ Leveen/shunt patency exam .............. 0.88 0.31 0.30 0.31 0.30 0.04 XXX 

78291 .... TC ...... A ........ Leveen/shunt patency exam .............. 0.00 5.78 4.39 NA NA 0.16 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38335 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

78299 .... ............ C ........ GI nuclear procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78299 .... 26 ....... C ........ GI nuclear procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78299 .... TC ...... C ........ GI nuclear procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78300 .... ............ A ........ Bone imaging, limited area ................. 0.62 4.19 3.40 NA NA 0.17 XXX 

78300 .... 26 ....... A ........ Bone imaging, limited area ................. 0.62 0.22 0.21 0.22 0.21 0.03 XXX 

78300 .... TC ...... A ........ Bone imaging, limited area ................. 0.00 3.97 3.19 NA NA 0.14 XXX 

78305 .... ............ A ........ Bone imaging, multiple areas ............. 0.83 5.42 4.63 NA NA 0.23 XXX 

78305 .... 26 ....... A ........ Bone imaging, multiple areas ............. 0.83 0.28 0.27 0.28 0.27 0.04 XXX 

78305 .... TC ...... A ........ Bone imaging, multiple areas ............. 0.00 5.14 4.36 NA NA 0.19 XXX 

78306 .... ............ A ........ Bone imaging, whole body ................. 0.86 6.01 5.23 NA NA 0.26 XXX 

78306 .... 26 ....... A ........ Bone imaging, whole body ................. 0.86 0.30 0.29 0.30 0.29 0.04 XXX 

78306 .... TC ...... A ........ Bone imaging, whole body ................. 0.00 5.71 4.94 NA NA 0.22 XXX 

78315 .... ............ A ........ Bone imaging, 3 phase ...................... 1.02 8.51 6.74 NA NA 0.29 XXX 

78315 .... 26 ....... A ........ Bone imaging, 3 phase ...................... 1.02 0.36 0.34 0.36 0.34 0.04 XXX 

78315 .... TC ...... A ........ Bone imaging, 3 phase ...................... 0.00 8.15 6.40 NA NA 0.25 XXX 

78320 .... ............ A ........ Bone imaging (3D) ............................. 1.04 5.29 5.73 NA NA 0.35 XXX 

78320 .... 26 ....... A ........ Bone imaging (3D) ............................. 1.04 0.36 0.35 0.36 0.35 0.04 XXX 

78320 .... TC ...... A ........ Bone imaging (3D) ............................. 0.00 4.93 5.38 NA NA 0.31 XXX 

78350 .... ............ N ........ Bone mineral, single photon ............... 0.22 0.51 0.72 NA NA 0.06 XXX 

78350 .... 26 ....... N ........ Bone mineral, single photon ............... 0.22 0.05 0.06 0.05 0.06 0.01 XXX 

78350 .... TC ...... N ........ Bone mineral, single photon ............... 0.00 0.46 0.65 NA NA 0.05 XXX 

78351 .... ............ N ........ Bone mineral, dual photon ................. 0.30 0.07 0.96 0.07 0.10 0.01 XXX 

78399 .... ............ C ........ Musculoskeletal nuclear exam ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78399 .... 26 ....... C ........ Musculoskeletal nuclear exam ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78399 .... TC ...... C ........ Musculoskeletal nuclear exam ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78414 .... ............ C ........ Non-imaging heart function ................ 0.45 0.00 0.11 NA NA 0.02 XXX 

78414 .... 26 ....... A ........ Non-imaging heart function ................ 0.45 0.16 0.16 0.16 0.16 0.02 XXX 

78414 .... TC ...... C ........ Non-imaging heart function ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78428 .... ............ A ........ Cardiac shunt imaging ........................ 0.78 5.11 3.85 NA NA 0.16 XXX 

78428 .... 26 ....... A ........ Cardiac shunt imaging ........................ 0.78 0.35 0.32 0.35 0.32 0.03 XXX 

78428 .... TC ...... A ........ Cardiac shunt imaging ........................ 0.00 4.76 3.53 NA NA 0.13 XXX 

78445 .... ............ A ........ Vascular flow imaging ........................ 0.49 4.42 3.21 NA NA 0.13 XXX 

78445 .... 26 ....... A ........ Vascular flow imaging ........................ 0.49 0.17 0.17 0.17 0.17 0.02 XXX 

78445 .... TC ...... A ........ Vascular flow imaging ........................ 0.00 4.25 3.04 NA NA 0.11 XXX 

78456 .... ............ A ........ Acute venous thrombus image ........... 1.00 9.10 6.84 NA NA 0.33 XXX 

78456 .... 26 ....... A ........ Acute venous thrombus image ........... 1.00 0.42 0.39 0.42 0.39 0.04 XXX 

78456 .... TC ...... A ........ Acute venous thrombus image ........... 0.00 8.68 6.45 NA NA 0.29 XXX 

78457 .... ............ A ........ Venous thrombosis imaging ............... 0.77 4.60 3.75 NA NA 0.17 XXX 

78457 .... 26 ....... A ........ Venous thrombosis imaging ............... 0.77 0.25 0.25 0.25 0.25 0.03 XXX 

78457 .... TC ...... A ........ Venous thrombosis imaging ............... 0.00 4.35 3.50 NA NA 0.14 XXX 

78458 .... ............ A ........ Ven thrombosis images, bilat ............. 0.90 4.44 4.37 NA NA 0.25 XXX 

78458 .... 26 ....... A ........ Ven thrombosis images, bilat ............. 0.90 0.29 0.30 0.29 0.30 0.04 XXX 

78458 .... TC ...... A ........ Ven thrombosis images, bilat ............. 0.00 4.15 4.07 NA NA 0.21 XXX 

78459 .... ............ C ........ Heart muscle imaging (PET) .............. 1.50 0.00 0.37 0.00 0.37 0.05 XXX 

78459 .... 26 ....... A ........ Heart muscle imaging (PET) .............. 1.50 0.59 0.57 0.59 0.57 0.05 XXX 

78459 .... TC ...... C ........ Heart muscle imaging (PET) .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78460 .... ............ A ........ Heart muscle blood, single ................. 0.86 4.60 3.60 NA NA 0.17 XXX 

78460 .... 26 ....... A ........ Heart muscle blood, single ................. 0.86 0.32 0.30 0.32 0.30 0.04 XXX 

78460 .... TC ...... A ........ Heart muscle blood, single ................. 0.00 4.29 3.30 NA NA 0.13 XXX 

78461 .... ............ A ........ Heart muscle blood, multiple .............. 1.23 4.02 4.55 NA NA 0.30 XXX 

78461 .... 26 ....... A ........ Heart muscle blood, multiple .............. 1.23 0.46 0.43 0.46 0.43 0.05 XXX 

78461 .... TC ...... A ........ Heart muscle blood, multiple .............. 0.00 3.56 4.11 NA NA 0.25 XXX 

78464 .... ............ A ........ Heart image (3d), single ..................... 1.09 5.71 6.59 NA NA 0.41 XXX 

78464 .... 26 ....... A ........ Heart image (3d), single ..................... 1.09 0.49 0.44 0.49 0.44 0.04 XXX 

78464 .... TC ...... A ........ Heart image (3d), single ..................... 0.00 5.22 6.15 NA NA 0.37 XXX 

78465 .... ............ A ........ Heart image (3d), multiple .................. 1.46 11.11 11.76 NA NA 0.67 XXX 

78465 .... 26 ....... A ........ Heart image (3d), multiple .................. 1.46 0.69 0.61 0.69 0.61 0.05 XXX 

78465 .... TC ...... A ........ Heart image (3d), multiple .................. 0.00 10.42 11.15 NA NA 0.62 XXX 

78466 .... ............ A ........ Heart infarct image ............................. 0.69 4.47 3.64 NA NA 0.17 XXX 

78466 .... 26 ....... A ........ Heart infarct image ............................. 0.69 0.28 0.25 0.28 0.25 0.03 XXX 

78466 .... TC ...... A ........ Heart infarct image ............................. 0.00 4.19 3.39 NA NA 0.14 XXX 

78468 .... ............ A ........ Heart infarct image (ef) ...................... 0.80 5.70 4.87 NA NA 0.22 XXX 

78468 .... 26 ....... A ........ Heart infarct image (ef) ...................... 0.80 0.39 0.34 0.39 0.34 0.03 XXX 

78468 .... TC ...... A ........ Heart infarct image (ef) ...................... 0.00 5.31 4.53 NA NA 0.19 XXX 

78469 .... ............ A ........ Heart infarct image (3D) ..................... 0.92 6.09 5.83 NA NA 0.31 XXX 

78469 .... 26 ....... A ........ Heart infarct image (3D) ..................... 0.92 0.43 0.37 0.43 0.37 0.03 XXX 

78469 .... TC ...... A ........ Heart infarct image (3D) ..................... 0.00 5.66 5.46 NA NA 0.28 XXX 

78472 .... ............ A ........ Gated heart, planar, single ................. 0.98 5.90 5.88 NA NA 0.34 XXX 

78472 .... 26 ....... A ........ Gated heart, planar, single ................. 0.98 0.40 0.37 0.40 0.37 0.04 XXX 

78472 .... TC ...... A ........ Gated heart, planar, single ................. 0.00 5.50 5.51 NA NA 0.30 XXX 

78473 .... ............ A ........ Gated heart, multiple .......................... 1.47 7.56 8.16 NA NA 0.48 XXX 

78473 .... 26 ....... A ........ Gated heart, multiple .......................... 1.47 0.63 0.56 0.63 0.56 0.06 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38336 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

78473 .... TC ...... A ........ Gated heart, multiple .......................... 0.00 6.93 7.60 NA NA 0.42 XXX 

78478 .... ............ A ........ Heart wall motion add-on ................... 0.50 0.78 1.29 NA NA 0.12 XXX 

78478 .... 26 ....... A ........ Heart wall motion add-on ................... 0.50 0.23 0.23 0.23 0.23 0.02 XXX 

78478 .... TC ...... A ........ Heart wall motion add-on ................... 0.00 0.54 1.05 NA NA 0.10 XXX 

78480 .... ............ A ........ Heart function add-on ......................... 0.30 0.68 1.23 NA NA 0.12 XXX 

78480 .... 26 ....... A ........ Heart function add-on ......................... 0.30 0.14 0.18 0.14 0.18 0.02 XXX 

78480 .... TC ...... A ........ Heart function add-on ......................... 0.00 0.54 1.05 NA NA 0.10 XXX 

78481 .... ............ A ........ Heart first pass, single ........................ 0.98 4.90 5.27 NA NA 0.31 XXX 

78481 .... 26 ....... A ........ Heart first pass, single ........................ 0.98 0.47 0.42 0.47 0.42 0.03 XXX 

78481 .... TC ...... A ........ Heart first pass, single ........................ 0.00 4.43 4.85 NA NA 0.28 XXX 

78483 .... ............ A ........ Heart first pass, multiple ..................... 1.47 6.64 7.56 NA NA 0.46 XXX 

78483 .... 26 ....... A ........ Heart first pass, multiple ..................... 1.47 0.75 0.65 0.75 0.65 0.05 XXX 

78483 .... TC ...... A ........ Heart first pass, multiple ..................... 0.00 5.89 6.91 NA NA 0.41 XXX 

78491 .... ............ C ........ Heart image (pet), single .................... 1.50 0.00 0.39 0.00 0.39 0.06 XXX 

78491 .... 26 ....... A ........ Heart image (pet), single .................... 1.50 0.62 0.60 0.62 0.60 0.06 XXX 

78491 .... TC ...... C ........ Heart image (pet), single .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78492 .... ............ C ........ Heart image (pet), multiple ................. 1.87 0.00 0.52 0.00 0.52 0.07 XXX 

78492 .... 26 ....... A ........ Heart image (pet), multiple ................. 1.87 0.88 0.81 0.88 0.81 0.07 XXX 

78492 .... TC ...... C ........ Heart image (pet), multiple ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78494 .... ............ A ........ Heart image, spect ............................. 1.19 6.05 6.80 NA NA 0.35 XXX 

78494 .... 26 ....... A ........ Heart image, spect ............................. 1.19 0.53 0.48 0.53 0.48 0.05 XXX 

78494 .... TC ...... A ........ Heart image, spect ............................. 0.00 5.52 6.32 NA NA 0.30 XXX 

78496 .... ............ A ........ Heart first pass add-on ....................... 0.50 0.86 4.07 0.86 4.07 0.32 ZZZ 

78496 .... 26 ....... A ........ Heart first pass add-on ....................... 0.50 0.22 0.21 0.22 0.21 0.02 ZZZ 

78496 .... TC ...... A ........ Heart first pass add-on ....................... 0.00 0.63 3.86 0.63 3.86 0.30 ZZZ 

78499 .... ............ C ........ Cardiovascular nuclear exam ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78499 .... 26 ....... C ........ Cardiovascular nuclear exam ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78499 .... TC ...... C ........ Cardiovascular nuclear exam ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78580 .... ............ A ........ Lung perfusion imaging ...................... 0.74 5.08 4.34 NA NA 0.21 XXX 

78580 .... 26 ....... A ........ Lung perfusion imaging ...................... 0.74 0.26 0.25 0.26 0.25 0.03 XXX 

78580 .... TC ...... A ........ Lung perfusion imaging ...................... 0.00 4.81 4.09 NA NA 0.18 XXX 

78584 .... ............ A ........ Lung V/Q image single breath ........... 0.99 3.00 3.23 NA NA 0.21 XXX 

78584 .... 26 ....... A ........ Lung V/Q image single breath ........... 0.99 0.35 0.33 0.35 0.33 0.04 XXX 

78584 .... TC ...... A ........ Lung V/Q image single breath ........... 0.00 2.65 2.90 NA NA 0.17 XXX 

78585 .... ............ A ........ Lung V/Q imaging ............................... 1.09 8.55 7.20 NA NA 0.35 XXX 

78585 .... 26 ....... A ........ Lung V/Q imaging ............................... 1.09 0.39 0.36 0.39 0.36 0.05 XXX 

78585 .... TC ...... A ........ Lung V/Q imaging ............................... 0.00 8.16 6.84 NA NA 0.30 XXX 

78586 .... ............ A ........ Aerosol lung image, single ................. 0.40 4.13 3.39 NA NA 0.16 XXX 

78586 .... 26 ....... A ........ Aerosol lung image, single ................. 0.40 0.14 0.13 0.14 0.13 0.02 XXX 

78586 .... TC ...... A ........ Aerosol lung image, single ................. 0.00 3.99 3.26 NA NA 0.14 XXX 

78587 .... ............ A ........ Aerosol lung image, multiple .............. 0.49 5.37 4.13 NA NA 0.16 XXX 

78587 .... 26 ....... A ........ Aerosol lung image, multiple .............. 0.49 0.17 0.16 0.17 0.16 0.02 XXX 

78587 .... TC ...... A ........ Aerosol lung image, multiple .............. 0.00 5.20 3.97 NA NA 0.14 XXX 

78588 .... ............ A ........ Perfusion lung image .......................... 1.09 8.58 5.99 NA NA 0.23 XXX 

78588 .... 26 ....... A ........ Perfusion lung image .......................... 1.09 0.38 0.36 0.38 0.36 0.05 XXX 

78588 .... TC ...... A ........ Perfusion lung image .......................... 0.00 8.19 5.63 NA NA 0.18 XXX 

78591 .... ............ A ........ Vent image, 1 breath, 1 proj .............. 0.40 4.13 3.52 NA NA 0.16 XXX 

78591 .... 26 ....... A ........ Vent image, 1 breath, 1 proj .............. 0.40 0.14 0.13 0.14 0.13 0.02 XXX 

78591 .... TC ...... A ........ Vent image, 1 breath, 1 proj .............. 0.00 3.99 3.38 NA NA 0.14 XXX 

78593 .... ............ A ........ Vent image, 1 proj, gas ...................... 0.49 4.77 4.15 NA NA 0.20 XXX 

78593 .... 26 ....... A ........ Vent image, 1 proj, gas ...................... 0.49 0.17 0.16 0.17 0.16 0.02 XXX 

78593 .... TC ...... A ........ Vent image, 1 proj, gas ...................... 0.00 4.60 3.99 NA NA 0.18 XXX 

78594 .... ............ A ........ Vent image, mult proj, gas ................. 0.53 5.22 5.15 NA NA 0.27 XXX 

78594 .... 26 ....... A ........ Vent image, mult proj, gas ................. 0.53 0.18 0.17 0.18 0.17 0.02 XXX 

78594 .... TC ...... A ........ Vent image, mult proj, gas ................. 0.00 5.05 4.98 NA NA 0.25 XXX 

78596 .... ............ A ........ Lung differential function .................... 1.27 8.59 8.00 NA NA 0.42 XXX 

78596 .... 26 ....... A ........ Lung differential function .................... 1.27 0.39 0.40 0.39 0.40 0.05 XXX 

78596 .... TC ...... A ........ Lung differential function .................... 0.00 8.19 7.60 NA NA 0.37 XXX 

78599 .... ............ C ........ Respiratory nuclear exam .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78599 .... 26 ....... C ........ Respiratory nuclear exam .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78599 .... TC ...... C ........ Respiratory nuclear exam .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78600 .... ............ A ........ Brain imaging, ltd static ...................... 0.44 4.33 4.10 NA NA 0.16 XXX 

78600 .... 26 ....... A ........ Brain imaging, ltd static ...................... 0.44 0.15 0.14 0.15 0.14 0.02 XXX 

78600 .... TC ...... A ........ Brain imaging, ltd static ...................... 0.00 4.18 3.95 NA NA 0.14 XXX 

78601 .... ............ A ........ Brain imaging, ltd w/flow .................... 0.51 5.33 4.40 NA NA 0.20 XXX 

78601 .... 26 ....... A ........ Brain imaging, ltd w/flow .................... 0.51 0.18 0.17 0.18 0.17 0.02 XXX 

78601 .... TC ...... A ........ Brain imaging, ltd w/flow .................... 0.00 5.15 4.23 NA NA 0.18 XXX 

78605 .... ............ A ........ Brain imaging, complete ..................... 0.53 4.79 4.13 NA NA 0.20 XXX 

78605 .... 26 ....... A ........ Brain imaging, complete ..................... 0.53 0.19 0.18 0.19 0.18 0.02 XXX 

78605 .... TC ...... A ........ Brain imaging, complete ..................... 0.00 4.60 3.95 NA NA 0.18 XXX 

78606 .... ............ A ........ Brain imaging, compl w/flow ............... 0.64 8.44 6.20 NA NA 0.24 XXX 

78606 .... 26 ....... A ........ Brain imaging, compl w/flow ............... 0.64 0.22 0.21 0.22 0.21 0.03 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38337 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

78606 .... TC ...... A ........ Brain imaging, compl w/flow ............... 0.00 8.22 5.99 NA NA 0.21 XXX 

78607 .... ............ A ........ Brain imaging (3D) ............................. 1.23 8.53 8.73 NA NA 0.40 XXX 

78607 .... 26 ....... A ........ Brain imaging (3D) ............................. 1.23 0.41 0.41 0.41 0.41 0.05 XXX 

78607 .... TC ...... A ........ Brain imaging (3D) ............................. 0.00 8.12 8.32 NA NA 0.35 XXX 

78608 .... ............ C ........ Brain imaging (PET) ........................... 1.50 0.00 0.33 0.00 0.33 0.06 XXX 

78608 .... 26 ....... A ........ Brain imaging (PET) ........................... 1.50 0.50 0.49 0.50 0.49 0.06 XXX 

78608 .... TC ...... C ........ Brain imaging (PET) ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78609 .... ............ C ........ Brain imaging (PET) ........................... 1.50 0.00 0.33 0.00 0.33 0.06 XXX 

78609 .... 26 ....... A ........ Brain imaging (PET) ........................... 1.50 0.52 0.50 0.52 0.50 0.06 XXX 

78609 .... TC ...... C ........ Brain imaging (PET) ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78610 .... ............ A ........ Brain flow imaging only ...................... 0.30 4.36 3.00 NA NA 0.11 XXX 

78610 .... 26 ....... A ........ Brain flow imaging only ...................... 0.30 0.10 0.11 0.10 0.11 0.01 XXX 

78610 .... TC ...... A ........ Brain flow imaging only ...................... 0.00 4.25 2.89 NA NA 0.10 XXX 

78615 .... ............ A ........ Cerebral vascular flow image ............. 0.42 5.44 4.65 NA NA 0.23 XXX 

78615 .... 26 ....... A ........ Cerebral vascular flow image ............. 0.42 0.15 0.14 0.15 0.14 0.02 XXX 

78615 .... TC ...... A ........ Cerebral vascular flow image ............. 0.00 5.29 4.51 NA NA 0.21 XXX 

78630 .... ............ A ........ Cerebrospinal fluid scan ..................... 0.68 8.57 6.84 NA NA 0.30 XXX 

78630 .... 26 ....... A ........ Cerebrospinal fluid scan ..................... 0.68 0.24 0.23 0.24 0.23 0.03 XXX 

78630 .... TC ...... A ........ Cerebrospinal fluid scan ..................... 0.00 8.33 6.62 NA NA 0.27 XXX 

78635 .... ............ A ........ CSF ventriculography ......................... 0.61 8.70 5.63 NA NA 0.16 XXX 

78635 .... 26 ....... A ........ CSF ventriculography ......................... 0.61 0.21 0.22 0.21 0.22 0.02 XXX 

78635 .... TC ...... A ........ CSF ventriculography ......................... 0.00 8.49 5.42 NA NA 0.14 XXX 

78645 .... ............ A ........ CSF shunt evaluation ......................... 0.57 8.38 5.93 NA NA 0.20 XXX 

78645 .... 26 ....... A ........ CSF shunt evaluation ......................... 0.57 0.20 0.19 0.20 0.19 0.02 XXX 

78645 .... TC ...... A ........ CSF shunt evaluation ......................... 0.00 8.18 5.75 NA NA 0.18 XXX 

78647 .... ............ A ........ Cerebrospinal fluid scan ..................... 0.90 8.41 8.18 NA NA 0.35 XXX 

78647 .... 26 ....... A ........ Cerebrospinal fluid scan ..................... 0.90 0.29 0.29 0.29 0.29 0.04 XXX 

78647 .... TC ...... A ........ Cerebrospinal fluid scan ..................... 0.00 8.12 7.89 NA NA 0.31 XXX 

78650 .... ............ A ........ CSF leakage imaging ......................... 0.61 8.47 6.61 NA NA 0.27 XXX 

78650 .... 26 ....... A ........ CSF leakage imaging ......................... 0.61 0.21 0.20 0.21 0.20 0.03 XXX 

78650 .... TC ...... A ........ CSF leakage imaging ......................... 0.00 8.26 6.41 NA NA 0.24 XXX 

78660 .... ............ A ........ Nuclear exam of tear flow .................. 0.53 4.22 3.23 NA NA 0.14 XXX 

78660 .... 26 ....... A ........ Nuclear exam of tear flow .................. 0.53 0.19 0.18 0.19 0.18 0.02 XXX 

78660 .... TC ...... A ........ Nuclear exam of tear flow .................. 0.00 4.03 3.05 NA NA 0.12 XXX 

78699 .... ............ C ........ Nervous system nuclear exam ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78699 .... 26 ....... C ........ Nervous system nuclear exam ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78699 .... TC ...... 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 4.35 3.76 NA NA 0.18 XXX 

78700 .... 26 ....... A ........ Kidney imaging, morphol .................... 0.45 0.16 0.15 0.16 0.15 0.02 XXX 

78700 .... TC ...... A ........ Kidney imaging, morphol .................... 0.00 4.19 3.61 NA NA 0.16 XXX 

78701 .... ............ A ........ Kidney imaging with flow .................... 0.49 5.33 4.48 NA NA 0.20 XXX 

78701 .... 26 ....... A ........ Kidney imaging with flow .................... 0.49 0.17 0.16 0.17 0.16 0.02 XXX 

78701 .... TC ...... A ........ Kidney imaging with flow .................... 0.00 5.16 4.32 NA NA 0.18 XXX 

78707 .... ............ A ........ K flow/funct image w/o drug ............... 0.96 5.43 5.06 NA NA 0.27 XXX 

78707 .... 26 ....... A ........ K flow/funct image w/o drug ............... 0.96 0.34 0.32 0.34 0.32 0.04 XXX 

78707 .... TC ...... A ........ K flow/funct image w/o drug ............... 0.00 5.09 4.74 NA NA 0.23 XXX 

78708 .... ............ A ........ K flow/funct image w/drug .................. 1.21 3.45 4.12 NA NA 0.28 XXX 

78708 .... 26 ....... A ........ K flow/funct image w/drug .................. 1.21 0.43 0.40 0.43 0.40 0.05 XXX 

78708 .... TC ...... A ........ K flow/funct image w/drug .................. 0.00 3.02 3.71 NA NA 0.23 XXX 

78709 .... ............ A ........ K flow/funct image, multiple ............... 1.41 8.80 6.79 NA NA 0.29 XXX 

78709 .... 26 ....... A ........ K flow/funct image, multiple ............... 1.41 0.50 0.47 0.50 0.47 0.06 XXX 

78709 .... TC ...... A ........ K flow/funct image, multiple ............... 0.00 8.30 6.33 NA NA 0.23 XXX 

78710 .... ............ A ........ Kidney imaging (3D) ........................... 0.66 5.22 5.64 NA NA 0.34 XXX 

78710 .... 26 ....... A ........ Kidney imaging (3D) ........................... 0.66 0.22 0.21 0.22 0.21 0.03 XXX 

78710 .... TC ...... A ........ Kidney imaging (3D) ........................... 0.00 5.00 5.43 NA NA 0.31 XXX 

78725 .... ............ A ........ Kidney function study ......................... 0.38 2.33 2.11 NA NA 0.13 XXX 

78725 .... 26 ....... A ........ Kidney function study ......................... 0.38 0.13 0.13 0.13 0.13 0.02 XXX 

78725 .... TC ...... A ........ Kidney function study ......................... 0.00 2.20 1.98 NA NA 0.11 XXX 

78730 .... ............ A ........ Urinary bladder retention .................... 0.15 1.97 1.78 NA NA 0.10 ZZZ 

78730 .... 26 ....... A ........ Urinary bladder retention .................... 0.15 0.06 0.09 0.06 0.09 0.02 ZZZ 

78730 .... TC ...... A ........ Urinary bladder retention .................... 0.00 1.92 1.69 NA NA 0.08 ZZZ 

78740 .... ............ A ........ Ureteral reflux study ........................... 0.57 5.61 3.88 NA NA 0.15 XXX 

78740 .... 26 ....... A ........ Ureteral reflux study ........................... 0.57 0.20 0.19 0.20 0.19 0.03 XXX 

78740 .... TC ...... A ........ Ureteral reflux study ........................... 0.00 5.42 3.70 NA NA 0.12 XXX 

78761 .... ............ A ........ Testicular imaging w/flow ................... 0.71 5.01 4.16 NA NA 0.20 XXX 

78761 .... 26 ....... A ........ Testicular imaging w/flow ................... 0.71 0.25 0.24 0.25 0.24 0.03 XXX 

78761 .... TC ...... A ........ Testicular imaging w/flow ................... 0.00 4.76 3.92 NA NA 0.17 XXX 

78799 .... ............ C ........ Genitourinary nuclear exam ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78799 .... 26 ....... C ........ Genitourinary nuclear exam ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78799 .... TC ...... 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 4.29 3.92 NA NA 0.22 XXX 

78800 .... 26 ....... A ........ Tumor imaging, limited area ............... 0.66 0.21 0.21 0.21 0.21 0.04 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38338 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

78800 .... TC ...... A ........ Tumor imaging, limited area ............... 0.00 4.08 3.71 NA NA 0.18 XXX 

78801 .... ............ A ........ Tumor imaging, mult areas ................ 0.79 5.99 5.20 NA NA 0.27 XXX 

78801 .... 26 ....... A ........ Tumor imaging, mult areas ................ 0.79 0.27 0.26 0.27 0.26 0.05 XXX 

78801 .... TC ...... A ........ Tumor imaging, mult areas ................ 0.00 5.72 4.94 NA NA 0.22 XXX 

78802 .... ............ A ........ Tumor imaging, whole body ............... 0.86 8.05 6.88 NA NA 0.34 XXX 

78802 .... 26 ....... A ........ Tumor imaging, whole body ............... 0.86 0.30 0.29 0.30 0.29 0.04 XXX 

78802 .... TC ...... A ........ Tumor imaging, whole body ............... 0.00 7.75 6.59 NA NA 0.30 XXX 

78803 .... ............ A ........ Tumor imaging (3D) ........................... 1.09 8.44 8.63 NA NA 0.40 XXX 

78803 .... 26 ....... A ........ Tumor imaging (3D) ........................... 1.09 0.38 0.37 0.38 0.37 0.05 XXX 

78803 .... TC ...... A ........ Tumor imaging (3D) ........................... 0.00 8.06 8.27 NA NA 0.35 XXX 

78804 .... ............ A ........ Tumor imaging, whole body ............... 1.07 14.68 12.95 NA NA 0.34 XXX 

78804 .... 26 ....... A ........ Tumor imaging, whole body ............... 1.07 0.37 0.36 0.37 0.36 0.04 XXX 

78804 .... TC ...... A ........ Tumor imaging, whole body ............... 0.00 14.31 12.59 NA NA 0.30 XXX 

78805 .... ............ A ........ Abscess imaging, ltd area .................. 0.73 4.18 3.88 NA NA 0.21 XXX 

78805 .... 26 ....... A ........ Abscess imaging, ltd area .................. 0.73 0.25 0.24 0.25 0.24 0.03 XXX 

78805 .... TC ...... A ........ Abscess imaging, ltd area .................. 0.00 3.93 3.64 NA NA 0.18 XXX 

78806 .... ............ A ........ Abscess imaging, whole body ............ 0.86 8.27 7.43 NA NA 0.39 XXX 

78806 .... 26 ....... A ........ Abscess imaging, whole body ............ 0.86 0.30 0.29 0.30 0.29 0.04 XXX 

78806 .... TC ...... A ........ Abscess imaging, whole body ............ 0.00 7.97 7.14 NA NA 0.35 XXX 

78807 .... ............ A ........ Nuclear localization/abscess .............. 1.09 8.40 8.51 NA NA 0.39 XXX 

78807 .... 26 ....... A ........ Nuclear localization/abscess .............. 1.09 0.37 0.37 0.37 0.37 0.04 XXX 

78807 .... TC ...... A ........ Nuclear localization/abscess .............. 0.00 8.03 8.14 NA NA 0.35 XXX 

78811 .... ............ C ........ Tumor imaging (pet), limited .............. 1.54 0.00 0.34 NA NA 0.11 XXX 

78811 .... 26 ....... A ........ Tumor imaging (pet), limited .............. 1.54 0.54 0.52 0.54 0.52 0.11 XXX 

78811 .... TC ...... C ........ Tumor imaging (pet), limited .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78812 .... ............ C ........ Tumor image (pet)/skul-thigh ............. 1.93 0.00 0.43 NA NA 0.11 XXX 

78812 .... 26 ....... A ........ Tumor image (pet)/skul-thigh ............. 1.93 0.67 0.65 0.67 0.65 0.11 XXX 

78812 .... TC ...... C ........ Tumor image (pet)/skul-thigh ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78813 .... ............ C ........ Tumor image (pet) full body ............... 2.00 0.00 0.44 NA NA 0.11 XXX 

78813 .... 26 ....... A ........ Tumor image (pet) full body ............... 2.00 0.69 0.67 0.69 0.67 0.11 XXX 

78813 .... TC ...... C ........ Tumor image (pet) full body ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78814 .... ............ C ........ Tumor image pet/ct, limited ................ 2.20 0.00 0.49 NA NA 0.11 XXX 

78814 .... 26 ....... A ........ Tumor image pet/ct, limited ................ 2.20 0.74 0.73 0.74 0.73 0.11 XXX 

78814 .... TC ...... C ........ Tumor image pet/ct, limited ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78815 .... ............ C ........ Tumorimage pet/ct skul-thigh ............. 2.44 0.00 0.54 NA NA 0.11 XXX 

78815 .... 26 ....... A ........ Tumorimage pet/ct skul-thigh ............. 2.44 0.84 0.82 0.84 0.82 0.11 XXX 

78815 .... TC ...... C ........ Tumorimage pet/ct skul-thigh ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78816 .... ............ C ........ Tumor image pet/ct full body .............. 2.50 0.00 0.55 NA NA 0.11 XXX 

78816 .... 26 ....... A ........ Tumor image pet/ct full body .............. 2.50 0.86 0.84 0.86 0.84 0.11 XXX 

78816 .... TC ...... C ........ Tumor image pet/ct full body .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78890 .... ............ B ........ Nuclear medicine data proc ............... 0.05 0.38 0.86 NA NA 0.07 XXX 

78890 .... 26 ....... B ........ Nuclear medicine data proc ............... 0.05 0.01 0.02 0.01 0.02 0.01 XXX 

78890 .... TC ...... B ........ Nuclear medicine data proc ............... 0.00 0.37 0.84 NA NA 0.06 XXX 

78891 .... ............ B ........ Nuclear med data proc ....................... 0.10 0.87 1.77 NA NA 0.14 XXX 

78891 .... 26 ....... B ........ Nuclear med data proc ....................... 0.10 0.02 0.03 0.02 0.03 0.01 XXX 

78891 .... TC ...... B ........ Nuclear med data proc ....................... 0.00 0.85 1.74 NA NA 0.13 XXX 

78999 .... ............ C ........ Nuclear diagnostic exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78999 .... 26 ....... C ........ Nuclear diagnostic exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78999 .... TC ...... 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 1.84 2.51 NA NA 0.22 XXX 

79005 .... 26 ....... A ........ Nuclear rx, oral admin ........................ 1.80 0.59 0.58 0.59 0.58 0.08 XXX 

79005 .... TC ...... A ........ Nuclear rx, oral admin ........................ 0.00 1.25 1.93 NA NA 0.14 XXX 

79101 .... ............ A ........ Nuclear rx, iv admin ........................... 1.96 2.14 2.70 NA NA 0.22 XXX 

79101 .... 26 ....... A ........ Nuclear rx, iv admin ........................... 1.96 0.74 0.69 0.74 0.69 0.08 XXX 

79101 .... TC ...... A ........ Nuclear rx, iv admin ........................... 0.00 1.41 2.01 NA NA 0.14 XXX 

79200 .... ............ A ........ Nuclear rx, intracav admin ................. 1.99 2.21 2.74 NA NA 0.23 XXX 

79200 .... 26 ....... A ........ Nuclear rx, intracav admin ................. 1.99 0.66 0.66 0.66 0.66 0.09 XXX 

79200 .... TC ...... A ........ Nuclear rx, intracav admin ................. 0.00 1.55 2.08 NA NA 0.14 XXX 

79300 .... ............ C ........ Nuclr rx, interstit colloid ...................... 1.60 0.00 0.37 NA NA 0.13 XXX 

79300 .... 26 ....... A ........ Nuclr rx, interstit colloid ...................... 1.60 0.52 0.55 0.52 0.55 0.13 XXX 

79300 .... TC ...... C ........ Nuclr rx, interstit colloid ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79403 .... ............ A ........ Hematopoietic nuclear tx .................... 2.25 2.90 4.01 NA NA 0.24 XXX 

79403 .... 26 ....... A ........ Hematopoietic nuclear tx .................... 2.25 0.76 0.81 0.76 0.81 0.10 XXX 

79403 .... TC ...... A ........ Hematopoietic nuclear tx .................... 0.00 2.14 3.20 NA NA 0.14 XXX 

79440 .... ............ A ........ Nuclear rx, intra-articular .................... 1.99 1.82 2.55 NA NA 0.22 XXX 

79440 .... 26 ....... A ........ Nuclear rx, intra-articular .................... 1.99 0.68 0.68 0.68 0.68 0.08 XXX 

79440 .... TC ...... A ........ Nuclear rx, intra-articular .................... 0.00 1.14 1.87 NA NA 0.14 XXX 

79445 .... ............ C ........ Nuclear rx, intra-arterial ...................... 2.40 0.00 0.53 0.00 0.53 0.12 XXX 

79445 .... 26 ....... A ........ Nuclear rx, intra-arterial ...................... 2.40 0.87 0.82 0.87 0.82 0.12 XXX 

79445 .... TC ...... C ........ Nuclear rx, intra-arterial ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79999 .... ............ C ........ Nuclear medicine therapy ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79999 .... 26 ....... C ........ Nuclear medicine therapy ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38339 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

79999 .... TC ...... 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 0.21 0.12 0.14 0.01 XXX 

80502 .... ............ A ........ Lab pathology consultation ................. 1.33 0.31 0.42 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 1.24 1.59 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 0.12 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 0.39 0.39 0.30 0.35 0.03 XXX 

86078 .... ............ A ........ Physician blood bank service ............. 0.94 0.39 0.42 0.30 0.35 0.03 XXX 

86079 .... ............ A ........ Physician blood bank service ............. 0.94 0.39 0.42 0.31 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 0.13 0.12 0.13 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 0.13 0.16 0.13 0.16 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 

86490 .... ............ A ........ Coccidioidomycosis skin test .............. 0.00 0.13 0.21 NA NA 0.02 XXX 

86510 .... ............ A ........ Histoplasmosis skin test ..................... 0.00 0.12 0.23 NA NA 0.02 XXX 

86580 .... ............ A ........ TB intradermal test ............................. 0.00 0.16 0.21 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 1.18 1.01 NA NA 0.04 XXX 

88104 .... 26 ....... A ........ Cytopath fl nongyn, smears ............... 0.56 0.16 0.20 0.16 0.20 0.02 XXX 

88104 .... TC ...... A ........ Cytopath fl nongyn, smears ............... 0.00 1.02 0.81 NA NA 0.02 XXX 

88106 .... ............ A ........ Cytopath fl nongyn, filter .................... 0.56 1.52 1.43 NA NA 0.04 XXX 

88106 .... 26 ....... A ........ Cytopath fl nongyn, filter .................... 0.56 0.15 0.20 0.15 0.20 0.02 XXX 

88106 .... TC ...... A ........ Cytopath fl nongyn, filter .................... 0.00 1.36 1.23 NA NA 0.02 XXX 

88107 .... ............ A ........ Cytopath fl nongyn, sm/fltr ................. 0.76 1.98 1.77 NA NA 0.05 XXX 

88107 .... 26 ....... A ........ Cytopath fl nongyn, sm/fltr ................. 0.76 0.23 0.28 0.23 0.28 0.03 XXX 

88107 .... TC ...... A ........ Cytopath fl nongyn, sm/fltr ................. 0.00 1.75 1.48 NA NA 0.02 XXX 

88108 .... ............ A ........ Cytopath, concentrate tech ................ 0.56 1.46 1.33 NA NA 0.04 XXX 

88108 .... 26 ....... A ........ Cytopath, concentrate tech ................ 0.56 0.16 0.20 0.16 0.20 0.02 XXX 

88108 .... TC ...... A ........ Cytopath, concentrate tech ................ 0.00 1.31 1.14 NA NA 0.02 XXX 

88112 .... ............ A ........ Cytopath, cell enhance tech ............... 1.18 1.47 1.72 NA NA 0.04 XXX 

88112 .... 26 ....... A ........ Cytopath, cell enhance tech ............... 1.18 0.30 0.41 0.30 0.41 0.02 XXX 

88112 .... TC ...... A ........ Cytopath, cell enhance tech ............... 0.00 1.17 1.32 NA NA 0.02 XXX 

88125 .... ............ A ........ Forensic cytopathology ....................... 0.26 0.29 0.28 NA NA 0.02 XXX 

88125 .... 26 ....... A ........ Forensic cytopathology ....................... 0.26 0.07 0.09 0.07 0.09 0.01 XXX 

88125 .... TC ...... A ........ Forensic cytopathology ....................... 0.00 0.22 0.19 NA NA 0.01 XXX 

88141 .... ............ A ........ Cytopath, c/v, interpret ....................... 0.42 0.37 0.26 0.37 0.26 0.02 XXX 

88160 .... ............ A ........ Cytopath smear, other source ............ 0.50 0.90 0.87 NA NA 0.04 XXX 

88160 .... 26 ....... A ........ Cytopath smear, other source ............ 0.50 0.13 0.17 0.13 0.17 0.02 XXX 

88160 .... TC ...... A ........ Cytopath smear, other source ............ 0.00 0.77 0.70 NA NA 0.02 XXX 

88161 .... ............ A ........ Cytopath smear, other source ............ 0.50 1.07 1.02 NA NA 0.04 XXX 

88161 .... 26 ....... A ........ Cytopath smear, other source ............ 0.50 0.15 0.18 0.15 0.18 0.02 XXX 

88161 .... TC ...... A ........ Cytopath smear, other source ............ 0.00 0.92 0.83 NA NA 0.02 XXX 

88162 .... ............ A ........ Cytopath smear, other source ............ 0.76 1.58 1.23 NA NA 0.05 XXX 

88162 .... 26 ....... A ........ Cytopath smear, other source ............ 0.76 0.24 0.27 0.24 0.27 0.03 XXX 

88162 .... TC ...... A ........ Cytopath smear, other source ............ 0.00 1.34 0.95 NA NA 0.02 XXX 

88172 .... ............ A ........ Cytopathology eval of fna ................... 0.60 0.81 0.78 NA NA 0.04 XXX 

88172 .... 26 ....... A ........ Cytopathology eval of fna ................... 0.60 0.17 0.22 0.17 0.22 0.02 XXX 

88172 .... TC ...... A ........ Cytopathology eval of fna ................... 0.00 0.63 0.56 NA NA 0.02 XXX 

88173 .... ............ A ........ Cytopath eval, fna, report ................... 1.39 2.19 2.18 NA NA 0.07 XXX 

88173 .... 26 ....... A ........ Cytopath eval, fna, report ................... 1.39 0.39 0.49 0.39 0.49 0.05 XXX 

88173 .... TC ...... A ........ Cytopath eval, fna, report ................... 0.00 1.80 1.69 NA NA 0.02 XXX 

88182 .... ............ A ........ Cell marker study ............................... 0.77 1.99 1.98 NA NA 0.07 XXX 

88182 .... 26 ....... A ........ Cell marker study ............................... 0.77 0.14 0.23 0.14 0.23 0.03 XXX 

88182 .... TC ...... A ........ Cell marker study ............................... 0.00 1.85 1.74 NA NA 0.04 XXX 

88184 .... ............ A ........ Flowcytometry/ tc, 1 marker ............... 0.00 2.44 1.88 NA NA 0.02 XXX 

88185 .... ............ A ........ Flowcytometry/tc, add-on ................... 0.00 1.48 1.06 NA NA 0.02 ZZZ 

88187 .... ............ A ........ Flowcytometry/read, 2–8 .................... 1.36 0.40 0.43 0.40 0.43 0.01 XXX 

88188 .... ............ A ........ Flowcytometry/read, 9–15 .................. 1.69 0.45 0.51 0.45 0.51 0.01 XXX 

88189 .... ............ A ........ Flowcytometry/read, 16 & > ............... 2.23 0.48 0.61 0.48 0.61 0.01 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38340 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

88199 .... ............ C ........ Cytopathology procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88199 .... 26 ....... C ........ Cytopathology procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88199 .... TC ...... 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 .... 26 ....... A ........ Surgical path, gross ............................ 0.08 0.02 0.03 0.02 0.03 0.01 XXX 

88300 .... TC ...... A ........ Surgical path, gross ............................ 0.00 0.53 0.48 NA NA 0.01 XXX 

88302 .... ............ A ........ Tissue exam by pathologist ................ 0.13 1.28 1.16 NA NA 0.03 XXX 

88302 .... 26 ....... A ........ Tissue exam by pathologist ................ 0.13 0.04 0.05 0.04 0.05 0.01 XXX 

88302 .... TC ...... A ........ Tissue exam by pathologist ................ 0.00 1.24 1.11 NA NA 0.02 XXX 

88304 .... ............ A ........ Tissue exam by pathologist ................ 0.22 1.45 1.40 NA NA 0.03 XXX 

88304 .... 26 ....... A ........ Tissue exam by pathologist ................ 0.22 0.06 0.07 0.06 0.07 0.01 XXX 

88304 .... TC ...... A ........ Tissue exam by pathologist ................ 0.00 1.39 1.32 NA NA 0.02 XXX 

88305 .... ............ A ........ Tissue exam by pathologist ................ 0.75 2.03 1.99 NA NA 0.07 XXX 

88305 .... 26 ....... A ........ Tissue exam by pathologist ................ 0.75 0.20 0.27 0.20 0.27 0.03 XXX 

88305 .... TC ...... A ........ Tissue exam by pathologist ................ 0.00 1.83 1.72 NA NA 0.04 XXX 

88307 .... ............ A ........ Tissue exam by pathologist ................ 1.59 4.38 3.78 NA NA 0.12 XXX 

88307 .... 26 ....... A ........ Tissue exam by pathologist ................ 1.59 0.48 0.58 0.48 0.58 0.06 XXX 

88307 .... TC ...... A ........ Tissue exam by pathologist ................ 0.00 3.90 3.20 NA NA 0.06 XXX 

88309 .... ............ A ........ Tissue exam by pathologist ................ 2.80 6.13 5.28 NA NA 0.14 XXX 

88309 .... 26 ....... A ........ Tissue exam by pathologist ................ 2.80 0.83 0.90 0.83 0.90 0.08 XXX 

88309 .... TC ...... A ........ Tissue exam by pathologist ................ 0.00 5.29 4.38 NA NA 0.06 XXX 

88311 .... ............ A ........ Decalcify tissue ................................... 0.24 0.24 0.23 NA NA 0.02 XXX 

88311 .... 26 ....... A ........ Decalcify tissue ................................... 0.24 0.07 0.08 0.07 0.08 0.01 XXX 

88311 .... TC ...... A ........ Decalcify tissue ................................... 0.00 0.17 0.15 NA NA 0.01 XXX 

88312 .... ............ A ........ Special stains ..................................... 0.54 2.27 1.93 NA NA 0.03 XXX 

88312 .... 26 ....... A ........ Special stains ..................................... 0.54 0.14 0.19 0.14 0.19 0.02 XXX 

88312 .... TC ...... A ........ Special stains ..................................... 0.00 2.13 1.74 NA NA 0.01 XXX 

88313 .... ............ A ........ Special stains ..................................... 0.24 1.93 1.59 NA NA 0.02 XXX 

88313 .... 26 ....... A ........ Special stains ..................................... 0.24 0.06 0.08 0.06 0.08 0.01 XXX 

88313 .... TC ...... A ........ Special stains ..................................... 0.00 1.87 1.51 NA NA 0.01 XXX 

88314 .... ............ A ........ Histochemical stain ............................. 0.45 1.94 2.01 NA NA 0.04 XXX 

88314 .... 26 ....... A ........ Histochemical stain ............................. 0.45 0.14 0.17 0.14 0.17 0.02 XXX 

88314 .... TC ...... A ........ Histochemical stain ............................. 0.00 1.80 1.84 NA NA 0.02 XXX 

88318 .... ............ A ........ Chemical histochemistry ..................... 0.42 2.93 2.30 NA NA 0.03 XXX 

88318 .... 26 ....... A ........ Chemical histochemistry ..................... 0.42 0.12 0.15 0.12 0.15 0.02 XXX 

88318 .... TC ...... A ........ Chemical histochemistry ..................... 0.00 2.80 2.14 NA NA 0.01 XXX 

88319 .... ............ A ........ Enzyme histochemistry ....................... 0.53 3.20 3.31 NA NA 0.04 XXX 

88319 .... 26 ....... A ........ Enzyme histochemistry ....................... 0.53 0.15 0.18 0.15 0.18 0.02 XXX 

88319 .... TC ...... A ........ Enzyme histochemistry ....................... 0.00 3.04 3.12 NA NA 0.02 XXX 

88321 .... ............ A ........ Microslide consultation ....................... 1.63 0.72 0.76 0.47 0.52 0.05 XXX 

88323 .... ............ A ........ Microslide consultation ....................... 1.83 2.20 1.99 NA NA 0.07 XXX 

88323 .... 26 ....... A ........ Microslide consultation ....................... 1.83 0.47 0.52 0.47 0.52 0.05 XXX 

88323 .... TC ...... A ........ Microslide consultation ....................... 0.00 1.73 1.47 NA NA 0.02 XXX 

88325 .... ............ A ........ Comprehensive review of data ........... 2.50 2.39 2.64 0.70 0.81 0.07 XXX 

88329 .... ............ A ........ Path consult introp .............................. 0.67 0.66 0.66 0.20 0.25 0.02 XXX 

88331 .... ............ A ........ Path consult intraop, 1 bloc ................ 1.19 1.20 1.16 NA NA 0.08 XXX 

88331 .... 26 ....... A ........ Path consult intraop, 1 bloc ................ 1.19 0.37 0.44 0.37 0.44 0.04 XXX 

88331 .... TC ...... A ........ Path consult intraop, 1 bloc ................ 0.00 0.83 0.72 NA NA 0.04 XXX 

88332 .... ............ A ........ Path consult intraop, addœl ................ 0.59 0.48 0.47 NA NA 0.04 XXX 

88332 .... 26 ....... A ........ Path consult intraop, addœl ................ 0.59 0.18 0.21 0.18 0.21 0.02 XXX 

88332 .... TC ...... A ........ Path consult intraop, addœl ................ 0.00 0.29 0.25 NA NA 0.02 XXX 

88333 .... ............ A ........ Intraop cyto path consult, 1 ................ 1.20 1.31 1.20 NA NA 0.08 XXX 

88333 .... 26 ....... A ........ Intraop cyto path consult, 1 ................ 1.20 0.37 0.45 0.37 0.45 0.04 XXX 

88333 .... TC ...... A ........ Intraop cyto path consult, 1 ................ 0.00 0.94 0.75 NA NA 0.04 XXX 

88334 .... ............ A ........ Intraop cyto path consult, 2 ................ 0.73 0.78 0.69 NA NA 0.04 XXX 

88334 .... 26 ....... A ........ Intraop cyto path consult, 2 ................ 0.73 0.22 0.24 0.22 0.24 0.02 XXX 

88334 .... TC ...... A ........ Intraop cyto path consult, 2 ................ 0.00 0.56 0.45 NA NA 0.02 XXX 

88342 .... ............ A ........ Immunohistochemistry ........................ 0.85 1.98 1.73 NA NA 0.05 XXX 

88342 .... 26 ....... A ........ Immunohistochemistry ........................ 0.85 0.23 0.30 0.23 0.30 0.03 XXX 

88342 .... TC ...... A ........ Immunohistochemistry ........................ 0.00 1.75 1.43 NA NA 0.02 XXX 

88346 .... ............ A ........ Immunofluorescent study ................... 0.86 1.89 1.74 NA NA 0.05 XXX 

88346 .... 26 ....... A ........ Immunofluorescent study ................... 0.86 0.23 0.30 0.23 0.30 0.03 XXX 

88346 .... TC ...... A ........ Immunofluorescent study ................... 0.00 1.66 1.45 NA NA 0.02 XXX 

88347 .... ............ A ........ Immunofluorescent study ................... 0.86 1.31 1.29 NA NA 0.05 XXX 

88347 .... 26 ....... A ........ Immunofluorescent study ................... 0.86 0.19 0.27 0.19 0.27 0.03 XXX 

88347 .... TC ...... A ........ Immunofluorescent study ................... 0.00 1.12 1.02 NA NA 0.02 XXX 

88348 .... ............ A ........ Electron microscopy ........................... 1.51 18.10 13.69 NA NA 0.13 XXX 

88348 .... 26 ....... A ........ Electron microscopy ........................... 1.51 0.42 0.53 0.42 0.53 0.06 XXX 

88348 .... TC ...... A ........ Electron microscopy ........................... 0.00 17.68 13.16 NA NA 0.07 XXX 

88349 .... ............ A ........ Scanning electron microscopy ........... 0.76 9.38 6.38 NA NA 0.09 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38341 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

88349 .... 26 ....... A ........ Scanning electron microscopy ........... 0.76 0.23 0.28 0.23 0.28 0.03 XXX 

88349 .... TC ...... A ........ Scanning electron microscopy ........... 0.00 9.15 6.10 NA NA 0.06 XXX 

88355 .... ............ A ........ Analysis, skeletal muscle ................... 1.85 3.19 6.00 NA NA 0.13 XXX 

88355 .... 26 ....... A ........ Analysis, skeletal muscle ................... 1.85 0.37 0.58 0.37 0.58 0.07 XXX 

88355 .... TC ...... A ........ Analysis, skeletal muscle ................... 0.00 2.82 5.42 NA NA 0.06 XXX 

88356 .... ............ A ........ Analysis, nerve ................................... 3.02 5.33 4.97 NA NA 0.19 XXX 

88356 .... 26 ....... A ........ Analysis, nerve ................................... 3.02 0.59 0.96 0.59 0.96 0.12 XXX 

88356 .... TC ...... A ........ Analysis, nerve ................................... 0.00 4.74 4.01 NA NA 0.07 XXX 

88358 .... ............ A ........ Analysis, tumor ................................... 0.95 1.09 0.97 NA NA 0.17 XXX 

88358 .... 26 ....... A ........ Analysis, tumor ................................... 0.95 0.16 0.28 0.16 0.28 0.10 XXX 

88358 .... TC ...... A ........ Analysis, tumor ................................... 0.00 0.93 0.69 NA NA 0.07 XXX 

88360 .... ............ A ........ Tumor immunohistochem/manual ...... 1.10 2.21 1.98 NA NA 0.08 XXX 

88360 .... 26 ....... A ........ Tumor immunohistochem/manual ...... 1.10 0.27 0.37 0.27 0.37 0.06 XXX 

88360 .... TC ...... A ........ Tumor immunohistochem/manual ...... 0.00 1.93 1.61 NA NA 0.02 XXX 

88361 .... ............ A ........ Tumor immunohistochem/comput ...... 1.18 2.77 2.88 NA NA 0.17 XXX 

88361 .... 26 ....... A ........ Tumor immunohistochem/comput ...... 1.18 0.27 0.38 0.27 0.38 0.10 XXX 

88361 .... TC ...... A ........ Tumor immunohistochem/comput ...... 0.00 2.50 2.51 NA NA 0.07 XXX 

88362 .... ............ A ........ Nerve teasing preparations ................ 2.17 4.95 4.87 NA NA 0.15 XXX 

88362 .... 26 ....... A ........ Nerve teasing preparations ................ 2.17 0.58 0.75 0.58 0.75 0.09 XXX 

88362 .... TC ...... A ........ Nerve teasing preparations ................ 0.00 4.37 4.12 NA NA 0.06 XXX 

88365 .... ............ A ........ Insitu hybridization (fish) ..................... 1.20 3.30 2.65 NA NA 0.05 XXX 

88365 .... 26 ....... A ........ Insitu hybridization (fish) ..................... 1.20 0.30 0.39 0.30 0.39 0.03 XXX 

88365 .... TC ...... A ........ Insitu hybridization (fish) ..................... 0.00 3.00 2.25 NA NA 0.02 XXX 

88367 .... ............ A ........ Insitu hybridization, auto ..................... 1.30 5.11 4.58 NA NA 0.12 XXX 

88367 .... 26 ....... A ........ Insitu hybridization, auto ..................... 1.30 0.23 0.38 0.23 0.38 0.06 XXX 

88367 .... TC ...... A ........ Insitu hybridization, auto ..................... 0.00 4.88 4.19 NA NA 0.06 XXX 

88368 .... ............ A ........ Insitu hybridization, manual ................ 1.40 4.93 3.62 NA NA 0.12 XXX 

88368 .... 26 ....... A ........ Insitu hybridization, manual ................ 1.40 0.26 0.42 0.26 0.42 0.06 XXX 

88368 .... TC ...... A ........ Insitu hybridization, manual ................ 0.00 4.67 3.20 NA NA 0.06 XXX 

88371 .... 26 ....... A ........ Protein, western blot tissue ................ 0.37 0.10 0.11 0.10 0.11 0.01 XXX 

88372 .... 26 ....... A ........ Protein analysis w/probe .................... 0.37 0.12 0.14 0.12 0.14 0.01 XXX 

88380 .... ............ C ........ Microdissection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88380 .... 26 ....... C ........ Microdissection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88380 .... TC ...... C ........ Microdissection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88384 .... ............ C ........ Eval molecular probes, 11–50 ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88384 .... 26 ....... C ........ Eval molecular probes, 11–50 ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88384 .... TC ...... 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 15.07 10.96 NA NA 0.12 XXX 

88385 .... 26 ....... A ........ Eval molecul probes, 51–250 ............. 1.50 0.27 0.45 0.27 0.45 0.06 XXX 

88385 .... TC ...... A ........ Eval molecul probes, 51–250 ............. 0.00 14.79 10.50 NA NA 0.06 XXX 

88386 .... ............ A ........ Eval molecul probes, 251–500 ........... 1.88 14.98 10.89 NA NA 0.16 XXX 

88386 .... 26 ....... A ........ Eval molecul probes, 251–500 ........... 1.88 0.35 0.58 0.35 0.58 0.08 XXX 

88386 .... TC ...... A ........ Eval molecul probes, 251–500 ........... 0.00 14.63 10.31 NA NA 0.08 XXX 

88399 .... ............ C ........ Surgical pathology procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88399 .... 26 ....... C ........ Surgical pathology procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88399 .... TC ...... 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 3.53 3.57 0.20 0.24 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 7.87 5.01 0.54 0.39 0.03 XXX 

89105 .... ............ A ........ Sample intestinal contents ................. 0.50 7.78 4.97 0.46 0.31 0.02 XXX 

89130 .... ............ A ........ Sample stomach contents .................. 0.45 6.47 4.17 0.37 0.26 0.02 XXX 

89132 .... ............ A ........ Sample stomach contents .................. 0.19 8.30 4.62 0.38 0.21 0.01 XXX 

89135 .... ............ A ........ Sample stomach contents .................. 0.79 8.74 5.33 0.67 0.46 0.04 XXX 

89136 .... ............ A ........ Sample stomach contents .................. 0.21 5.87 3.99 0.26 0.19 0.01 XXX 

89140 .... ............ A ........ Sample stomach contents .................. 0.94 6.14 4.21 0.43 0.36 0.04 XXX 

89141 .... ............ A ........ Sample stomach contents .................. 0.85 6.30 4.39 0.49 0.39 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 

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 0.11 0.12 0.04 0.09 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 0.09 0.01 ZZZ 

90473 .... ............ R ........ Immune admin oral/nasal ................... 0.17 0.17 0.18 0.04 0.05 0.01 XXX 

90474 .... ............ R ........ Immune admin oral/nasal addl ........... 0.15 0.08 0.09 0.04 0.05 0.01 ZZZ 

90760 .... ............ A ........ Hydration iv infusion, init .................... 0.17 1.31 1.37 NA NA 0.07 XXX 

90761 .... ............ A ........ Hydrate iv infusion, add-on ................ 0.09 0.31 0.36 NA NA 0.04 ZZZ 

90765 .... ............ A ........ Ther/proph/diag iv inf, init ................... 0.21 1.60 1.68 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 0.68 0.79 NA NA 0.04 ZZZ 

mstockstill on PROD1PC66 with PROPOSALS2

38342 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

90768 .... ............ A ........ Ther/diag concurrent inf ..................... 0.17 0.33 0.38 NA NA 0.04 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 1.32 1.31 NA NA 0.04 XXX 

90775 .... ............ A ........ Ther/proph/diag inj add-on ................. 0.10 0.51 0.54 NA NA 0.04 ZZZ 

90779 .... ............ C ........ Ther/prop/diag inj/inf proc ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90801 .... ............ A ........ Psy dx interview ................................. 2.80 1.49 1.33 0.60 0.77 0.06 XXX 

90802 .... ............ A ........ Intac psy dx interview ......................... 3.01 1.53 1.36 0.68 0.83 0.07 XXX 

90804 .... ............ A ........ Psytx, office, 20–30 min ..................... 1.21 0.56 0.53 0.22 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 0.62 0.33 0.46 0.04 XXX 

90807 .... ............ A ........ Psytx, off, 45–50 min w/e&m ............. 2.02 0.70 0.70 0.36 0.49 0.05 XXX 

90808 .... ............ A ........ Psytx, office, 75–80 min ..................... 2.79 0.69 0.86 0.50 0.70 0.06 XXX 

90809 .... ............ A ........ Psytx, off, 75–80, w/e&m ................... 2.95 0.86 0.93 0.53 0.72 0.07 XXX 

90810 .... ............ A ........ Intac psytx, off, 20–30 min ................. 1.32 0.53 0.52 0.23 0.33 0.04 XXX 

90811 .... ............ A ........ Intac psytx, 20–30, w/e&m ................. 1.48 0.72 0.65 0.26 0.36 0.04 XXX 

90812 .... ............ A ........ Intac psytx, off, 45–50 min ................. 1.97 0.65 0.72 0.35 0.50 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 0.82 0.95 0.54 0.76 0.06 XXX 

90815 .... ............ A ........ Intac psytx, 75–80 w/e&m .................. 3.06 1.00 1.03 0.54 0.75 0.07 XXX 

90816 .... ............ A ........ Psytx, hosp, 20–30 min ...................... 1.25 NA NA 0.33 0.40 0.03 XXX 

90817 .... ............ A ........ Psytx, hosp, 20–30 min w/e&m .......... 1.41 NA NA 0.35 0.41 0.03 XXX 

90818 .... ............ A ........ Psytx, hosp, 45–50 min ...................... 1.89 NA NA 0.44 0.57 0.04 XXX 

90819 .... ............ A ........ Psytx, hosp, 45–50 min w/e&m .......... 2.05 NA NA 0.46 0.56 0.05 XXX 

90821 .... ............ A ........ Psytx, hosp, 75–80 min ...................... 2.83 NA NA 0.60 0.81 0.06 XXX 

90822 .... ............ A ........ Psytx, hosp, 75–80 min w/e&m .......... 2.99 NA NA 0.63 0.79 0.08 XXX 

90823 .... ............ A ........ Intac psytx, hosp, 20–30 min ............. 1.36 NA NA 0.35 0.42 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 0.63 0.84 0.06 XXX 

90829 .... ............ A ........ Intac psytx, hsp 75–80 w/e&m ........... 3.10 NA NA 0.65 0.82 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 0.43 0.54 0.04 XXX 

90847 .... ............ R ........ Family psytx w/patient ........................ 2.21 0.74 0.78 0.50 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 0.30 0.02 XXX 

90865 .... ............ A ........ Narcosynthesis ................................... 2.84 1.17 1.27 0.63 0.78 0.12 XXX 

90870 .... ............ A ........ Electroconvulsive therapy ................... 1.88 1.91 1.92 0.38 0.49 0.04 000 

90875 .... ............ N ........ Psychophysiological therapy .............. 1.20 0.52 0.71 0.28 0.37 0.04 XXX 

90876 .... ............ N ........ Psychophysiological therapy .............. 1.90 0.67 0.92 0.44 0.59 0.05 XXX 

90880 .... ............ A ........ Hypnotherapy ..................................... 2.19 0.58 0.81 0.39 0.54 0.05 XXX 

90885 .... ............ B ........ Psy evaluation of records ................... 0.97 0.22 0.29 0.22 0.29 0.02 XXX 

90887 .... ............ B ........ Consultation with family ...................... 1.48 0.61 0.72 0.34 0.45 0.04 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 0.31 0.06 000 

90918 .... ............ I .......... ESRD related services, month ........... 11.16 4.68 5.39 3.73 4.92 0.36 XXX 

90919 .... ............ I .......... ESRD related services, month ........... 8.53 3.02 3.51 2.55 3.28 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 1.70 2.07 1.61 2.02 0.14 XXX 

90922 .... ............ I .......... ESRD related services, day ............... 0.37 0.16 0.19 0.12 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 0.06 0.05 0.06 0.01 XXX 

90935 .... ............ A ........ Hemodialysis, one evaluation ............. 1.22 NA NA 0.54 0.61 0.04 000 

90937 .... ............ A ........ Hemodialysis, repeated eval .............. 2.11 NA NA 0.77 0.88 0.07 000 

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 

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 2.11 1.24 2.11 1.24 0.04 000 

91000 .... 26 ....... A ........ Esophageal intubation ........................ 0.73 0.22 0.24 0.22 0.24 0.03 000 

91000 .... TC ...... A ........ Esophageal intubation ........................ 0.00 1.88 0.99 1.88 0.99 0.01 000 

91010 .... ............ A ........ Esophagus motility study .................... 1.25 3.64 4.03 3.64 4.03 0.12 000 

91010 .... 26 ....... A ........ Esophagus motility study .................... 1.25 0.55 0.50 0.55 0.50 0.06 000 

91010 .... TC ...... A ........ Esophagus motility study .................... 0.00 3.09 3.53 3.09 3.53 0.06 000 

91011 .... ............ A ........ Esophagus motility study .................... 1.50 5.33 5.28 5.33 5.28 0.13 000 

91011 .... 26 ....... A ........ Esophagus motility study .................... 1.50 0.72 0.63 0.72 0.63 0.07 000 

91011 .... TC ...... A ........ Esophagus motility study .................... 0.00 4.60 4.65 4.60 4.65 0.06 000 

mstockstill on PROD1PC66 with PROPOSALS2

38343 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

91012 .... ............ A ........ Esophagus motility study .................... 1.46 5.41 5.60 5.41 5.60 0.13 000 

91012 .... 26 ....... A ........ Esophagus motility study .................... 1.46 0.69 0.60 0.69 0.60 0.06 000 

91012 .... TC ...... A ........ Esophagus motility study .................... 0.00 4.72 4.99 4.72 4.99 0.07 000 

91020 .... ............ A ........ Gastric motility studies ....................... 1.44 4.77 4.64 4.77 4.64 0.13 000 

91020 .... 26 ....... A ........ Gastric motility studies ....................... 1.44 0.61 0.55 0.61 0.55 0.07 000 

91020 .... TC ...... A ........ Gastric motility studies ....................... 0.00 4.16 4.09 4.16 4.09 0.06 000 

91022 .... ............ A ........ Duodenal motility study ...................... 1.44 3.11 3.76 3.11 3.76 0.13 000 

91022 .... 26 ....... A ........ Duodenal motility study ...................... 1.44 0.62 0.57 0.62 0.57 0.07 000 

91022 .... TC ...... A ........ Duodenal motility study ...................... 0.00 2.49 3.19 2.49 3.19 0.06 000 

91030 .... ............ A ........ Acid perfusion of esophagus .............. 0.91 2.87 2.66 2.87 2.66 0.06 000 

91030 .... 26 ....... A ........ Acid perfusion of esophagus .............. 0.91 0.42 0.37 0.42 0.37 0.04 000 

91030 .... TC ...... A ........ Acid perfusion of esophagus .............. 0.00 2.45 2.28 2.45 2.28 0.02 000 

91034 .... ............ A ........ Gastroesophageal reflux test ............. 0.97 4.12 4.68 4.12 4.68 0.12 000 

91034 .... 26 ....... A ........ Gastroesophageal reflux test ............. 0.97 0.43 0.38 0.43 0.38 0.06 000 

91034 .... TC ...... A ........ Gastroesophageal reflux test ............. 0.00 3.69 4.30 3.69 4.30 0.06 000 

91035 .... ............ A ........ G-esoph reflx tst w/electrod ............... 1.59 11.28 11.04 11.28 11.04 0.12 000 

91035 .... 26 ....... A ........ G-esoph reflx tst w/electrod ............... 1.59 0.71 0.64 0.71 0.64 0.06 000 

91035 .... TC ...... A ........ G-esoph reflx tst w/electrod ............... 0.00 10.57 10.40 10.57 10.40 0.06 000 

91037 .... ............ A ........ Esoph imped function test .................. 0.97 3.45 3.18 3.45 3.18 0.12 000 

91037 .... 26 ....... A ........ Esoph imped function test .................. 0.97 0.45 0.39 0.45 0.39 0.06 000 

91037 .... TC ...... A ........ Esoph imped function test .................. 0.00 3.00 2.79 3.00 2.79 0.06 000 

91038 .... ............ A ........ Esoph imped funct test > 1h .............. 1.10 2.79 2.50 2.79 2.50 0.12 000 

91038 .... 26 ....... A ........ Esoph imped funct test > 1h .............. 1.10 0.51 0.45 0.51 0.45 0.06 000 

91038 .... TC ...... A ........ Esoph imped funct test > 1h .............. 0.00 2.28 2.05 2.28 2.05 0.06 000 

91040 .... ............ A ........ Esoph balloon distension tst .............. 0.97 7.63 9.66 7.63 9.66 0.12 000 

91040 .... 26 ....... A ........ Esoph balloon distension tst .............. 0.97 0.28 0.33 0.28 0.33 0.06 000 

91040 .... TC ...... A ........ Esoph balloon distension tst .............. 0.00 7.35 9.33 7.35 9.33 0.06 000 

91052 .... ............ A ........ Gastric analysis test ........................... 0.79 2.93 2.70 2.93 2.70 0.05 000 

91052 .... 26 ....... A ........ Gastric analysis test ........................... 0.79 0.37 0.33 0.37 0.33 0.03 000 

91052 .... TC ...... A ........ Gastric analysis test ........................... 0.00 2.56 2.37 2.56 2.37 0.02 000 

91055 .... ............ A ........ Gastric intubation for smear ............... 0.94 2.56 2.73 2.56 2.73 0.07 000 

91055 .... 26 ....... A ........ Gastric intubation for smear ............... 0.94 0.29 0.28 0.29 0.28 0.05 000 

91055 .... TC ...... A ........ Gastric intubation for smear ............... 0.00 2.27 2.45 2.27 2.45 0.02 000 

91065 .... ............ A ........ Breath hydrogen test .......................... 0.20 1.33 1.39 1.33 1.39 0.03 000 

91065 .... 26 ....... A ........ Breath hydrogen test .......................... 0.20 0.06 0.07 0.06 0.07 0.01 000 

91065 .... TC ...... A ........ Breath hydrogen test .......................... 0.00 1.26 1.32 1.26 1.32 0.02 000 

91100 .... ............ A ........ Pass intestine bleeding tube .............. 1.08 2.12 2.46 0.32 0.31 0.07 000 

91105 .... ............ A ........ Gastric intubation treatment ............... 0.37 1.65 1.89 0.07 0.08 0.03 000 

91110 .... ............ A ........ Gi tract capsule endoscopy ................ 3.64 20.46 21.33 NA NA 0.16 XXX 

91110 .... 26 ....... A ........ Gi tract capsule endoscopy ................ 3.64 1.68 1.49 1.68 1.49 0.09 XXX 

91110 .... TC ...... A ........ Gi tract capsule endoscopy ................ 0.00 18.78 19.85 NA NA 0.07 XXX 

91111 .... ............ A ........ Esophageal capsule endoscopy ......... 1.00 18.64 18.65 NA NA 0.05 XXX 

91111 .... 26 ....... A ........ Esophageal capsule endoscopy ......... 1.00 0.45 0.46 0.45 0.46 0.03 XXX 

91111 .... TC ...... A ........ Esophageal capsule endoscopy ......... 0.00 18.19 18.19 NA NA 0.02 XXX 

91120 .... ............ A ........ Rectal sensation test .......................... 0.97 8.81 9.93 8.81 9.93 0.11 XXX 

91120 .... 26 ....... A ........ Rectal sensation test .......................... 0.97 0.28 0.31 0.28 0.31 0.07 XXX 

91120 .... TC ...... A ........ Rectal sensation test .......................... 0.00 8.53 9.62 8.53 9.62 0.04 XXX 

91122 .... ............ A ........ Anal pressure record .......................... 1.77 4.29 4.60 4.29 4.60 0.21 000 

91122 .... 26 ....... A ........ Anal pressure record .......................... 1.77 0.63 0.60 0.63 0.60 0.13 000 

91122 .... TC ...... A ........ Anal pressure record .......................... 0.00 3.66 4.01 3.66 4.01 0.08 000 

91132 .... ............ C ........ Electrogastrography ............................ 0.52 0.00 0.13 NA NA 0.02 XXX 

91132 .... 26 ....... A ........ Electrogastrography ............................ 0.52 0.26 0.22 0.26 0.22 0.02 XXX 

91132 .... TC ...... C ........ Electrogastrography ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91133 .... ............ C ........ Electrogastrography w/test ................. 0.66 0.00 0.17 NA NA 0.03 XXX 

91133 .... 26 ....... A ........ Electrogastrography w/test ................. 0.66 0.32 0.27 0.32 0.27 0.03 XXX 

91133 .... TC ...... C ........ Electrogastrography w/test ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91299 .... ............ C ........ Gastroenterology procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91299 .... 26 ....... C ........ Gastroenterology procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91299 .... TC ...... C ........ Gastroenterology procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92002 .... ............ A ........ Eye exam, new patient ....................... 0.88 0.94 0.96 0.26 0.31 0.02 XXX 

92004 .... ............ A ........ Eye exam, new patient ....................... 1.82 1.58 1.64 0.56 0.62 0.04 XXX 

92012 .... ............ A ........ Eye exam established pat .................. 0.92 0.99 1.00 0.32 0.29 0.02 XXX 

92014 .... ............ A ........ Eye exam & treatment ........................ 1.42 1.38 1.39 0.47 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 0.87 0.98 0.07 XXX 

92019 .... ............ A ........ Eye exam & treatment ........................ 1.31 NA NA 0.36 0.47 0.03 XXX 

92020 .... ............ A ........ Special eye evaluation ....................... 0.37 0.25 0.30 0.13 0.14 0.01 XXX 

92025 .... ............ A ........ Corneal topography ............................ 0.35 0.43 0.44 0.43 0.44 0.02 XXX 

92025 .... 26 ....... A ........ Corneal topography ............................ 0.35 0.12 0.12 0.12 0.12 0.01 XXX 

92025 .... TC ...... A ........ Corneal topography ............................ 0.00 0.31 0.32 0.31 0.32 0.01 XXX 

92060 .... ............ A ........ Special eye evaluation ....................... 0.69 0.77 0.76 NA NA 0.03 XXX 

92060 .... 26 ....... A ........ Special eye evaluation ....................... 0.69 0.23 0.26 0.23 0.26 0.02 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38344 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

92060 .... TC ...... A ........ Special eye evaluation ....................... 0.00 0.54 0.49 NA NA 0.01 XXX 

92065 .... ............ A ........ Orthoptic/pleoptic training ................... 0.37 0.85 0.70 NA NA 0.02 XXX 

92065 .... 26 ....... A ........ Orthoptic/pleoptic training ................... 0.37 0.09 0.12 0.09 0.12 0.01 XXX 

92065 .... TC ...... A ........ Orthoptic/pleoptic training ................... 0.00 0.76 0.57 NA NA 0.01 XXX 

92070 .... ............ A ........ Fitting of contact lens ......................... 0.70 0.90 0.99 0.23 0.28 0.02 XXX 

92081 .... ............ A ........ Visual field examination(s) ................. 0.36 0.95 0.95 NA NA 0.02 XXX 

92081 .... 26 ....... A ........ Visual field examination(s) ................. 0.36 0.11 0.13 0.11 0.13 0.01 XXX 

92081 .... TC ...... A ........ Visual field examination(s) ................. 0.00 0.84 0.82 NA NA 0.01 XXX 

92082 .... ............ A ........ Visual field examination(s) ................. 0.44 1.31 1.28 NA NA 0.02 XXX 

92082 .... 26 ....... A ........ Visual field examination(s) ................. 0.44 0.14 0.17 0.14 0.17 0.01 XXX 

92082 .... TC ...... A ........ Visual field examination(s) ................. 0.00 1.18 1.11 NA NA 0.01 XXX 

92083 .... ............ A ........ Visual field examination(s) ................. 0.50 1.51 1.48 NA NA 0.02 XXX 

92083 .... 26 ....... A ........ Visual field examination(s) ................. 0.50 0.17 0.20 0.17 0.20 0.01 XXX 

92083 .... TC ...... A ........ Visual field examination(s) ................. 0.00 1.34 1.28 NA NA 0.01 XXX 

92100 .... ............ A ........ Serial tonometry exam(s) ................... 0.92 1.24 1.30 0.28 0.33 0.02 XXX 

92120 .... ............ A ........ Tonography & eye evaluation ............ 0.81 0.97 1.02 0.25 0.29 0.02 XXX 

92130 .... ............ A ........ Water provocation tonography ........... 0.81 1.18 1.23 0.28 0.33 0.02 XXX 

92135 .... ............ A ........ Opthalmic dx imaging ......................... 0.35 0.79 0.79 NA NA 0.02 XXX 

92135 .... 26 ....... A ........ Opthalmic dx imaging ......................... 0.35 0.12 0.13 0.12 0.13 0.01 XXX 

92135 .... TC ...... A ........ Opthalmic dx imaging ......................... 0.00 0.67 0.66 NA NA 0.01 XXX 

92136 .... ............ A ........ Ophthalmic biometry ........................... 0.54 1.42 1.54 NA NA 0.08 XXX 

92136 .... 26 ....... A ........ Ophthalmic biometry ........................... 0.54 0.20 0.22 0.20 0.22 0.01 XXX 

92136 .... TC ...... A ........ Ophthalmic biometry ........................... 0.00 1.22 1.32 NA NA 0.07 XXX 

92140 .... ............ A ........ Glaucoma provocative tests ............... 0.50 0.88 0.94 0.14 0.18 0.01 XXX 

92225 .... ............ A ........ Special eye exam, initial ..................... 0.38 0.24 0.23 0.13 0.14 0.01 XXX 

92226 .... ............ A ........ Special eye exam, subsequent .......... 0.33 0.23 0.22 0.12 0.13 0.01 XXX 

92230 .... ............ A ........ Eye exam with photos ........................ 0.60 0.68 1.11 0.19 0.20 0.02 XXX 

92235 .... ............ A ........ Eye exam with photos ........................ 0.81 2.25 2.44 NA NA 0.08 XXX 

92235 .... 26 ....... A ........ Eye exam with photos ........................ 0.81 0.29 0.34 0.29 0.34 0.02 XXX 

92235 .... TC ...... A ........ Eye exam with photos ........................ 0.00 1.96 2.11 NA NA 0.06 XXX 

92240 .... ............ A ........ Icg angiography .................................. 1.10 4.37 5.26 NA NA 0.09 XXX 

92240 .... 26 ....... A ........ Icg angiography .................................. 1.10 0.40 0.45 0.40 0.45 0.03 XXX 

92240 .... TC ...... A ........ Icg angiography .................................. 0.00 3.97 4.80 NA NA 0.06 XXX 

92250 .... ............ A ........ Eye exam with photos ........................ 0.44 1.29 1.42 NA NA 0.02 XXX 

92250 .... 26 ....... A ........ Eye exam with photos ........................ 0.44 0.14 0.17 0.14 0.17 0.01 XXX 

92250 .... TC ...... A ........ Eye exam with photos ........................ 0.00 1.15 1.25 NA NA 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 0.99 1.24 NA NA 0.06 XXX 

92265 .... 26 ....... A ........ Eye muscle evaluation ....................... 0.81 0.24 0.26 0.24 0.26 0.04 XXX 

92265 .... TC ...... A ........ Eye muscle evaluation ....................... 0.00 0.75 0.98 NA NA 0.02 XXX 

92270 .... ............ A ........ Electro-oculography ............................ 0.81 1.31 1.44 NA NA 0.05 XXX 

92270 .... 26 ....... A ........ Electro-oculography ............................ 0.81 0.23 0.28 0.23 0.28 0.03 XXX 

92270 .... TC ...... A ........ Electro-oculography ............................ 0.00 1.08 1.15 NA NA 0.02 XXX 

92275 .... ............ A ........ Electroretinography ............................. 1.01 2.41 2.19 NA NA 0.05 XXX 

92275 .... 26 ....... A ........ Electroretinography ............................. 1.01 0.35 0.40 0.35 0.40 0.03 XXX 

92275 .... TC ...... A ........ Electroretinography ............................. 0.00 2.06 1.79 NA NA 0.02 XXX 

92283 .... ............ A ........ Color vision examination .................... 0.17 0.98 0.92 NA NA 0.02 XXX 

92283 .... 26 ....... A ........ Color vision examination .................... 0.17 0.05 0.06 0.05 0.06 0.01 XXX 

92283 .... TC ...... A ........ Color vision examination .................... 0.00 0.93 0.86 NA NA 0.01 XXX 

92284 .... ............ A ........ Dark adaptation eye exam ................. 0.24 1.12 1.52 NA NA 0.02 XXX 

92284 .... 26 ....... A ........ Dark adaptation eye exam ................. 0.24 0.07 0.08 0.07 0.08 0.01 XXX 

92284 .... TC ...... A ........ Dark adaptation eye exam ................. 0.00 1.05 1.44 NA NA 0.01 XXX 

92285 .... ............ A ........ Eye photography ................................ 0.20 0.79 0.90 NA NA 0.02 XXX 

92285 .... 26 ....... A ........ Eye photography ................................ 0.20 0.07 0.08 0.07 0.08 0.01 XXX 

92285 .... TC ...... A ........ Eye photography ................................ 0.00 0.72 0.81 NA NA 0.01 XXX 

92286 .... ............ A ........ Internal eye photography .................... 0.66 2.08 2.58 NA NA 0.04 XXX 

92286 .... 26 ....... A ........ Internal eye photography .................... 0.66 0.22 0.26 0.22 0.26 0.02 XXX 

92286 .... TC ...... A ........ Internal eye photography .................... 0.00 1.85 2.32 NA NA 0.02 XXX 

92287 .... ............ A ........ Internal eye photography .................... 0.81 1.90 2.15 0.28 0.30 0.02 XXX 

92310 .... ............ N ........ Contact lens fitting .............................. 1.17 1.05 1.08 0.27 0.36 0.04 XXX 

92311 .... ............ A ........ Contact lens fitting .............................. 1.08 1.27 1.18 0.31 0.34 0.03 XXX 

92312 .... ............ A ........ Contact lens fitting .............................. 1.26 1.45 1.28 0.34 0.43 0.03 XXX 

92313 .... ............ A ........ Contact lens fitting .............................. 0.92 1.42 1.25 0.31 0.30 0.02 XXX 

92314 .... ............ N ........ Prescription of contact lens ................ 0.69 1.12 1.03 0.16 0.21 0.01 XXX 

92315 .... ............ A ........ Prescription of contact lens ................ 0.45 1.30 1.08 0.13 0.15 0.01 XXX 

92316 .... ............ A ........ Prescription of contact lens ................ 0.68 1.63 1.28 0.23 0.26 0.02 XXX 

92317 .... ............ A ........ Prescription of contact lens ................ 0.45 1.30 1.15 0.11 0.14 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 0.72 1.18 NA NA 0.06 XXX 

92340 .... ............ N ........ Fitting of spectacles ............................ 0.37 0.44 0.57 0.09 0.12 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 0.47 0.62 0.12 0.17 0.01 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38345 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

92352 .... ............ B ........ Special spectacles fitting .................... 0.37 0.56 0.62 0.09 0.12 0.01 XXX 

92353 .... ............ B ........ Special spectacles fitting .................... 0.50 0.59 0.66 0.12 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 2.39 NA NA 0.01 XXX 

92358 .... ............ B ........ Eye prosthesis service ....................... 0.00 0.23 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 0.00 0.00 0.00 XXX 

92499 .... 26 ....... C ........ Eye service or procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92499 .... TC ...... 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 0.91 0.99 0.05 000 

92504 .... ............ A ........ Ear microscopy examination .............. 0.18 0.59 0.54 0.06 0.07 0.01 XXX 

92506 .... ............ A ........ Speech/hearing evaluation ................. 0.86 3.47 3.00 0.28 0.33 0.03 XXX 

92507 .... ............ A ........ Speech/hearing therapy ..................... 0.52 1.22 1.16 0.16 0.19 0.02 XXX 

92508 .... ............ A ........ Speech/hearing therapy ..................... 0.26 0.55 0.52 0.09 0.10 0.01 XXX 

92511 .... ............ A ........ Nasopharyngoscopy ........................... 0.84 3.10 3.17 0.67 0.72 0.03 000 

92512 .... ............ A ........ Nasal function studies ........................ 0.55 0.99 1.06 0.18 0.18 0.02 XXX 

92516 .... ............ A ........ Facial nerve function test ................... 0.43 1.23 1.20 0.14 0.18 0.01 XXX 

92520 .... ............ A ........ Laryngeal function studies .................. 0.75 0.93 0.71 0.24 0.31 0.03 XXX 

92526 .... ............ A ........ Oral function therapy .......................... 0.55 1.69 1.66 0.17 0.18 0.02 XXX 

92541 .... ............ A ........ Spontaneous nystagmus test ............. 0.40 1.14 1.08 NA NA 0.04 XXX 

92541 .... 26 ....... A ........ Spontaneous nystagmus test ............. 0.40 0.11 0.15 0.11 0.15 0.02 XXX 

92541 .... TC ...... A ........ Spontaneous nystagmus test ............. 0.00 1.03 0.93 NA NA 0.02 XXX 

92542 .... ............ A ........ Positional nystagmus test ................... 0.33 1.28 1.20 NA NA 0.03 XXX 

92542 .... 26 ....... A ........ Positional nystagmus test ................... 0.33 0.09 0.12 0.09 0.12 0.01 XXX 

92542 .... TC ...... A ........ Positional nystagmus test ................... 0.00 1.19 1.08 NA NA 0.02 XXX 

92543 .... ............ A ........ Caloric vestibular test ......................... 0.10 0.64 0.61 NA NA 0.02 XXX 

92543 .... 26 ....... A ........ Caloric vestibular test ......................... 0.10 0.03 0.04 0.03 0.04 0.01 XXX 

92543 .... TC ...... A ........ Caloric vestibular test ......................... 0.00 0.62 0.57 NA NA 0.01 XXX 

92544 .... ............ A ........ Optokinetic nystagmus test ................ 0.26 1.02 0.96 NA NA 0.03 XXX 

92544 .... 26 ....... A ........ Optokinetic nystagmus test ................ 0.26 0.07 0.10 0.07 0.10 0.01 XXX 

92544 .... TC ...... A ........ Optokinetic nystagmus test ................ 0.00 0.95 0.86 NA NA 0.02 XXX 

92545 .... ............ A ........ Oscillating tracking test ...................... 0.23 0.99 0.90 NA NA 0.03 XXX 

92545 .... 26 ....... A ........ Oscillating tracking test ...................... 0.23 0.06 0.09 0.06 0.09 0.01 XXX 

92545 .... TC ...... A ........ Oscillating tracking test ...................... 0.00 0.93 0.81 NA NA 0.02 XXX 

92546 .... ............ A ........ Sinusoidal rotational test .................... 0.29 1.79 1.89 NA NA 0.03 XXX 

92546 .... 26 ....... A ........ Sinusoidal rotational test .................... 0.29 0.08 0.11 0.08 0.11 0.01 XXX 

92546 .... TC ...... A ........ Sinusoidal rotational test .................... 0.00 1.72 1.79 NA NA 0.02 XXX 

92547 .... ............ A ........ Supplemental electrical test ............... 0.00 0.11 0.10 0.11 0.10 0.06 ZZZ 

92548 .... ............ A ........ Posturography .................................... 0.50 1.68 1.96 NA NA 0.15 XXX 

92548 .... 26 ....... A ........ Posturography .................................... 0.50 0.14 0.20 0.14 0.20 0.02 XXX 

92548 .... TC ...... A ........ Posturography .................................... 0.00 1.55 1.76 NA NA 0.13 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 0.60 0.51 NA NA 0.04 XXX 

92553 .... ............ A ........ Audiometry, air & bone ....................... 0.00 0.76 0.70 NA NA 0.06 XXX 

92555 .... ............ A ........ Speech threshold audiometry ............. 0.00 0.41 0.39 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 0.30 0.91 0.30 0.91 0.12 XXX 

92561 .... ............ A ........ Bekesy audiometry, diagnosis ............ 0.00 0.69 0.70 NA NA 0.06 XXX 

92562 .... ............ A ........ Loudness balance test ....................... 0.00 0.61 0.52 NA NA 0.04 XXX 

92563 .... ............ A ........ Tone decay hearing test ..................... 0.00 0.54 0.45 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 0.32 NA NA 0.04 XXX 

92567 .... ............ A ........ Tympanometry .................................... 0.20 0.13 0.38 0.13 0.38 0.06 XXX 

92568 .... ............ A ........ Acoustic refl threshold tst ................... 0.29 0.10 0.25 0.10 0.25 0.04 XXX 

92569 .... ............ A ........ Acoustic reflex decay test .................. 0.20 0.07 0.26 0.07 0.26 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 0.58 0.34 NA NA 0.01 XXX 

92575 .... ............ A ........ Sensorineural acuity test .................... 0.00 1.14 0.71 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 0.62 0.35 0.62 0.06 XXX 

92582 .... ............ A ........ Conditioning play audiometry ............. 0.00 1.16 0.93 NA NA 0.06 XXX 

92583 .... ............ A ........ Select picture audiometry ................... 0.00 0.73 0.80 NA NA 0.08 XXX 

92584 .... ............ A ........ Electrocochleography ......................... 0.00 1.35 1.88 NA NA 0.21 XXX 

92585 .... ............ A ........ Auditor evoke potent, compre ............ 0.50 2.09 2.04 NA NA 0.17 XXX 

92585 .... 26 ....... A ........ Auditor evoke potent, compre ............ 0.50 0.15 0.18 0.15 0.18 0.03 XXX 

92585 .... TC ...... A ........ Auditor evoke potent, compre ............ 0.00 1.93 1.86 NA NA 0.14 XXX 

92586 .... ............ A ........ Auditor evoke potent, limit .................. 0.00 1.40 1.63 NA NA 0.14 XXX 

92587 .... ............ A ........ Evoked auditory test ........................... 0.13 0.65 1.01 NA NA 0.12 XXX 

92587 .... 26 ....... A ........ Evoked auditory test ........................... 0.13 0.04 0.05 0.04 0.05 0.01 XXX 

92587 .... TC ...... A ........ Evoked auditory test ........................... 0.00 0.61 0.96 NA NA 0.11 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38346 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

92588 .... ............ A ........ Evoked auditory test ........................... 0.36 1.11 1.36 NA NA 0.14 XXX 

92588 .... 26 ....... A ........ Evoked auditory test ........................... 0.36 0.11 0.14 0.11 0.14 0.01 XXX 

92588 .... TC ...... A ........ Evoked auditory test ........................... 0.00 1.00 1.22 NA NA 0.13 XXX 

92596 .... ............ A ........ Ear protector evaluation ..................... 0.00 1.01 0.79 NA NA 0.06 XXX 

92597 .... ............ A ........ Oral speech device eval ..................... 0.86 1.81 1.73 0.29 0.36 0.03 XXX 

92601 .... ............ A ........ Cochlear implt f/up exam < 7 ............. 2.30 4.87 3.84 NA NA 0.07 XXX 

92602 .... ............ A ........ Reprogram cochlear implt < 7 ............ 1.30 0.89 2.04 NA NA 0.07 XXX 

92603 .... ............ A ........ Cochlear implt f/up exam 7 > ............. 2.25 1.19 2.00 0.74 1.85 0.07 XXX 

92604 .... ............ A ........ Reprogram cochlear implt 7 > ............ 1.25 0.78 1.29 0.41 1.16 0.07 XXX 

92607 .... ............ A ........ Ex for speech device rx, 1hr .............. 0.00 4.59 3.78 NA NA 0.05 XXX 

92608 .... ............ A ........ Ex for speech device rx addl .............. 0.00 0.87 0.71 NA NA 0.05 XXX 

92609 .... ............ A ........ Use of speech device service ............ 0.00 2.43 1.99 NA NA 0.04 XXX 

92610 .... ............ A ........ Evaluate swallowing function ............. 0.00 1.69 2.55 NA NA 0.08 XXX 

92611 .... ............ A ........ Motion fluoroscopy/swallow ................ 0.00 1.93 2.67 NA NA 0.08 XXX 

92612 .... ............ A ........ Endoscopy swallow tst (fees) ............. 1.27 2.95 2.81 0.42 0.53 0.04 XXX 

92613 .... ............ A ........ Endoscopy swallow tst (fees) ............. 0.71 0.24 0.32 0.24 0.31 0.05 XXX 

92614 .... ............ A ........ Laryngoscopic sensory test ................ 1.27 2.41 2.43 0.42 0.53 0.04 XXX 

92615 .... ............ A ........ Eval laryngoscopy sense tst ............... 0.63 0.21 0.28 0.21 0.28 0.05 XXX 

92616 .... ............ A ........ Fees w/laryngeal sense test ............... 1.88 3.15 3.23 0.62 0.79 0.06 XXX 

92617 .... ............ A ........ Interprt fees/laryngeal test .................. 0.79 0.27 0.35 0.26 0.35 0.05 XXX 

92620 .... ............ A ........ Auditory function, 60 min .................... 0.00 1.92 1.52 NA NA 0.06 XXX 

92621 .... ............ A ........ Auditory function, + 15 min ................ 0.00 0.43 0.34 NA NA 0.06 ZZZ 

92625 .... ............ A ........ Tinnitus assessment ........................... 0.00 1.92 1.51 1.92 1.51 0.06 XXX 

92626 .... ............ A ........ Eval aud rehab status ........................ 0.00 1.99 2.07 NA NA 0.06 XXX 

92627 .... ............ A ........ Eval aud status rehab add-on ............ 0.00 0.45 0.50 0.45 0.50 0.02 ZZZ 

92640 .... ............ A ........ Aud brainstem implt programg ........... 0.00 1.32 1.37 1.32 1.37 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 3.21 3.71 0.77 0.88 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 4.22 5.29 1.39 1.30 0.07 000 

92961 .... ............ A ........ Cardioversion, electric, int .................. 4.59 NA NA 2.35 2.24 0.29 000 

92970 .... ............ A ........ Cardioassist, internal .......................... 3.51 NA NA 1.44 1.28 0.16 000 

92971 .... ............ A ........ Cardioassist, external ......................... 1.77 NA NA 1.06 0.96 0.06 000 

92973 .... ............ A ........ Percut coronary thrombectomy .......... 3.28 NA NA 1.69 1.51 0.23 ZZZ 

92974 .... ............ A ........ Cath place, cardio brachytx ................ 3.00 NA NA 1.55 1.39 0.21 ZZZ 

92975 .... ............ A ........ Dissolve clot, heart vessel .................. 7.24 NA NA 3.68 3.29 0.50 000 

92977 .... ............ A ........ Dissolve clot, heart vessel .................. 0.00 1.68 4.87 NA NA 0.46 XXX 

92978 .... ............ C ........ Intravasc us, heart add-on ................. 1.80 NA NA NA NA 0.30 ZZZ 

92978 .... 26 ....... A ........ Intravasc us, heart add-on ................. 1.80 0.92 0.83 0.92 0.83 0.06 ZZZ 

92978 .... TC ...... C ........ Intravasc us, heart add-on ................. 0.00 NA NA NA NA 0.24 ZZZ 

92979 .... ............ C ........ Intravasc us, heart add-on ................. 1.44 NA NA NA NA 0.19 ZZZ 

92979 .... 26 ....... A ........ Intravasc us, heart add-on ................. 1.44 0.74 0.66 0.74 0.66 0.06 ZZZ 

92979 .... TC ...... C ........ Intravasc us, heart add-on ................. 0.00 NA NA NA NA 0.13 ZZZ 

92980 .... ............ A ........ Insert intracoronary stent .................... 14.82 NA NA 7.80 7.03 1.03 000 

92981 .... ............ A ........ Insert intracoronary stent .................... 4.16 NA NA 2.14 1.91 0.29 ZZZ 

92982 .... ............ A ........ Coronary artery dilation ...................... 10.96 NA NA 5.82 5.25 0.76 000 

92984 .... ............ A ........ Coronary artery dilation ...................... 2.97 NA NA 1.52 1.36 0.21 ZZZ 

92986 .... ............ A ........ Revision of aortic valve ...................... 22.70 NA NA 14.75 13.48 1.51 090 

92987 .... ............ A ........ Revision of mitral valve ...................... 23.48 NA NA 15.33 13.94 1.59 090 

92990 .... ............ A ........ Revision of pulmonary valve .............. 18.12 NA NA 10.98 10.44 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 6.38 5.76 0.84 000 

92996 .... ............ A ........ Coronary atherectomy add-on ............ 3.26 NA NA 1.68 1.50 0.10 ZZZ 

92997 .... ............ A ........ Pul art balloon repr, percut ................. 11.98 NA NA 5.52 5.13 0.40 000 

92998 .... ............ A ........ Pul art balloon repr, percut ................. 5.99 NA NA 2.91 2.54 0.28 ZZZ 

93000 .... ............ A ........ Electrocardiogram, complete .............. 0.17 0.33 0.42 0.33 0.42 0.03 XXX 

93005 .... ............ A ........ Electrocardiogram, tracing .................. 0.00 0.27 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 4.10 5.07 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 1.84 1.91 1.84 1.91 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 1.48 1.59 NA NA 0.11 XXX 

93018 .... ............ A ........ Cardiovascular stress test .................. 0.30 0.14 0.13 0.14 0.13 0.01 XXX 

93024 .... ............ A ........ Cardiac drug stress test ..................... 1.17 2.31 1.96 NA NA 0.12 XXX 

93024 .... 26 ....... A ........ Cardiac drug stress test ..................... 1.17 0.55 0.51 0.55 0.51 0.04 XXX 

93024 .... TC ...... A ........ Cardiac drug stress test ..................... 0.00 1.75 1.45 NA NA 0.08 XXX 

93025 .... ............ A ........ Microvolt t-wave assess ..................... 0.75 3.81 5.72 NA NA 0.14 XXX 

93025 .... 26 ....... A ........ Microvolt t-wave assess ..................... 0.75 0.37 0.33 0.37 0.33 0.03 XXX 

93025 .... TC ...... A ........ Microvolt t-wave assess ..................... 0.00 3.44 5.39 NA NA 0.11 XXX 

93040 .... ............ A ........ Rhythm ECG with report .................... 0.16 0.19 0.20 0.19 0.20 0.02 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38347 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

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 1.88 2.82 1.88 2.82 0.24 XXX 

93225 .... ............ A ........ ECG monitor/record, 24 hrs ............... 0.00 0.83 1.04 NA NA 0.08 XXX 

93226 .... ............ A ........ ECG monitor/report, 24 hrs ................ 0.00 1.15 1.67 NA NA 0.14 XXX 

93227 .... ............ A ........ ECG monitor/review, 24 hrs ............... 0.52 0.26 0.23 0.26 0.23 0.02 XXX 

93230 .... ............ A ........ ECG monitor/report, 24 hrs ................ 0.52 1.70 2.89 1.70 2.89 0.26 XXX 

93231 .... ............ A ........ Ecg monitor/record, 24 hrs ................. 0.00 0.70 1.11 NA NA 0.11 XXX 

93232 .... ............ A ........ ECG monitor/report, 24 hrs ................ 0.00 1.31 1.75 NA NA 0.13 XXX 

93233 .... ............ A ........ ECG monitor/review, 24 hrs ............... 0.52 0.22 0.21 0.22 0.21 0.02 XXX 

93235 .... ............ C ........ ECG monitor/report, 24 hrs ................ 0.45 0.00 1.43 NA NA 0.16 XXX 

93236 .... ............ C ........ ECG monitor/report, 24 hrs ................ 0.00 0.00 1.31 NA NA 0.14 XXX 

93237 .... ............ A ........ ECG monitor/review, 24 hrs ............... 0.45 0.21 0.19 0.21 0.19 0.02 XXX 

93268 .... ............ A ........ ECG record/review ............................. 0.52 0.75 4.93 0.75 4.93 0.28 XXX 

93270 .... ............ A ........ ECG recording .................................... 0.00 0.28 0.76 NA NA 0.08 XXX 

93271 .... ............ A ........ Ecg/monitoring and analysis .............. 0.00 5.15 5.60 NA NA 0.18 XXX 

93272 .... ............ A ........ Ecg/review, interpret only ................... 0.52 0.21 0.20 0.21 0.20 0.02 XXX 

93278 .... ............ A ........ ECG/signal-averaged ......................... 0.25 0.61 0.93 NA NA 0.12 XXX 

93278 .... 26 ....... A ........ ECG/signal-averaged ......................... 0.25 0.10 0.10 0.10 0.10 0.01 XXX 

93278 .... TC ...... A ........ ECG/signal-averaged ......................... 0.00 0.51 0.83 NA NA 0.11 XXX 

93303 .... ............ A ........ Echo transthoracic .............................. 1.30 4.37 4.40 NA NA 0.27 XXX 

93303 .... 26 ....... A ........ Echo transthoracic .............................. 1.30 0.52 0.51 0.52 0.51 0.04 XXX 

93303 .... TC ...... A ........ Echo transthoracic .............................. 0.00 3.86 3.89 NA NA 0.23 XXX 

93304 .... ............ A ........ Echo transthoracic .............................. 0.75 3.02 2.65 NA NA 0.15 XXX 

93304 .... 26 ....... A ........ Echo transthoracic .............................. 0.75 0.29 0.29 0.29 0.29 0.02 XXX 

93304 .... TC ...... A ........ Echo transthoracic .............................. 0.00 2.73 2.36 NA NA 0.13 XXX 

93307 .... ............ A ........ Echo exam of heart ............................ 0.92 3.61 3.94 NA NA 0.26 XXX 

93307 .... 26 ....... A ........ Echo exam of heart ............................ 0.92 0.44 0.40 0.44 0.40 0.03 XXX 

93307 .... TC ...... A ........ Echo exam of heart ............................ 0.00 3.18 3.54 NA NA 0.23 XXX 

93308 .... ............ A ........ Echo exam of heart ............................ 0.53 2.53 2.35 NA NA 0.15 XXX 

93308 .... 26 ....... A ........ Echo exam of heart ............................ 0.53 0.26 0.23 0.26 0.23 0.02 XXX 

93308 .... TC ...... A ........ Echo exam of heart ............................ 0.00 2.28 2.12 NA NA 0.13 XXX 

93312 .... ............ A ........ Echo transesophageal ........................ 2.20 7.17 5.93 NA NA 0.37 XXX 

93312 .... 26 ....... A ........ Echo transesophageal ........................ 2.20 0.94 0.88 0.94 0.88 0.08 XXX 

93312 .... TC ...... A ........ Echo transesophageal ........................ 0.00 6.23 5.05 NA NA 0.29 XXX 

93313 .... ............ A ........ Echo transesophageal ........................ 0.95 NA NA 0.13 0.17 0.06 XXX 

93314 .... ............ A ........ Echo transesophageal ........................ 1.25 7.00 5.66 NA NA 0.33 XXX 

93314 .... 26 ....... A ........ Echo transesophageal ........................ 1.25 0.54 0.51 0.54 0.51 0.04 XXX 

93314 .... TC ...... A ........ Echo transesophageal ........................ 0.00 6.46 5.15 NA NA 0.29 XXX 

93315 .... ............ C ........ Echo transesophageal ........................ 2.78 NA NA NA NA 0.09 XXX 

93315 .... 26 ....... A ........ Echo transesophageal ........................ 2.78 1.26 1.15 1.26 1.15 0.09 XXX 

93315 .... TC ...... C ........ Echo transesophageal ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93316 .... ............ A ........ Echo transesophageal ........................ 0.95 NA NA 0.25 0.25 0.05 XXX 

93317 .... ............ C ........ Echo transesophageal ........................ 1.83 NA NA NA NA 0.08 XXX 

93317 .... 26 ....... A ........ Echo transesophageal ........................ 1.83 0.60 0.66 0.60 0.66 0.08 XXX 

93317 .... TC ...... C ........ Echo transesophageal ........................ 0.00 0.00 1.79 0.00 1.79 0.00 XXX 

93318 .... ............ C ........ Echo transesophageal intraop ............ 2.20 0.00 0.39 0.00 0.39 0.14 XXX 

93318 .... 26 ....... A ........ Echo transesophageal intraop ............ 2.20 0.83 0.67 0.83 0.67 0.14 XXX 

93318 .... TC ...... C ........ Echo transesophageal intraop ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93320 .... ............ A ........ Doppler echo exam, heart .................. 0.38 1.62 1.75 1.62 1.75 0.13 ZZZ 

93320 .... 26 ....... A ........ Doppler echo exam, heart .................. 0.38 0.18 0.17 0.18 0.17 0.01 ZZZ 

93320 .... TC ...... A ........ Doppler echo exam, heart .................. 0.00 1.44 1.59 1.44 1.59 0.12 ZZZ 

93321 .... ............ A ........ Doppler echo exam, heart .................. 0.15 0.59 0.89 0.59 0.89 0.09 ZZZ 

93321 .... 26 ....... A ........ Doppler echo exam, heart .................. 0.15 0.07 0.07 0.07 0.07 0.01 ZZZ 

93321 .... TC ...... A ........ Doppler echo exam, heart .................. 0.00 0.52 0.82 0.52 0.82 0.08 ZZZ 

93325 .... ............ B ........ Doppler color flow add-on .................. 0.07 0.64 1.79 0.64 1.79 0.22 ZZZ 

93325 .... 26 ....... B ........ Doppler color flow add-on .................. 0.07 0.03 0.03 0.03 0.03 0.01 ZZZ 

93325 .... TC ...... B ........ Doppler color flow add-on .................. 0.00 0.61 1.76 0.61 1.76 0.21 ZZZ 

93350 .... ............ A ........ Echo transthoracic .............................. 1.48 4.92 3.66 NA NA 0.18 XXX 

93350 .... 26 ....... A ........ Echo transthoracic .............................. 1.48 0.73 0.66 0.73 0.66 0.05 XXX 

93350 .... TC ...... A ........ Echo transthoracic .............................. 0.00 4.19 3.00 NA NA 0.13 XXX 

93501 .... ............ A ........ Right heart catheterization ................. 3.02 18.09 15.33 NA NA 1.26 000 

93501 .... 26 ....... A ........ Right heart catheterization ................. 3.02 1.51 1.35 1.51 1.35 0.21 000 

93501 .... TC ...... A ........ Right heart catheterization ................. 0.00 16.58 13.98 NA NA 1.05 000 

93503 .... ............ A ........ Insert/place heart catheter .................. 2.91 NA NA 0.43 0.56 0.20 000 

93505 .... ............ A ........ Biopsy of heart lining .......................... 4.37 20.23 8.97 NA NA 0.46 000 

93505 .... 26 ....... A ........ Biopsy of heart lining .......................... 4.37 2.19 1.96 2.19 1.96 0.30 000 

93505 .... TC ...... A ........ Biopsy of heart lining .......................... 0.00 18.03 7.00 NA NA 0.16 000 

93508 .... ............ A ........ Cath placement, angiography ............ 4.09 27.89 17.02 NA NA 0.93 000 

93508 .... 26 ....... A ........ Cath placement, angiography ............ 4.09 2.09 2.12 2.09 2.12 0.28 000 

93508 .... TC ...... A ........ Cath placement, angiography ............ 0.00 25.80 14.90 NA NA 0.65 000 

93510 .... ............ A ........ Left heart catheterization .................... 4.32 27.22 29.03 NA NA 2.62 000 

mstockstill on PROD1PC66 with PROPOSALS2

38348 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

93510 .... 26 ....... A ........ Left heart catheterization .................... 4.32 2.19 2.21 2.19 2.21 0.30 000 

93510 .... TC ...... A ........ Left heart catheterization .................... 0.00 25.03 26.82 NA NA 2.32 000 

93511 .... ............ A ........ Left heart catheterization .................... 5.02 NA NA NA NA 2.60 000 

93511 .... 26 ....... A ........ Left heart catheterization .................... 5.02 2.53 2.51 2.53 2.51 0.35 000 

93511 .... TC ...... A ........ Left heart catheterization .................... 0.00 NA NA NA NA 2.25 000 

93514 .... ............ A ........ Left heart catheterization .................... 7.04 NA NA NA NA 0.49 000 

93514 .... 26 ....... A ........ Left heart catheterization .................... 7.04 2.72 3.00 2.72 3.00 0.49 000 

93524 .... ............ A ........ Left heart catheterization .................... 6.94 NA NA NA NA 3.44 000 

93524 .... 26 ....... A ........ Left heart catheterization .................... 6.94 3.60 3.42 3.60 3.42 0.48 000 

93524 .... TC ...... A ........ Left heart catheterization .................... 0.00 NA NA NA NA 2.96 000 

93526 .... ............ A ........ Rt & Lt heart catheters ....................... 5.98 33.97 37.42 NA NA 3.47 000 

93526 .... 26 ....... A ........ Rt & Lt heart catheters ....................... 5.98 3.04 2.97 3.04 2.97 0.42 000 

93526 .... TC ...... A ........ Rt & Lt heart catheters ....................... 0.00 30.93 34.46 NA NA 3.05 000 

93527 .... ............ A ........ Rt & Lt heart catheters ....................... 7.27 NA NA NA NA 3.47 000 

93527 .... 26 ....... A ........ Rt & Lt heart catheters ....................... 7.27 3.70 3.56 3.70 3.56 0.51 000 

93527 .... TC ...... A ........ Rt & Lt heart catheters ....................... 0.00 NA NA NA NA 2.96 000 

93528 .... ............ A ........ Rt & Lt heart catheters ....................... 8.99 NA NA NA NA 3.58 000 

93528 .... 26 ....... A ........ Rt & Lt heart catheters ....................... 8.99 4.26 4.21 4.26 4.21 0.62 000 

93528 .... TC ...... A ........ Rt & Lt heart catheters ....................... 0.00 NA NA NA NA 2.96 000 

93529 .... ............ A ........ Rt, lt heart catheterization .................. 4.79 NA NA NA NA 3.29 000 

93529 .... 26 ....... A ........ Rt, lt heart catheterization .................. 4.79 2.44 2.39 2.44 2.39 0.33 000 

93529 .... TC ...... A ........ Rt, lt heart catheterization .................. 0.00 NA NA NA NA 2.96 000 

93530 .... ............ A ........ Rt heart cath, congenital .................... 4.22 NA NA NA NA 1.34 000 

93530 .... 26 ....... A ........ Rt heart cath, congenital .................... 4.22 1.77 1.87 1.77 1.87 0.29 000 

93530 .... TC ...... A ........ Rt heart cath, congenital .................... 0.00 NA NA NA NA 1.05 000 

93531 .... ............ A ........ R & l heart cath, congenital ................ 8.34 NA NA NA NA 3.63 000 

93531 .... 26 ....... A ........ R & l heart cath, congenital ................ 8.34 2.76 3.34 2.76 3.34 0.58 000 

93531 .... TC ...... A ........ R & l heart cath, congenital ................ 0.00 NA NA NA NA 3.05 000 

93532 .... ............ A ........ R & l heart cath, congenital ................ 9.99 NA NA NA NA 0.69 000 

93532 .... 26 ....... A ........ R & l heart cath, congenital ................ 9.99 3.41 3.94 3.41 3.94 0.69 000 

93533 .... ............ A ........ R & l heart cath, congenital ................ 6.69 NA NA NA NA 0.47 000 

93533 .... 26 ....... A ........ R & l heart cath, congenital ................ 6.69 2.96 2.90 2.96 2.90 0.47 000 

93539 .... ............ A ........ Injection, cardiac cath ......................... 0.40 2.39 0.92 NA NA 0.01 000 

93540 .... ............ A ........ Injection, cardiac cath ......................... 0.43 0.67 0.35 NA NA 0.01 000 

93541 .... ............ A ........ Injection for lung angiogram ............... 0.29 NA NA 0.15 0.13 0.01 000 

93542 .... ............ A ........ Injection for heart x-rays ..................... 0.29 0.46 0.23 NA NA 0.01 000 

93543 .... ............ A ........ Injection for heart x-rays ..................... 0.29 2.54 0.93 NA NA 0.01 000 

93544 .... ............ A ........ Injection for aortography ..................... 0.25 1.78 0.67 NA NA 0.01 000 

93545 .... ............ A ........ Inject for coronary x-rays .................... 0.40 5.67 2.01 NA NA 0.01 000 

93555 .... ............ A ........ Imaging, cardiac cath ......................... 0.81 0.57 3.56 NA NA 0.37 XXX 

93555 .... 26 ....... A ........ Imaging, cardiac cath ......................... 0.81 0.41 0.37 0.41 0.37 0.03 XXX 

93555 .... TC ...... A ........ Imaging, cardiac cath ......................... 0.00 0.16 3.19 NA NA 0.34 XXX 

93556 .... ............ A ........ Imaging, cardiac cath ......................... 0.83 0.84 5.47 NA NA 0.54 XXX 

93556 .... 26 ....... A ........ Imaging, cardiac cath ......................... 0.83 0.42 0.38 0.42 0.38 0.03 XXX 

93556 .... TC ...... A ........ Imaging, cardiac cath ......................... 0.00 0.42 5.09 NA NA 0.51 XXX 

93561 .... ............ A ........ Cardiac output measurement ............. 0.50 NA NA NA NA 0.08 000 

93561 .... 26 ....... A ........ Cardiac output measurement ............. 0.50 0.14 0.15 0.14 0.15 0.02 000 

93561 .... TC ...... A ........ Cardiac output measurement ............. 0.00 NA NA NA NA 0.06 000 

93562 .... ............ A ........ Cardiac output measurement ............. 0.16 NA NA NA NA 0.05 000 

93562 .... 26 ....... A ........ Cardiac output measurement ............. 0.16 0.03 0.04 0.03 0.04 0.01 000 

93562 .... TC ...... A ........ Cardiac output measurement ............. 0.00 NA NA NA NA 0.04 000 

93571 .... ............ A ........ Heart flow reserve measure ............... 1.80 NA NA NA NA 0.30 ZZZ 

93571 .... 26 ....... A ........ Heart flow reserve measure ............... 1.80 0.92 0.81 0.92 0.81 0.06 ZZZ 

93571 .... TC ...... A ........ Heart flow reserve measure ............... 0.00 . 4.57 . 4.57 0.24 ZZZ 

93572 .... ............ A ........ Heart flow reserve measure ............... 1.44 0.71 0.61 0.71 0.61 0.04 ZZZ 

93572 .... 26 ....... A ........ Heart flow reserve measure ............... 1.44 0.71 0.61 0.71 0.61 0.04 ZZZ 

93580 .... ............ A ........ Transcath closure of asd .................... 17.97 NA NA 9.05 8.33 1.25 000 

93581 .... ............ A ........ Transcath closure of vsd .................... 24.39 NA NA 10.89 10.56 1.72 000 

93600 .... ............ C ........ Bundle of His recording ...................... 2.12 NA NA NA NA 0.29 000 

93600 .... 26 ....... A ........ Bundle of His recording ...................... 2.12 1.04 0.95 1.04 0.95 0.16 000 

93600 .... TC ...... C ........ Bundle of His recording ...................... 0.00 0.00 1.31 0.00 1.31 0.13 000 

93602 .... ............ C ........ Intra-atrial recording ........................... 2.12 NA NA NA NA 0.24 000 

93602 .... 26 ....... A ........ Intra-atrial recording ........................... 2.12 1.01 0.93 1.01 0.93 0.17 000 

93602 .... TC ...... C ........ Intra-atrial recording ........................... 0.00 0.00 0.74 0.00 0.74 0.07 000 

93603 .... ............ C ........ Right ventricular recording ................. 2.12 NA NA NA NA 0.29 000 

93603 .... 26 ....... A ........ Right ventricular recording ................. 2.12 1.00 0.92 1.00 0.92 0.18 000 

93603 .... TC ...... C ........ Right ventricular recording ................. 0.00 0.00 1.12 0.00 1.12 0.11 000 

93609 .... ............ C ........ Map tachycardia, add-on .................... 4.99 NA NA NA NA 0.52 ZZZ 

93609 .... 26 ....... A ........ Map tachycardia, add-on .................... 4.99 2.51 2.27 2.51 2.27 0.35 ZZZ 

93609 .... TC ...... C ........ Map tachycardia, add-on .................... 0.00 0.00 1.82 0.00 1.82 0.17 ZZZ 

93610 .... ............ C ........ Intra-atrial pacing ................................ 3.02 NA NA NA NA 0.34 000 

93610 .... 26 ....... A ........ Intra-atrial pacing ................................ 3.02 1.41 1.30 1.41 1.30 0.24 000 

mstockstill on PROD1PC66 with PROPOSALS2

38349 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

93610 .... TC ...... C ........ Intra-atrial pacing ................................ 0.00 NA NA NA NA 0.10 000 

93612 .... ............ C ........ Intraventricular pacing ........................ 3.02 NA NA NA NA 0.36 000 

93612 .... 26 ....... A ........ Intraventricular pacing ........................ 3.02 1.37 1.28 1.37 1.28 0.25 000 

93612 .... TC ...... C ........ Intraventricular pacing ........................ 0.00 0.00 1.07 0.00 1.07 0.11 000 

93613 .... ............ A ........ Electrophys map 3d, add-on .............. 6.99 NA NA 3.54 3.20 0.49 ZZZ 

93615 .... ............ C ........ Esophageal recording ......................... 0.99 NA NA NA NA 0.05 000 

93615 .... 26 ....... A ........ Esophageal recording ......................... 0.99 0.51 0.39 0.51 0.39 0.03 000 

93615 .... TC ...... C ........ Esophageal recording ......................... 0.00 0.00 0.21 0.00 0.21 0.02 000 

93616 .... ............ C ........ Esophageal recording ......................... 1.49 0.00 0.45 0.00 0.45 0.09 000 

93616 .... 26 ....... A ........ Esophageal recording ......................... 1.49 0.26 0.37 0.26 0.37 0.09 000 

93616 .... TC ...... C ........ Esophageal recording ......................... 0.00 0.00 0.16 0.00 0.16 0.00 000 

93618 .... ............ C ........ Heart rhythm pacing ........................... 4.25 NA NA NA NA 0.54 000 

93618 .... 26 ....... A ........ Heart rhythm pacing ........................... 4.25 2.19 1.96 2.19 1.96 0.30 000 

93618 .... TC ...... C ........ Heart rhythm pacing ........................... 0.00 0.00 2.65 0.00 2.65 0.24 000 

93619 .... ............ C ........ Electrophysiology evaluation .............. 7.31 NA NA NA NA 0.98 000 

93619 .... 26 ....... A ........ Electrophysiology evaluation .............. 7.31 3.71 3.48 3.71 3.48 0.51 000 

93619 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 5.15 0.00 5.15 0.47 000 

93620 .... ............ C ........ Electrophysiology evaluation .............. 11.57 NA NA 0.00 7.91 0.80 000 

93620 .... 26 ....... A ........ Electrophysiology evaluation .............. 11.57 5.84 5.43 5.84 5.43 0.80 000 

93620 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 4.43 0.00 4.43 0.00 000 

93621 .... ............ C ........ Electrophysiology evaluation .............. 2.10 0.00 0.60 0.00 0.60 0.15 ZZZ 

93621 .... 26 ....... A ........ Electrophysiology evaluation .............. 2.10 1.06 0.95 1.06 0.95 0.15 ZZZ 

93621 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93622 .... ............ C ........ Electrophysiology evaluation .............. 3.10 0.00 0.89 0.00 0.89 0.22 ZZZ 

93622 .... 26 ....... A ........ Electrophysiology evaluation .............. 3.10 1.50 1.39 1.50 1.39 0.22 ZZZ 

93622 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93623 .... ............ C ........ Stimulation, pacing heart .................... 2.85 0.00 0.81 0.00 0.81 0.20 ZZZ 

93623 .... 26 ....... A ........ Stimulation, pacing heart .................... 2.85 1.43 1.29 1.43 1.29 0.20 ZZZ 

93623 .... TC ...... C ........ Stimulation, pacing heart .................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93624 .... ............ C ........ Electrophysiologic study ..................... 4.80 NA NA 0.00 1.54 0.46 000 

93624 .... 26 ....... A ........ Electrophysiologic study ..................... 4.80 2.49 2.37 2.49 2.37 0.33 000 

93624 .... TC ...... C ........ Electrophysiologic study ..................... 0.00 0.00 1.33 0.00 1.33 0.13 000 

93631 .... ............ C ........ Heart pacing, mapping ....................... 7.59 0.00 4.92 0.00 4.92 0.97 000 

93631 .... 26 ....... A ........ Heart pacing, mapping ....................... 7.59 2.75 2.76 2.75 2.76 0.97 000 

93631 .... TC ...... C ........ Heart pacing, mapping ....................... 0.00 0.00 3.07 0.00 3.07 0.00 000 

93640 .... ............ C ........ Evaluation heart device ...................... 3.51 NA NA NA NA 0.66 000 

93640 .... 26 ....... A ........ Evaluation heart device ...................... 3.51 1.74 1.58 1.74 1.58 0.24 000 

93640 .... TC ...... C ........ Evaluation heart device ...................... 0.00 0.00 4.79 0.00 4.79 0.42 000 

93641 .... ............ C ........ Electrophysiology evaluation .............. 5.92 NA NA NA NA 0.83 000 

93641 .... 26 ....... A ........ Electrophysiology evaluation .............. 5.92 2.99 2.69 2.99 2.69 0.41 000 

93641 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 4.79 0.00 4.79 0.42 000 

93642 .... ............ A ........ Electrophysiology evaluation .............. 4.88 7.08 8.29 7.08 8.29 0.57 000 

93642 .... 26 ....... A ........ Electrophysiology evaluation .............. 4.88 2.48 2.38 2.48 2.38 0.15 000 

93642 .... TC ...... A ........ Electrophysiology evaluation .............. 0.00 4.60 5.91 4.60 5.91 0.42 000 

93650 .... ............ A ........ Ablate heart dysrhythm focus ............. 10.49 NA NA 5.58 5.09 0.73 000 

93651 .... ............ A ........ Ablate heart dysrhythm focus ............. 16.23 NA NA 8.19 7.37 1.13 000 

93652 .... ............ A ........ Ablate heart dysrhythm focus ............. 17.65 NA NA 8.47 7.88 1.23 000 

93660 .... ............ A ........ Tilt table evaluation ............................ 1.89 2.90 2.69 2.90 2.69 0.08 000 

93660 .... 26 ....... A ........ Tilt table evaluation ............................ 1.89 0.94 0.85 0.94 0.85 0.06 000 

93660 .... TC ...... A ........ Tilt table evaluation ............................ 0.00 1.97 1.84 1.97 1.84 0.02 000 

93662 .... ............ C ........ Intracardiac ecg (ice) .......................... 2.80 0.00 0.81 0.00 0.81 0.09 ZZZ 

93662 .... 26 ....... A ........ Intracardiac ecg (ice) .......................... 2.80 1.41 1.28 1.41 1.28 0.09 ZZZ 

93662 .... TC ...... C ........ Intracardiac ecg (ice) .......................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93668 .... ............ N ........ Peripheral vascular rehab .................. 0.00 0.40 0.40 NA NA 0.01 XXX 

93701 .... ............ A ........ Bioimpedance, thoracic ...................... 0.17 0.68 0.83 NA NA 0.02 XXX 

93701 .... 26 ....... A ........ Bioimpedance, thoracic ...................... 0.17 0.06 0.07 0.06 0.07 0.01 XXX 

93701 .... TC ...... A ........ Bioimpedance, thoracic ...................... 0.00 0.62 0.77 NA NA 0.01 XXX 

93720 .... ............ A ........ Total body plethysmography .............. 0.17 1.26 1.00 1.26 1.00 0.07 XXX 

93721 .... ............ A ........ Plethysmography tracing .................... 0.00 1.12 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 3.04 4.54 3.04 4.54 0.39 000 

93724 .... 26 ....... A ........ Analyze pacemaker system ............... 4.88 2.21 2.13 2.21 2.13 0.15 000 

93724 .... TC ...... A ........ Analyze pacemaker system ............... 0.00 0.84 2.41 0.84 2.41 0.24 000 

93727 .... ............ A ........ Analyze ilr system .............................. 0.52 0.61 0.41 0.61 0.41 0.02 XXX 

93731 .... ............ A ........ Analyze pacemaker system ............... 0.45 0.76 0.72 NA NA 0.05 XXX 

93731 .... 26 ....... A ........ Analyze pacemaker system ............... 0.45 0.23 0.20 0.23 0.20 0.01 XXX 

93731 .... TC ...... A ........ Analyze pacemaker system ............... 0.00 0.53 0.52 NA NA 0.04 XXX 

93732 .... ............ A ........ Analyze pacemaker system ............... 0.92 1.11 1.00 NA NA 0.07 XXX 

93732 .... 26 ....... A ........ Analyze pacemaker system ............... 0.92 0.46 0.41 0.46 0.41 0.03 XXX 

93732 .... TC ...... A ........ Analyze pacemaker system ............... 0.00 0.64 0.58 NA NA 0.04 XXX 

93733 .... ............ A ........ Telephone analy, pacemaker ............. 0.17 0.90 0.85 NA NA 0.07 XXX 

93733 .... 26 ....... A ........ Telephone analy, pacemaker ............. 0.17 0.08 0.07 0.08 0.07 0.01 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38350 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

93733 .... TC ...... A ........ Telephone analy, pacemaker ............. 0.00 0.82 0.78 NA NA 0.06 XXX 

93734 .... ............ A ........ Analyze pacemaker system ............... 0.38 0.68 0.59 NA NA 0.03 XXX 

93734 .... 26 ....... A ........ Analyze pacemaker system ............... 0.38 0.19 0.17 0.19 0.17 0.01 XXX 

93734 .... TC ...... A ........ Analyze pacemaker system ............... 0.00 0.48 0.42 NA NA 0.02 XXX 

93735 .... ............ A ........ Analyze pacemaker system ............... 0.74 0.92 0.83 NA NA 0.06 XXX 

93735 .... 26 ....... A ........ Analyze pacemaker system ............... 0.74 0.37 0.33 0.37 0.33 0.02 XXX 

93735 .... TC ...... A ........ Analyze pacemaker system ............... 0.00 0.55 0.50 NA NA 0.04 XXX 

93736 .... ............ A ........ Telephonic analy, pacemaker ............ 0.15 0.88 0.79 NA NA 0.07 XXX 

93736 .... 26 ....... A ........ Telephonic analy, pacemaker ............ 0.15 0.07 0.06 0.07 0.06 0.01 XXX 

93736 .... TC ...... A ........ Telephonic analy, pacemaker ............ 0.00 0.82 0.73 NA NA 0.06 XXX 

93740 .... ............ B ........ Temperature gradient studies ............ 0.16 0.04 0.11 NA NA 0.02 XXX 

93740 .... 26 ....... B ........ Temperature gradient studies ............ 0.16 0.04 0.04 0.04 0.04 0.01 XXX 

93740 .... TC ...... B ........ Temperature gradient studies ............ 0.00 0.00 0.07 NA NA 0.01 XXX 

93741 .... ............ A ........ Analyze ht pace device sngl .............. 0.80 0.98 0.99 NA NA 0.07 XXX 

93741 .... 26 ....... A ........ Analyze ht pace device sngl .............. 0.80 0.41 0.36 0.41 0.36 0.03 XXX 

93741 .... TC ...... A ........ Analyze ht pace device sngl .............. 0.00 0.57 0.62 NA NA 0.04 XXX 

93742 .... ............ A ........ Analyze ht pace device sngl .............. 0.91 1.11 1.08 NA NA 0.07 XXX 

93742 .... 26 ....... A ........ Analyze ht pace device sngl .............. 0.91 0.46 0.42 0.46 0.42 0.03 XXX 

93742 .... TC ...... A ........ Analyze ht pace device sngl .............. 0.00 0.65 0.66 NA NA 0.04 XXX 

93743 .... ............ A ........ Analyze ht pace device dual .............. 1.03 1.15 1.15 NA NA 0.07 XXX 

93743 .... 26 ....... A ........ Analyze ht pace device dual .............. 1.03 0.52 0.47 0.52 0.47 0.03 XXX 

93743 .... TC ...... A ........ Analyze ht pace device dual .............. 0.00 0.62 0.68 NA NA 0.04 XXX 

93744 .... ............ A ........ Analyze ht pace device dual .............. 1.18 1.29 1.22 NA NA 0.08 XXX 

93744 .... 26 ....... A ........ Analyze ht pace device dual .............. 1.18 0.60 0.54 0.60 0.54 0.04 XXX 

93744 .... TC ...... A ........ Analyze ht pace device dual .............. 0.00 0.69 0.68 NA NA 0.04 XXX 

93745 .... ............ C ........ Set-up cardiovert-defibrill .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93745 .... 26 ....... C ........ Set-up cardiovert-defibrill .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93745 .... TC ...... C ........ Set-up cardiovert-defibrill .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93770 .... ............ B ........ Measure venous pressure .................. 0.16 0.04 0.06 NA NA 0.02 XXX 

93770 .... 26 ....... B ........ Measure venous pressure .................. 0.16 0.04 0.05 0.04 0.05 0.01 XXX 

93770 .... TC ...... B ........ Measure venous pressure .................. 0.00 0.00 0.01 NA NA 0.01 XXX 

93784 .... ............ A ........ Ambulatory BP monitoring .................. 0.38 1.13 1.40 1.13 1.40 0.03 XXX 

93786 .... ............ A ........ Ambulatory BP recording ................... 0.00 0.86 0.89 NA NA 0.01 XXX 

93788 .... ............ A ........ Ambulatory BP analysis ..................... 0.00 0.51 0.51 NA NA 0.01 XXX 

93790 .... ............ A ........ Review/report BP recording ............... 0.38 0.14 0.13 0.14 0.13 0.01 XXX 

93797 .... ............ I .......... Cardiac rehab ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

93798 .... ............ I .......... Cardiac rehab/monitor ........................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

93799 .... ............ C ........ Cardiovascular procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93799 .... 26 ....... C ........ Cardiovascular procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93799 .... TC ...... C ........ Cardiovascular procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93875 .... ............ A ........ Extracranial study ............................... 0.22 2.50 2.42 NA NA 0.12 XXX 

93875 .... 26 ....... A ........ Extracranial study ............................... 0.22 0.07 0.08 0.07 0.08 0.01 XXX 

93875 .... TC ...... A ........ Extracranial study ............................... 0.00 2.44 2.35 NA NA 0.11 XXX 

93880 .... ............ A ........ Extracranial study ............................... 0.60 6.05 5.80 NA NA 0.39 XXX 

93880 .... 26 ....... A ........ Extracranial study ............................... 0.60 0.21 0.20 0.21 0.20 0.04 XXX 

93880 .... TC ...... A ........ Extracranial study ............................... 0.00 5.84 5.59 NA NA 0.35 XXX 

93882 .... ............ A ........ Extracranial study ............................... 0.40 4.06 3.77 NA NA 0.26 XXX 

93882 .... 26 ....... A ........ Extracranial study ............................... 0.40 0.11 0.12 0.11 0.12 0.04 XXX 

93882 .... TC ...... A ........ Extracranial study ............................... 0.00 3.94 3.65 NA NA 0.22 XXX 

93886 .... ............ A ........ Intracranial study ................................ 0.94 6.94 6.83 NA NA 0.45 XXX 

93886 .... 26 ....... A ........ Intracranial study ................................ 0.94 0.28 0.33 0.28 0.33 0.06 XXX 

93886 .... TC ...... A ........ Intracranial study ................................ 0.00 6.66 6.50 NA NA 0.39 XXX 

93888 .... ............ A ........ Intracranial study ................................ 0.62 4.83 4.52 NA NA 0.32 XXX 

93888 .... 26 ....... A ........ Intracranial study ................................ 0.62 0.20 0.21 0.20 0.21 0.05 XXX 

93888 .... TC ...... A ........ Intracranial study ................................ 0.00 4.63 4.30 NA NA 0.27 XXX 

93890 .... ............ A ........ Tcd, vasoreactivity study .................... 1.00 6.35 5.58 NA NA 0.45 XXX 

93890 .... 26 ....... A ........ Tcd, vasoreactivity study .................... 1.00 0.31 0.36 0.31 0.36 0.06 XXX 

93890 .... TC ...... A ........ Tcd, vasoreactivity study .................... 0.00 6.04 5.23 NA NA 0.39 XXX 

93892 .... ............ A ........ Tcd, emboli detect w/o inj .................. 1.15 6.77 5.94 NA NA 0.45 XXX 

93892 .... 26 ....... A ........ Tcd, emboli detect w/o inj .................. 1.15 0.32 0.39 0.32 0.39 0.06 XXX 

93892 .... TC ...... A ........ Tcd, emboli detect w/o inj .................. 0.00 6.44 5.54 NA NA 0.39 XXX 

93893 .... ............ A ........ Tcd, emboli detect w/inj ...................... 1.15 6.92 5.87 NA NA 0.45 XXX 

93893 .... 26 ....... A ........ Tcd, emboli detect w/inj ...................... 1.15 0.33 0.40 0.33 0.40 0.06 XXX 

93893 .... TC ...... A ........ Tcd, emboli detect w/inj ...................... 0.00 6.59 5.47 NA NA 0.39 XXX 

93922 .... ............ A ........ Extremity study ................................... 0.25 3.05 2.87 NA NA 0.15 XXX 

93922 .... 26 ....... A ........ Extremity study ................................... 0.25 0.08 0.08 0.08 0.08 0.02 XXX 

93922 .... TC ...... A ........ Extremity study ................................... 0.00 2.97 2.79 NA NA 0.13 XXX 

93923 .... ............ A ........ Extremity study ................................... 0.45 4.60 4.32 NA NA 0.26 XXX 

93923 .... 26 ....... A ........ Extremity study ................................... 0.45 0.14 0.15 0.14 0.15 0.04 XXX 

93923 .... TC ...... A ........ Extremity study ................................... 0.00 4.46 4.17 NA NA 0.22 XXX 

93924 .... ............ A ........ Extremity study ................................... 0.50 5.82 5.31 NA NA 0.30 XXX 

93924 .... 26 ....... A ........ Extremity study ................................... 0.50 0.16 0.17 0.16 0.17 0.05 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38351 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

93924 .... TC ...... A ........ Extremity study ................................... 0.00 5.66 5.14 NA NA 0.25 XXX 

93925 .... ............ A ........ Lower extremity study ........................ 0.58 7.88 7.33 NA NA 0.39 XXX 

93925 .... 26 ....... A ........ Lower extremity study ........................ 0.58 0.19 0.20 0.19 0.20 0.04 XXX 

93925 .... TC ...... A ........ Lower extremity study ........................ 0.00 7.70 7.13 NA NA 0.35 XXX 

93926 .... ............ A ........ Lower extremity study ........................ 0.39 5.07 4.56 NA NA 0.27 XXX 

93926 .... 26 ....... A ........ Lower extremity study ........................ 0.39 0.11 0.12 0.11 0.12 0.04 XXX 

93926 .... TC ...... A ........ Lower extremity study ........................ 0.00 4.96 4.44 NA NA 0.23 XXX 

93930 .... ............ A ........ Upper extremity study ........................ 0.46 6.16 5.75 NA NA 0.41 XXX 

93930 .... 26 ....... A ........ Upper extremity study ........................ 0.46 0.15 0.16 0.15 0.16 0.04 XXX 

93930 .... TC ...... A ........ Upper extremity study ........................ 0.00 6.01 5.59 NA NA 0.37 XXX 

93931 .... ............ A ........ Upper extremity study ........................ 0.31 4.11 3.80 NA NA 0.27 XXX 

93931 .... 26 ....... A ........ Upper extremity study ........................ 0.31 0.10 0.10 0.10 0.10 0.03 XXX 

93931 .... TC ...... A ........ Upper extremity study ........................ 0.00 4.02 3.70 NA NA 0.24 XXX 

93965 .... ............ A ........ Extremity study ................................... 0.35 2.96 2.87 NA NA 0.14 XXX 

93965 .... 26 ....... A ........ Extremity study ................................... 0.35 0.11 0.12 0.11 0.12 0.02 XXX 

93965 .... TC ...... A ........ Extremity study ................................... 0.00 2.86 2.76 NA NA 0.12 XXX 

93970 .... ............ A ........ Extremity study ................................... 0.68 6.13 5.67 NA NA 0.46 XXX 

93970 .... 26 ....... A ........ Extremity study ................................... 0.68 0.21 0.22 0.21 0.22 0.06 XXX 

93970 .... TC ...... A ........ Extremity study ................................... 0.00 5.92 5.45 NA NA 0.40 XXX 

93971 .... ............ A ........ Extremity study ................................... 0.45 4.02 3.79 NA NA 0.30 XXX 

93971 .... 26 ....... A ........ Extremity study ................................... 0.45 0.15 0.15 0.15 0.15 0.03 XXX 

93971 .... TC ...... A ........ Extremity study ................................... 0.00 3.88 3.64 NA NA 0.27 XXX 

93975 .... ............ A ........ Vascular study .................................... 1.80 8.32 7.96 NA NA 0.56 XXX 

93975 .... 26 ....... A ........ Vascular study .................................... 1.80 0.62 0.61 0.62 0.61 0.13 XXX 

93975 .... TC ...... A ........ Vascular study .................................... 0.00 7.69 7.35 NA NA 0.43 XXX 

93976 .... ............ A ........ Vascular study .................................... 1.21 4.53 4.40 NA NA 0.35 XXX 

93976 .... 26 ....... A ........ Vascular study .................................... 1.21 0.43 0.40 0.43 0.40 0.05 XXX 

93976 .... TC ...... A ........ Vascular study .................................... 0.00 4.11 4.00 NA NA 0.30 XXX 

93978 .... ............ A ........ Vascular study .................................... 0.65 5.92 5.21 NA NA 0.43 XXX 

93978 .... 26 ....... A ........ Vascular study .................................... 0.65 0.21 0.22 0.21 0.22 0.06 XXX 

93978 .... TC ...... A ........ Vascular study .................................... 0.00 5.71 4.99 NA NA 0.37 XXX 

93979 .... ............ A ........ Vascular study .................................... 0.44 4.09 3.67 NA NA 0.27 XXX 

93979 .... 26 ....... A ........ Vascular study .................................... 0.44 0.14 0.15 0.14 0.15 0.03 XXX 

93979 .... TC ...... A ........ Vascular study .................................... 0.00 3.95 3.52 NA NA 0.24 XXX 

93980 .... ............ A ........ Penile vascular study ......................... 1.25 3.45 3.16 NA NA 0.42 XXX 

93980 .... 26 ....... A ........ Penile vascular study ......................... 1.25 0.47 0.44 0.47 0.44 0.08 XXX 

93980 .... TC ...... A ........ Penile vascular study ......................... 0.00 2.99 2.72 NA NA 0.34 XXX 

93981 .... ............ A ........ Penile vascular study ......................... 0.44 2.82 2.84 NA NA 0.33 XXX 

93981 .... 26 ....... A ........ Penile vascular study ......................... 0.44 0.16 0.15 0.16 0.15 0.02 XXX 

93981 .... TC ...... A ........ Penile vascular study ......................... 0.00 2.66 2.69 NA NA 0.31 XXX 

93990 .... ............ A ........ Doppler flow testing ............................ 0.25 5.16 4.57 NA NA 0.26 XXX 

93990 .... 26 ....... A ........ Doppler flow testing ............................ 0.25 0.06 0.07 0.06 0.07 0.03 XXX 

93990 .... TC ...... A ........ Doppler flow testing ............................ 0.00 5.09 4.50 NA NA 0.23 XXX 

94002 .... ............ A ........ Vent mgmt inpat, init day ................... 1.99 NA NA 0.36 0.33 0.09 XXX 

94003 .... ............ A ........ Vent mgmt inpat, subq day ................ 1.37 NA NA 0.32 0.33 0.06 XXX 

94004 .... ............ A ........ Vent mgmt nf per day ......................... 1.00 NA NA 0.23 0.24 0.04 XXX 

94005 .... ............ B ........ Home vent mgmt supervision ............. 1.50 0.69 0.69 NA NA 0.06 XXX 

94010 .... ............ A ........ Breathing capacity test ....................... 0.17 0.73 0.70 NA NA 0.03 XXX 

94010 .... 26 ....... A ........ Breathing capacity test ....................... 0.17 0.04 0.05 0.04 0.05 0.01 XXX 

94010 .... TC ...... A ........ Breathing capacity test ....................... 0.00 0.69 0.66 NA NA 0.02 XXX 

94014 .... ............ A ........ Patient recorded spirometry ............... 0.52 0.80 0.78 0.80 0.78 0.03 XXX 

94015 .... ............ A ........ Patient recorded spirometry ............... 0.00 0.66 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 1.30 1.19 1.30 1.19 0.07 XXX 

94060 .... 26 ....... A ........ Evaluation of wheezing ...................... 0.31 0.08 0.09 0.08 0.09 0.01 XXX 

94060 .... TC ...... A ........ Evaluation of wheezing ...................... 0.00 1.22 1.10 1.22 1.10 0.06 XXX 

94070 .... ............ A ........ Evaluation of wheezing ...................... 0.60 0.99 0.90 NA NA 0.13 XXX 

94070 .... 26 ....... A ........ Evaluation of wheezing ...................... 0.60 0.15 0.16 0.15 0.16 0.03 XXX 

94070 .... TC ...... A ........ Evaluation of wheezing ...................... 0.00 0.84 0.74 NA NA 0.10 XXX 

94150 .... ............ B ........ Vital capacity test ............................... 0.07 0.47 0.48 NA NA 0.02 XXX 

94150 .... 26 ....... B ........ Vital capacity test ............................... 0.07 0.02 0.03 0.02 0.03 0.01 XXX 

94150 .... TC ...... B ........ Vital capacity test ............................... 0.00 0.46 0.45 NA NA 0.01 XXX 

94200 .... ............ A ........ Lung function test (MBC/MVV) ........... 0.11 0.50 0.47 NA NA 0.03 XXX 

94200 .... 26 ....... A ........ Lung function test (MBC/MVV) ........... 0.11 0.03 0.03 0.03 0.03 0.01 XXX 

94200 .... TC ...... A ........ Lung function test (MBC/MVV) ........... 0.00 0.47 0.44 NA NA 0.02 XXX 

94240 .... ............ A ........ Residual lung capacity ....................... 0.26 0.81 0.74 NA NA 0.06 XXX 

94240 .... 26 ....... A ........ Residual lung capacity ....................... 0.26 0.06 0.07 0.06 0.07 0.01 XXX 

94240 .... TC ...... A ........ Residual lung capacity ....................... 0.00 0.75 0.66 NA NA 0.05 XXX 

94250 .... ............ A ........ Expired gas collection ........................ 0.11 0.51 0.58 NA NA 0.02 XXX 

94250 .... 26 ....... A ........ Expired gas collection ........................ 0.11 0.03 0.03 0.03 0.03 0.01 XXX 

94250 .... TC ...... A ........ Expired gas collection ........................ 0.00 0.48 0.55 NA NA 0.01 XXX 

94260 .... ............ A ........ Thoracic gas volume .......................... 0.13 0.75 0.67 NA NA 0.05 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38352 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

94260 .... 26 ....... A ........ Thoracic gas volume .......................... 0.13 0.03 0.04 0.03 0.04 0.01 XXX 

94260 .... TC ...... A ........ Thoracic gas volume .......................... 0.00 0.72 0.63 NA NA 0.04 XXX 

94350 .... ............ A ........ Lung nitrogen washout curve ............. 0.26 0.61 0.69 NA NA 0.05 XXX 

94350 .... 26 ....... A ........ Lung nitrogen washout curve ............. 0.26 0.06 0.07 0.06 0.07 0.01 XXX 

94350 .... TC ...... A ........ Lung nitrogen washout curve ............. 0.00 0.55 0.62 NA NA 0.04 XXX 

94360 .... ............ A ........ Measure airflow resistance ................. 0.26 0.94 0.83 NA NA 0.07 XXX 

94360 .... 26 ....... A ........ Measure airflow resistance ................. 0.26 0.06 0.07 0.06 0.07 0.01 XXX 

94360 .... TC ...... A ........ Measure airflow resistance ................. 0.00 0.88 0.75 NA NA 0.06 XXX 

94370 .... ............ A ........ Breath airway closing volume ............ 0.26 0.60 0.66 NA NA 0.03 XXX 

94370 .... 26 ....... A ........ Breath airway closing volume ............ 0.26 0.07 0.08 0.07 0.08 0.01 XXX 

94370 .... TC ...... A ........ Breath airway closing volume ............ 0.00 0.53 0.58 NA NA 0.02 XXX 

94375 .... ............ A ........ Respiratory flow volume loop ............. 0.31 0.71 0.66 NA NA 0.03 XXX 

94375 .... 26 ....... A ........ Respiratory flow volume loop ............. 0.31 0.08 0.09 0.08 0.09 0.01 XXX 

94375 .... TC ...... A ........ Respiratory flow volume loop ............. 0.00 0.64 0.57 NA NA 0.02 XXX 

94400 .... ............ A ........ CO2 breathing response curve .......... 0.40 1.02 0.93 NA NA 0.09 XXX 

94400 .... 26 ....... A ........ CO2 breathing response curve .......... 0.40 0.10 0.11 0.10 0.11 0.03 XXX 

94400 .... TC ...... A ........ CO2 breathing response curve .......... 0.00 0.92 0.82 NA NA 0.06 XXX 

94450 .... ............ A ........ Hypoxia response curve ..................... 0.40 1.00 0.93 NA NA 0.04 XXX 

94450 .... 26 ....... A ........ Hypoxia response curve ..................... 0.40 0.09 0.10 0.09 0.10 0.02 XXX 

94450 .... TC ...... A ........ Hypoxia response curve ..................... 0.00 0.91 0.82 NA NA 0.02 XXX 

94452 .... ............ A ........ Hast w/report ...................................... 0.31 1.26 1.12 NA NA 0.04 XXX 

94452 .... 26 ....... A ........ Hast w/report ...................................... 0.31 0.07 0.08 0.07 0.08 0.02 XXX 

94452 .... TC ...... A ........ Hast w/report ...................................... 0.00 1.18 1.03 NA NA 0.02 XXX 

94453 .... ............ A ........ Hast w/oxygen titrate .......................... 0.40 1.67 1.58 NA NA 0.04 XXX 

94453 .... 26 ....... A ........ Hast w/oxygen titrate .......................... 0.40 0.10 0.11 0.10 0.11 0.02 XXX 

94453 .... TC ...... A ........ Hast w/oxygen titrate .......................... 0.00 1.57 1.46 NA NA 0.02 XXX 

94610 .... ............ A ........ Surfactant admin thru tube ................. 1.16 0.34 0.35 0.34 0.35 0.26 XXX 

94620 .... ............ A ........ Pulmonary stress test/simple ............. 0.64 0.79 1.64 NA NA 0.13 XXX 

94620 .... 26 ....... A ........ Pulmonary stress test/simple ............. 0.64 0.17 0.18 0.17 0.18 0.03 XXX 

94620 .... TC ...... A ........ Pulmonary stress test/simple ............. 0.00 0.62 1.45 NA NA 0.10 XXX 

94621 .... ............ A ........ Pulm stress test/complex ................... 1.42 3.11 2.67 NA NA 0.16 XXX 

94621 .... 26 ....... A ........ Pulm stress test/complex ................... 1.42 0.44 0.45 0.44 0.45 0.06 XXX 

94621 .... TC ...... A ........ Pulm stress test/complex ................... 0.00 2.67 2.22 NA NA 0.10 XXX 

94640 .... ............ A ........ Airway inhalation treatment ................ 0.00 0.37 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 0.95 0.93 NA NA 0.02 XXX 

94645 .... ............ A ........ Cbt, each addl hour ............................ 0.00 0.34 0.34 NA NA 0.02 XXX 

94660 .... ............ A ........ Pos airway pressure, CPAP ............... 0.76 0.80 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 0.47 NA NA 0.02 XXX 

94680 .... ............ A ........ Exhaled air analysis, o2 ..................... 0.26 1.05 1.46 1.05 1.46 0.07 XXX 

94680 .... 26 ....... A ........ Exhaled air analysis, o2 ..................... 0.26 0.07 0.08 0.07 0.08 0.01 XXX 

94680 .... TC ...... A ........ Exhaled air analysis, o2 ..................... 0.00 0.98 1.39 0.98 1.39 0.06 XXX 

94681 .... ............ A ........ Exhaled air analysis, o2/co2 .............. 0.20 1.06 1.79 NA NA 0.13 XXX 

94681 .... 26 ....... A ........ Exhaled air analysis, o2/co2 .............. 0.20 0.05 0.06 0.05 0.06 0.01 XXX 

94681 .... TC ...... A ........ Exhaled air analysis, o2/co2 .............. 0.00 1.01 1.74 NA NA 0.12 XXX 

94690 .... ............ A ........ Exhaled air analysis ........................... 0.07 1.03 1.51 NA NA 0.05 XXX 

94690 .... 26 ....... A ........ Exhaled air analysis ........................... 0.07 0.02 0.02 0.02 0.02 0.01 XXX 

94690 .... TC ...... A ........ Exhaled air analysis ........................... 0.00 1.01 1.49 NA NA 0.04 XXX 

94720 .... ............ A ........ Monoxide diffusing capacity ............... 0.26 1.14 1.07 NA NA 0.07 XXX 

94720 .... 26 ....... A ........ Monoxide diffusing capacity ............... 0.26 0.06 0.07 0.06 0.07 0.01 XXX 

94720 .... TC ...... A ........ Monoxide diffusing capacity ............... 0.00 1.08 1.00 NA NA 0.06 XXX 

94725 .... ............ A ........ Membrane diffusion capacity .............. 0.26 0.97 1.94 NA NA 0.13 XXX 

94725 .... 26 ....... A ........ Membrane diffusion capacity .............. 0.26 0.07 0.08 0.07 0.08 0.01 XXX 

94725 .... TC ...... A ........ Membrane diffusion capacity .............. 0.00 0.90 1.87 NA NA 0.12 XXX 

94750 .... ............ A ........ Pulmonary compliance study ............. 0.23 1.75 1.54 NA NA 0.05 XXX 

94750 .... 26 ....... A ........ Pulmonary compliance study ............. 0.23 0.06 0.07 0.06 0.07 0.01 XXX 

94750 .... TC ...... A ........ Pulmonary compliance study ............. 0.00 1.69 1.47 NA NA 0.04 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 0.65 NA NA 0.10 XXX 

94770 .... ............ A ........ Exhaled carbon dioxide test ............... 0.15 0.80 0.77 NA NA 0.08 XXX 

94770 .... 26 ....... A ........ Exhaled carbon dioxide test ............... 0.15 0.04 0.04 0.04 0.04 0.01 XXX 

94770 .... TC ...... A ........ Exhaled carbon dioxide test ............... 0.00 0.76 0.73 NA NA 0.07 XXX 

94772 .... ............ C ........ Breath recording, infant ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94772 .... 26 ....... C ........ Breath recording, infant ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94772 .... TC ...... 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 

mstockstill on PROD1PC66 with PROPOSALS2

38353 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

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 0.00 0.00 0.00 XXX 

94799 .... 26 ....... C ........ Pulmonary service/procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94799 .... TC ...... C ........ Pulmonary service/procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95004 .... ............ A ........ Percut allergy skin tests ..................... 0.00 0.15 0.13 NA NA 0.01 XXX 

95010 .... ............ A ........ Percut allergy titrate test .................... 0.15 0.31 0.31 0.05 0.06 0.01 XXX 

95012 .... ............ A ........ Exhaled nitric oxide meas .................. 0.00 0.48 0.48 NA NA 0.01 XXX 

95015 .... ............ A ........ Id allergy titrate-drug/bug ................... 0.15 0.21 0.18 0.05 0.06 0.01 XXX 

95024 .... ............ A ........ Id allergy test, drug/bug ...................... 0.00 0.17 0.17 NA NA 0.01 XXX 

95027 .... ............ A ........ Id allergy titrate-airborne .................... 0.00 0.10 0.15 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 0.15 0.20 NA NA 0.01 XXX 

95056 .... ............ A ........ Photosensitivity tests .......................... 0.00 1.24 0.70 NA NA 0.01 XXX 

95060 .... ............ A ........ Eye allergy tests ................................. 0.00 0.72 0.53 0.72 0.53 0.02 XXX 

95065 .... ............ A ........ Nose allergy test ................................. 0.00 0.68 0.43 0.68 0.43 0.01 XXX 

95070 .... ............ A ........ Bronchial allergy tests ........................ 0.00 0.80 1.54 NA NA 0.02 XXX 

95071 .... ............ A ........ Bronchial allergy tests ........................ 0.00 0.96 1.93 NA NA 0.02 XXX 

95075 .... ............ A ........ Ingestion challenge test ...................... 0.95 0.66 0.74 0.26 0.32 0.03 XXX 

95115 .... ............ A ........ Immunotherapy, one injection ............ 0.00 0.22 0.31 0.00 0.19 0.02 XXX 

95117 .... ............ A ........ Immunotherapy injections ................... 0.00 0.28 0.39 0.00 0.25 0.02 XXX 

95144 .... ............ A ........ Antigen therapy services .................... 0.06 0.26 0.23 0.02 0.02 0.01 XXX 

95145 .... ............ A ........ Antigen therapy services .................... 0.06 0.35 0.34 0.02 0.02 0.01 XXX 

95146 .... ............ A ........ Antigen therapy services .................... 0.06 0.66 0.55 0.02 0.03 0.01 XXX 

95147 .... ............ A ........ Antigen therapy services .................... 0.06 0.64 0.53 0.02 0.02 0.01 XXX 

95148 .... ............ A ........ Antigen therapy services .................... 0.06 0.95 0.76 0.02 0.03 0.01 XXX 

95149 .... ............ A ........ Antigen therapy services .................... 0.06 1.26 1.03 0.02 0.03 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 0.03 0.01 XXX 

95180 .... ............ A ........ Rapid desensitization ......................... 2.01 1.61 1.82 0.74 0.83 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 3.46 3.79 NA NA 0.01 XXX 

95251 .... ............ A ........ Gluc monitor, cont, phys i&r ............... 0.85 0.26 0.23 0.26 0.23 0.02 XXX 

95805 .... ............ A ........ Multiple sleep latency test .................. 1.88 6.93 12.11 NA NA 0.43 XXX 

95805 .... 26 ....... A ........ Multiple sleep latency test .................. 1.88 0.51 0.58 0.51 0.58 0.09 XXX 

95805 .... TC ...... A ........ Multiple sleep latency test .................. 0.00 6.42 11.53 NA NA 0.34 XXX 

95806 .... ............ A ........ Sleep study, unattended ..................... 1.66 3.87 3.60 NA NA 0.39 XXX 

95806 .... 26 ....... A ........ Sleep study, unattended ..................... 1.66 0.47 0.51 0.47 0.51 0.08 XXX 

95806 .... TC ...... A ........ Sleep study, unattended ..................... 0.00 3.40 3.09 NA NA 0.31 XXX 

95807 .... ............ A ........ Sleep study, attended ......................... 1.66 12.21 11.95 NA NA 0.50 XXX 

95807 .... 26 ....... A ........ Sleep study, attended ......................... 1.66 0.41 0.48 0.41 0.48 0.08 XXX 

95807 .... TC ...... A ........ Sleep study, attended ......................... 0.00 11.80 11.47 NA NA 0.42 XXX 

95808 .... ............ A ........ Polysomnography, 1–3 ....................... 2.65 15.60 14.39 NA NA 0.55 XXX 

95808 .... 26 ....... A ........ Polysomnography, 1–3 ....................... 2.65 0.71 0.82 0.71 0.82 0.13 XXX 

95808 .... TC ...... A ........ Polysomnography, 1–3 ....................... 0.00 14.89 13.58 NA NA 0.42 XXX 

95810 .... ............ A ........ Polysomnography, 4 or more ............. 3.52 17.52 17.53 NA NA 0.59 XXX 

95810 .... 26 ....... A ........ Polysomnography, 4 or more ............. 3.52 0.90 1.05 0.90 1.05 0.17 XXX 

95810 .... TC ...... A ........ Polysomnography, 4 or more ............. 0.00 16.62 16.49 NA NA 0.42 XXX 

95811 .... ............ A ........ Polysomnography w/cpap .................. 3.79 19.51 19.38 NA NA 0.61 XXX 

95811 .... 26 ....... A ........ Polysomnography w/cpap .................. 3.79 0.96 1.12 0.96 1.12 0.18 XXX 

95811 .... TC ...... A ........ Polysomnography w/cpap .................. 0.00 18.54 18.26 NA NA 0.43 XXX 

95812 .... ............ A ........ Eeg, 41–60 minutes ........................... 1.08 5.84 4.94 NA NA 0.17 XXX 

95812 .... 26 ....... A ........ Eeg, 41–60 minutes ........................... 1.08 0.30 0.38 0.30 0.38 0.06 XXX 

95812 .... TC ...... A ........ Eeg, 41–60 minutes ........................... 0.00 5.54 4.56 NA NA 0.11 XXX 

95813 .... ............ A ........ Eeg, over 1 hour ................................. 1.73 6.46 5.75 NA NA 0.20 XXX 

95813 .... 26 ....... A ........ Eeg, over 1 hour ................................. 1.73 0.49 0.60 0.49 0.60 0.09 XXX 

95813 .... TC ...... A ........ Eeg, over 1 hour ................................. 0.00 5.97 5.16 NA NA 0.11 XXX 

95816 .... ............ A ........ Eeg, awake and drowsy ..................... 1.08 5.23 4.48 NA NA 0.16 XXX 

95816 .... 26 ....... A ........ Eeg, awake and drowsy ..................... 1.08 0.30 0.38 0.30 0.38 0.06 XXX 

95816 .... TC ...... A ........ Eeg, awake and drowsy ..................... 0.00 4.92 4.09 NA NA 0.10 XXX 

95819 .... ............ A ........ Eeg, awake and asleep ...................... 1.08 6.07 4.53 NA NA 0.16 XXX 

95819 .... 26 ....... A ........ Eeg, awake and asleep ...................... 1.08 0.30 0.38 0.30 0.38 0.06 XXX 

95819 .... TC ...... A ........ Eeg, awake and asleep ...................... 0.00 5.77 4.15 NA NA 0.10 XXX 

95822 .... ............ A ........ Eeg, coma or sleep only .................... 1.08 5.47 5.04 NA NA 0.19 XXX 

95822 .... 26 ....... A ........ Eeg, coma or sleep only .................... 1.08 0.30 0.38 0.30 0.38 0.06 XXX 

95822 .... TC ...... A ........ Eeg, coma or sleep only .................... 0.00 5.16 4.65 NA NA 0.13 XXX 

95824 .... ............ C ........ Eeg, cerebral death only .................... 0.74 0.00 0.23 0.00 0.23 0.04 XXX 

95824 .... 26 ....... A ........ Eeg, cerebral death only .................... 0.74 0.21 0.26 0.21 0.26 0.04 XXX 

95824 .... TC ...... C ........ Eeg, cerebral death only .................... 0.00 0.00 0.03 0.00 0.03 0.00 XXX 

95827 .... ............ A ........ Eeg, all night recording ...................... 1.08 11.40 7.06 NA NA 0.19 XXX 

95827 .... 26 ....... A ........ Eeg, all night recording ...................... 1.08 0.30 0.35 0.30 0.35 0.05 XXX 

95827 .... TC ...... A ........ Eeg, all night recording ...................... 0.00 11.10 6.71 NA NA 0.14 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38354 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

95829 .... ............ A ........ Surgery electrocorticogram ................ 6.20 20.92 26.68 NA NA 0.50 XXX 

95829 .... 26 ....... A ........ Surgery electrocorticogram ................ 6.20 1.59 1.99 1.59 1.99 0.48 XXX 

95829 .... TC ...... A ........ Surgery electrocorticogram ................ 0.00 19.32 24.69 NA NA 0.02 XXX 

95830 .... ............ A ........ Insert electrodes for EEG ................... 1.70 2.94 3.12 0.42 0.58 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 0.53 0.14 0.19 0.02 XXX 

95834 .... ............ A ........ Body muscle testing, manual ............. 0.60 0.54 0.59 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 0.23 0.24 0.04 0.05 0.01 XXX 

95857 .... ............ A ........ Tensilon test ....................................... 0.53 0.58 0.59 0.16 0.20 0.02 XXX 

95860 .... ............ A ........ Muscle test, one limb ......................... 0.96 1.15 1.29 NA NA 0.07 XXX 

95860 .... 26 ....... A ........ Muscle test, one limb ......................... 0.96 0.32 0.37 0.32 0.37 0.05 XXX 

95860 .... TC ...... A ........ Muscle test, one limb ......................... 0.00 0.83 0.92 NA NA 0.02 XXX 

95861 .... ............ A ........ Muscle test, 2 limbs ............................ 1.54 1.65 1.54 NA NA 0.13 XXX 

95861 .... 26 ....... A ........ Muscle test, 2 limbs ............................ 1.54 0.51 0.60 0.51 0.60 0.07 XXX 

95861 .... TC ...... A ........ Muscle test, 2 limbs ............................ 0.00 1.14 0.94 NA NA 0.06 XXX 

95863 .... ............ A ........ Muscle test, 3 limbs ............................ 1.87 1.91 1.83 NA NA 0.15 XXX 

95863 .... 26 ....... A ........ Muscle test, 3 limbs ............................ 1.87 0.57 0.69 0.57 0.69 0.09 XXX 

95863 .... TC ...... A ........ Muscle test, 3 limbs ............................ 0.00 1.34 1.14 NA NA 0.06 XXX 

95864 .... ............ A ........ Muscle test, 4 limbs ............................ 1.99 2.14 2.40 NA NA 0.21 XXX 

95864 .... 26 ....... A ........ Muscle test, 4 limbs ............................ 1.99 0.62 0.75 0.62 0.75 0.09 XXX 

95864 .... TC ...... A ........ Muscle test, 4 limbs ............................ 0.00 1.52 1.65 NA NA 0.12 XXX 

95865 .... ............ A ........ Muscle test, larynx .............................. 1.57 1.40 1.42 NA NA 0.11 XXX 

95865 .... 26 ....... A ........ Muscle test, larynx .............................. 1.57 0.50 0.63 0.50 0.63 0.08 XXX 

95865 .... TC ...... A ........ Muscle test, larynx .............................. 0.00 0.90 0.79 NA NA 0.03 XXX 

95866 .... ............ A ........ Muscle test, hemidiaphragm .............. 1.25 1.31 1.04 NA NA 0.10 XXX 

95866 .... 26 ....... A ........ Muscle test, hemidiaphragm .............. 1.25 0.39 0.48 0.39 0.48 0.07 XXX 

95866 .... TC ...... A ........ Muscle test, hemidiaphragm .............. 0.00 0.92 0.56 NA NA 0.03 XXX 

95867 .... ............ A ........ Muscle test cran nerv unilat ............... 0.79 1.15 1.04 NA NA 0.07 XXX 

95867 .... 26 ....... A ........ Muscle test cran nerv unilat ............... 0.79 0.24 0.29 0.24 0.29 0.03 XXX 

95867 .... TC ...... A ........ Muscle test cran nerv unilat ............... 0.00 0.90 0.74 NA NA 0.04 XXX 

95868 .... ............ A ........ Muscle test cran nerve bilat ............... 1.18 1.47 1.33 NA NA 0.10 XXX 

95868 .... 26 ....... A ........ Muscle test cran nerve bilat ............... 1.18 0.37 0.44 0.37 0.44 0.05 XXX 

95868 .... TC ...... A ........ Muscle test cran nerve bilat ............... 0.00 1.10 0.89 NA NA 0.05 XXX 

95869 .... ............ A ........ Muscle test, thor paraspinal ............... 0.37 1.02 0.69 NA NA 0.04 XXX 

95869 .... 26 ....... A ........ Muscle test, thor paraspinal ............... 0.37 0.12 0.14 0.12 0.14 0.02 XXX 

95869 .... TC ...... A ........ Muscle test, thor paraspinal ............... 0.00 0.90 0.55 NA NA 0.02 XXX 

95870 .... ............ A ........ Muscle test, nonparaspinal ................. 0.37 0.98 0.68 NA NA 0.04 XXX 

95870 .... 26 ....... A ........ Muscle test, nonparaspinal ................. 0.37 0.12 0.14 0.12 0.14 0.02 XXX 

95870 .... TC ...... A ........ Muscle test, nonparaspinal ................. 0.00 0.86 0.54 NA NA 0.02 XXX 

95872 .... ............ A ........ Muscle test, one fiber ......................... 2.88 1.63 1.44 NA NA 0.13 XXX 

95872 .... 26 ....... A ........ Muscle test, one fiber ......................... 2.88 0.88 0.77 0.88 0.77 0.08 XXX 

95872 .... TC ...... A ........ Muscle test, one fiber ......................... 0.00 0.75 0.68 NA NA 0.05 XXX 

95873 .... ............ A ........ Guide nerv destr, elec stim ................ 0.37 1.01 0.68 1.01 0.68 0.04 ZZZ 

95873 .... 26 ....... A ........ Guide nerv destr, elec stim ................ 0.37 0.14 0.15 0.14 0.15 0.02 ZZZ 

95873 .... TC ...... A ........ Guide nerv destr, elec stim ................ 0.00 0.87 0.53 0.87 0.53 0.02 ZZZ 

95874 .... ............ A ........ Guide nerv destr, needle emg ............ 0.37 0.95 0.66 0.95 0.66 0.04 ZZZ 

95874 .... 26 ....... A ........ Guide nerv destr, needle emg ............ 0.37 0.12 0.15 0.12 0.15 0.02 ZZZ 

95874 .... TC ...... A ........ Guide nerv destr, needle emg ............ 0.00 0.83 0.52 0.83 0.52 0.02 ZZZ 

95875 .... ............ A ........ Limb exercise test .............................. 1.10 1.46 1.43 NA NA 0.11 XXX 

95875 .... 26 ....... A ........ Limb exercise test .............................. 1.10 0.39 0.42 0.39 0.42 0.05 XXX 

95875 .... TC ...... A ........ Limb exercise test .............................. 0.00 1.07 1.01 NA NA 0.06 XXX 

95900 .... ............ A ........ Motor nerve conduction test ............... 0.42 0.91 1.09 NA NA 0.04 XXX 

95900 .... 26 ....... A ........ Motor nerve conduction test ............... 0.42 0.14 0.16 0.14 0.16 0.02 XXX 

95900 .... TC ...... A ........ Motor nerve conduction test ............... 0.00 0.77 0.93 NA NA 0.02 XXX 

95903 .... ............ A ........ Motor nerve conduction test ............... 0.60 0.99 1.10 NA NA 0.05 XXX 

95903 .... 26 ....... A ........ Motor nerve conduction test ............... 0.60 0.17 0.22 0.17 0.22 0.03 XXX 

95903 .... TC ...... A ........ Motor nerve conduction test ............... 0.00 0.82 0.88 NA NA 0.02 XXX 

95904 .... ............ A ........ Sense nerve conduction test .............. 0.34 0.84 0.97 NA NA 0.04 XXX 

95904 .... 26 ....... A ........ Sense nerve conduction test .............. 0.34 0.10 0.13 0.10 0.13 0.02 XXX 

95904 .... TC ...... A ........ Sense nerve conduction test .............. 0.00 0.74 0.84 NA NA 0.02 XXX 

95920 .... ............ A ........ Intraop nerve test add-on ................... 2.11 1.72 1.99 1.72 1.99 0.23 ZZZ 

95920 .... 26 ....... A ........ Intraop nerve test add-on ................... 2.11 0.63 0.79 0.63 0.79 0.16 ZZZ 

95920 .... TC ...... A ........ Intraop nerve test add-on ................... 0.00 1.09 1.20 1.09 1.20 0.07 ZZZ 

95921 .... ............ A ........ Autonomic nerv function test .............. 0.90 1.14 0.93 NA NA 0.06 XXX 

95921 .... 26 ....... A ........ Autonomic nerv function test .............. 0.90 0.24 0.29 0.24 0.29 0.04 XXX 

95921 .... TC ...... A ........ Autonomic nerv function test .............. 0.00 0.90 0.64 NA NA 0.02 XXX 

95922 .... ............ A ........ Autonomic nerv function test .............. 0.96 1.59 1.20 NA NA 0.07 XXX 

95922 .... 26 ....... A ........ Autonomic nerv function test .............. 0.96 0.26 0.33 0.26 0.33 0.05 XXX 

95922 .... TC ...... A ........ Autonomic nerv function test .............. 0.00 1.33 0.86 NA NA 0.02 XXX 

95923 .... ............ A ........ Autonomic nerv function test .............. 0.90 2.31 2.10 NA NA 0.07 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38355 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

95923 .... 26 ....... A ........ Autonomic nerv function test .............. 0.90 0.26 0.32 0.26 0.32 0.05 XXX 

95923 .... TC ...... A ........ Autonomic nerv function test .............. 0.00 2.06 1.78 NA NA 0.02 XXX 

95925 .... ............ A ........ Somatosensory testing ....................... 0.54 3.04 2.10 NA NA 0.10 XXX 

95925 .... 26 ....... A ........ Somatosensory testing ....................... 0.54 0.15 0.19 0.15 0.19 0.04 XXX 

95925 .... TC ...... A ........ Somatosensory testing ....................... 0.00 2.88 1.91 NA NA 0.06 XXX 

95926 .... ............ A ........ Somatosensory testing ....................... 0.54 2.96 2.05 NA NA 0.09 XXX 

95926 .... 26 ....... A ........ Somatosensory testing ....................... 0.54 0.15 0.19 0.15 0.19 0.03 XXX 

95926 .... TC ...... A ........ Somatosensory testing ....................... 0.00 2.81 1.86 NA NA 0.06 XXX 

95927 .... ............ A ........ Somatosensory testing ....................... 0.54 3.10 2.12 NA NA 0.10 XXX 

95927 .... 26 ....... A ........ Somatosensory testing ....................... 0.54 0.17 0.21 0.17 0.21 0.04 XXX 

95927 .... TC ...... A ........ Somatosensory testing ....................... 0.00 2.93 1.91 NA NA 0.06 XXX 

95928 .... ............ A ........ C motor evoked, uppr limbs ............... 1.50 3.90 3.47 NA NA 0.09 XXX 

95928 .... 26 ....... A ........ C motor evoked, uppr limbs ............... 1.50 0.44 0.55 0.44 0.55 0.06 XXX 

95928 .... TC ...... A ........ C motor evoked, uppr limbs ............... 0.00 3.46 2.92 NA NA 0.03 XXX 

95929 .... ............ A ........ C motor evoked, lwr limbs .................. 1.50 4.22 3.73 NA NA 0.09 XXX 

95929 .... 26 ....... A ........ C motor evoked, lwr limbs .................. 1.50 0.45 0.56 0.45 0.56 0.06 XXX 

95929 .... TC ...... A ........ C motor evoked, lwr limbs .................. 0.00 3.78 3.17 NA NA 0.03 XXX 

95930 .... ............ A ........ Visual evoked potential test ............... 0.35 2.62 2.43 NA NA 0.03 XXX 

95930 .... 26 ....... A ........ Visual evoked potential test ............... 0.35 0.10 0.13 0.10 0.13 0.02 XXX 

95930 .... TC ...... A ........ Visual evoked potential test ............... 0.00 2.52 2.31 NA NA 0.01 XXX 

95933 .... ............ A ........ Blink reflex test ................................... 0.59 1.10 1.06 NA NA 0.10 XXX 

95933 .... 26 ....... A ........ Blink reflex test ................................... 0.59 0.17 0.20 0.17 0.20 0.04 XXX 

95933 .... TC ...... A ........ Blink reflex test ................................... 0.00 0.93 0.86 NA NA 0.06 XXX 

95934 .... ............ A ........ H-reflex test ........................................ 0.51 0.85 0.65 NA NA 0.04 XXX 

95934 .... 26 ....... A ........ H-reflex test ........................................ 0.51 0.16 0.19 0.16 0.19 0.02 XXX 

95934 .... TC ...... A ........ H-reflex test ........................................ 0.00 0.70 0.46 NA NA 0.02 XXX 

95936 .... ............ A ........ H-reflex test ........................................ 0.55 0.59 0.52 NA NA 0.05 XXX 

95936 .... 26 ....... A ........ H-reflex test ........................................ 0.55 0.16 0.20 0.16 0.20 0.03 XXX 

95936 .... TC ...... A ........ H-reflex test ........................................ 0.00 0.42 0.32 NA NA 0.02 XXX 

95937 .... ............ A ........ Neuromuscular junction test ............... 0.65 0.91 0.76 NA NA 0.10 XXX 

95937 .... 26 ....... A ........ Neuromuscular junction test ............... 0.65 0.20 0.23 0.20 0.23 0.08 XXX 

95937 .... TC ...... A ........ Neuromuscular junction test ............... 0.00 0.71 0.52 NA NA 0.02 XXX 

95950 .... ............ A ........ Ambulatory eeg monitoring ................ 1.51 4.88 4.41 NA NA 0.51 XXX 

95950 .... 26 ....... A ........ Ambulatory eeg monitoring ................ 1.51 0.43 0.54 0.43 0.54 0.08 XXX 

95950 .... TC ...... A ........ Ambulatory eeg monitoring ................ 0.00 4.45 3.88 NA NA 0.43 XXX 

95951 .... ............ C ........ EEG monitoring/videorecord .............. 5.99 0.00 20.01 0.00 20.01 0.32 XXX 

95951 .... 26 ....... A ........ EEG monitoring/videorecord .............. 5.99 1.69 2.12 1.69 2.12 0.32 XXX 

95951 .... TC ...... C ........ EEG monitoring/videorecord .............. 0.00 0.00 18.45 0.00 18.45 0.00 XXX 

95953 .... ............ A ........ EEG monitoring/computer .................. 3.30 7.16 7.40 NA NA 0.60 XXX 

95953 .... 26 ....... A ........ EEG monitoring/computer .................. 3.30 0.93 1.12 0.93 1.12 0.17 XXX 

95953 .... TC ...... A ........ EEG monitoring/computer .................. 0.00 6.23 6.28 NA NA 0.43 XXX 

95954 .... ............ A ........ EEG monitoring/giving drugs .............. 2.45 4.34 4.37 NA NA 0.19 XXX 

95954 .... 26 ....... A ........ EEG monitoring/giving drugs .............. 2.45 0.43 0.75 0.43 0.75 0.13 XXX 

95954 .... TC ...... A ........ EEG monitoring/giving drugs .............. 0.00 3.91 3.62 NA NA 0.06 XXX 

95955 .... ............ A ........ EEG during surgery ............................ 1.01 2.73 2.53 2.73 2.53 0.22 XXX 

95955 .... 26 ....... A ........ EEG during surgery ............................ 1.01 0.28 0.32 0.28 0.32 0.05 XXX 

95955 .... TC ...... A ........ EEG during surgery ............................ 0.00 2.45 2.21 2.45 2.21 0.17 XXX 

95956 .... ............ A ........ Eeg monitoring, cable/radio ................ 3.08 16.14 15.69 NA NA 0.59 XXX 

95956 .... 26 ....... A ........ Eeg monitoring, cable/radio ................ 3.08 0.87 1.09 0.87 1.09 0.16 XXX 

95956 .... TC ...... A ........ Eeg monitoring, cable/radio ................ 0.00 15.27 14.60 NA NA 0.43 XXX 

95957 .... ............ A ........ EEG digital analysis ........................... 1.98 5.80 4.18 NA NA 0.23 XXX 

95957 .... 26 ....... A ........ EEG digital analysis ........................... 1.98 0.56 0.71 0.56 0.71 0.11 XXX 

95957 .... TC ...... A ........ EEG digital analysis ........................... 0.00 5.24 3.47 NA NA 0.12 XXX 

95958 .... ............ A ........ EEG monitoring/function test .............. 4.24 6.66 5.05 NA NA 0.34 XXX 

95958 .... 26 ....... A ........ EEG monitoring/function test .............. 4.24 1.24 1.49 1.24 1.49 0.21 XXX 

95958 .... TC ...... A ........ EEG monitoring/function test .............. 0.00 5.42 3.57 NA NA 0.13 XXX 

95961 .... ............ A ........ Electrode stimulation, brain ................ 2.97 3.04 2.85 NA NA 0.55 XXX 

95961 .... 26 ....... A ........ Electrode stimulation, brain ................ 2.97 0.88 1.11 0.88 1.11 0.48 XXX 

95961 .... TC ...... A ........ Electrode stimulation, brain ................ 0.00 2.16 1.74 NA NA 0.07 XXX 

95962 .... ............ A ........ Electrode stim, brain add-on .............. 3.21 2.20 2.46 2.20 2.46 0.39 ZZZ 

95962 .... 26 ....... A ........ Electrode stim, brain add-on .............. 3.21 0.91 1.16 0.91 1.16 0.32 ZZZ 

95962 .... TC ...... A ........ Electrode stim, brain add-on .............. 0.00 1.28 1.30 1.28 1.30 0.07 ZZZ 

95965 .... ............ C ........ Meg, spontaneous .............................. 7.99 0.00 2.09 0.00 2.09 0.46 XXX 

95965 .... 26 ....... A ........ Meg, spontaneous .............................. 7.99 2.31 2.86 2.31 2.86 0.46 XXX 

95965 .... TC ...... C ........ Meg, spontaneous .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95966 .... ............ C ........ Meg, evoked, single ........................... 3.99 0.00 1.05 0.00 1.05 0.19 XXX 

95966 .... 26 ....... A ........ Meg, evoked, single ........................... 3.99 1.17 1.44 1.17 1.44 0.19 XXX 

95966 .... TC ...... C ........ Meg, evoked, single ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95967 .... ............ C ........ Meg, evoked, each addœl ................... 3.49 0.00 0.75 0.00 0.75 0.16 ZZZ 

95967 .... 26 ....... A ........ Meg, evoked, each addœl ................... 3.49 1.01 1.09 1.01 1.09 0.16 ZZZ 

95967 .... TC ...... C ........ Meg, evoked, each addœl ................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

95970 .... ............ A ........ Analyze neurostim, no prog ............... 0.45 0.89 0.87 0.13 0.14 0.03 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38356 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

95971 .... ............ A ........ Analyze neurostim, simple ................. 0.78 0.58 0.63 0.19 0.21 0.07 XXX 

95972 .... ............ A ........ Analyze neurostim, complex .............. 1.50 1.15 1.19 0.45 0.47 0.14 XXX 

95973 .... ............ A ........ Analyze neurostim, complex .............. 0.92 0.49 0.57 0.22 0.29 0.07 ZZZ 

95974 .... ............ A ........ Cranial neurostim, complex ................ 3.00 1.44 1.58 0.79 1.06 0.16 XXX 

95975 .... ............ A ........ Cranial neurostim, complex ................ 1.70 0.73 0.82 0.47 0.60 0.12 ZZZ 

95978 .... ............ A ........ Analyze neurostim brain/1h ................ 3.50 1.86 1.89 1.04 1.17 0.18 XXX 

95979 .... ............ A ........ Analyz neurostim brain add-on .......... 1.64 0.73 0.80 0.47 0.58 0.08 ZZZ 

95990 .... ............ A ........ Spin/brain pump refil & main .............. 0.00 1.61 1.56 NA NA 0.06 XXX 

95991 .... ............ A ........ Spin/brain pump refil & main .............. 0.77 1.60 1.55 0.18 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 0.51 0.11 XXX 

96001 .... ............ A ........ Motion test w/ft press meas ............... 2.15 NA NA 0.55 0.60 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 0.12 0.02 XXX 

96004 .... ............ A ........ Phys review of motion tests ............... 2.14 0.65 0.78 0.65 0.78 0.11 XXX 

96020 .... ............ C ........ Functional brain mapping ................... 0.00 NA NA NA NA 0.17 XXX 

96020 .... 26 ....... A ........ Functional brain mapping ................... 3.43 1.05 0.92 1.05 0.92 0.17 XXX 

96020 .... TC ...... C ........ Functional brain mapping ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

96040 .... ............ B ........ Genetic counseling, 30 min ................ 0.00 0.97 0.97 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 1.09 0.90 0.10 0.13 0.01 XXX 

96103 .... ............ A ........ Psycho testing admin by comp .......... 0.51 0.91 0.63 0.10 0.13 0.02 XXX 

96105 .... ............ A ........ Assessment of aphasia ...................... 0.00 1.64 1.77 NA NA 0.18 XXX 

96110 .... ............ A ........ Developmental test, lim ...................... 0.00 0.18 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 0.53 0.68 0.41 0.53 0.18 XXX 

96118 .... ............ A ........ Neuropsych tst by psych/phys ........... 1.86 0.83 1.11 0.33 0.48 0.18 XXX 

96119 .... ............ A ........ Neuropsych testing by tec .................. 0.55 1.51 1.27 0.10 0.15 0.18 XXX 

96120 .... ............ A ........ Neuropsych tst admin w/comp ........... 0.51 1.67 1.25 0.10 0.13 0.02 XXX 

96150 .... ............ A ........ Assess hlth/behave, init ...................... 0.50 0.10 0.14 0.09 0.14 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 0.03 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 0.13 0.02 XXX 

96401 .... ............ A ........ Chemo, anti-neopl, sq/im ................... 0.21 1.84 1.51 NA NA 0.01 XXX 

96402 .... ............ A ........ Chemo hormon antineopl sq/im ......... 0.19 0.77 0.88 NA NA 0.01 XXX 

96405 .... ............ A ........ Chemo intralesional, up to 7 .............. 0.52 3.67 3.03 0.24 0.24 0.03 000 

96406 .... ............ A ........ Chemo intralesional over 7 ................ 0.80 3.58 3.25 0.33 0.30 0.03 000 

96409 .... ............ A ........ Chemo, iv push, sngl drug ................. 0.24 2.77 2.84 NA NA 0.06 XXX 

96411 .... ............ A ........ Chemo, iv push, addl drug ................. 0.20 1.49 1.55 NA NA 0.06 ZZZ 

96413 .... ............ A ........ Chemo, iv infusion, 1 hr ..................... 0.28 3.61 3.90 NA NA 0.08 XXX 

96415 .... ............ A ........ Chemo, iv infusion, addl hr ................ 0.19 0.65 0.71 NA NA 0.07 ZZZ 

96416 .... ............ A ........ Chemo prolong infuse w/pump .......... 0.21 4.05 4.33 NA NA 0.08 XXX 

96417 .... ............ A ........ Chemo iv infus each addl seq ............ 0.21 1.71 1.83 NA NA 0.07 ZZZ 

96420 .... ............ A ........ Chemo, ia, push tecnique .................. 0.17 2.77 2.70 NA NA 0.08 XXX 

96422 .... ............ A ........ Chemo ia infusion up to 1 hr .............. 0.17 4.46 4.53 NA NA 0.08 XXX 

96423 .... ............ A ........ Chemo ia infuse each addl hr ............ 0.17 1.98 1.92 NA NA 0.02 ZZZ 

96425 .... ............ A ........ Chemotherapy, infusion method ........ 0.17 4.64 4.53 NA NA 0.08 XXX 

96440 .... ............ A ........ Chemotherapy, intracavitary ............... 2.37 5.46 6.81 0.97 1.10 0.17 000 

96445 .... ............ A ........ Chemotherapy, intracavitary ............... 2.20 5.39 6.72 0.97 1.07 0.14 000 

96450 .... ............ A ........ Chemotherapy, into CNS ................... 1.53 4.95 5.95 0.84 1.07 0.09 000 

96521 .... ............ A ........ Refill/maint, portable pump ................. 0.21 3.13 3.44 NA NA 0.06 XXX 

96522 .... ............ A ........ Refill/maint pump/resvr syst ............... 0.21 2.76 2.69 NA NA 0.06 XXX 

96523 .... ............ T ......... Irrig drug delivery device .................... 0.04 0.64 0.67 NA NA 0.01 XXX 

96542 .... ............ A ........ Chemotherapy injection ...................... 0.75 3.53 3.89 0.33 0.50 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 3.72 2.84 NA NA 0.04 XXX 

96570 .... ............ A ........ Photodynamic tx, 30 min .................... 1.10 0.40 0.39 0.40 0.39 0.11 ZZZ 

96571 .... ............ A ........ Photodynamic tx, addl 15 min ............ 0.55 0.20 0.19 0.20 0.19 0.03 ZZZ 

96900 .... ............ A ........ Ultraviolet light therapy ....................... 0.00 0.56 0.50 NA NA 0.02 XXX 

96902 .... ............ B ........ Trichogram .......................................... 0.41 0.11 0.14 0.09 0.13 0.01 XXX 

96904 .... ............ R ........ Whole body photography ................... 0.00 1.89 1.89 NA NA 0.01 XXX 

96910 .... ............ A ........ Photochemotherapy with UV–B ......... 0.00 2.00 1.49 NA NA 0.04 XXX 

96912 .... ............ A ........ Photochemotherapy with UV–A ......... 0.00 2.57 1.92 NA NA 0.05 XXX 

96913 .... ............ A ........ Photochemotherapy, UV–A or B ........ 0.00 3.45 2.60 NA NA 0.10 XXX 

96920 .... ............ A ........ Laser tx, skin < 250 sq cm ................. 1.15 3.57 3.06 0.57 0.57 0.02 000 

96921 .... ............ A ........ Laser tx, skin 250–500 sq cm ............ 1.17 3.32 2.99 0.52 0.55 0.03 000 

96922 .... ............ A ........ Laser tx, skin > 500 sq cm ................. 2.10 4.63 4.06 1.05 0.84 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 0.66 0.71 NA NA 0.05 XXX 

97002 .... ............ A ........ Pt re-evaluation .................................. 0.60 0.41 0.42 NA NA 0.02 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38357 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

97003 .... ............ A ........ Ot evaluation ...................................... 1.20 0.76 0.83 NA NA 0.06 XXX 

97004 .... ............ A ........ Ot re-evaluation .................................. 0.60 0.54 0.61 NA NA 0.02 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 0.19 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 0.16 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 0.07 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 0.35 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 0.05 NA NA 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 0.28 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 0.10 NA NA 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 0.26 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 

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 

97605 .... ............ A ........ Neg press wound tx, < 50 cm ............ 0.55 0.40 0.37 0.12 0.17 0.02 XXX 

97606 .... ............ A ........ Neg press wound tx, > 50 cm ............ 0.60 0.42 0.39 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 0.28 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 0.58 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 0.31 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 0.19 0.03 XXX 

97811 .... ............ N ........ Acupunct w/o stimul addl 15m ........... 0.50 0.15 0.20 0.12 0.15 0.03 ZZZ 

97813 .... ............ N ........ Acupunct w/stimul 15 min .................. 0.65 0.27 0.34 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 0.48 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 0.28 0.18 0.17 0.01 000 

98942 .... ............ A ........ Chiropractic manipulation ................... 0.87 0.34 0.35 0.24 0.23 0.02 000 

98943 .... ............ N ........ Chiropractic manipulation ................... 0.40 0.17 0.20 0.09 0.12 0.01 XXX 

98960 .... ............ B ........ Self-mgmt educ & train, 1 pt .............. 0.00 0.58 0.57 NA NA 0.01 XXX 

98961 .... ............ B ........ Self-mgmt educ/train, 2–4 pt .............. 0.00 0.28 0.27 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 

99082 .... ............ C ........ Unusual physician travel .................... 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 

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 1.82 1.74 0.61 0.56 0.08 000 

99173 .... ............ N ........ Visual acuity screen ........................... 0.00 0.06 0.06 NA NA 0.01 XXX 

99175 .... ............ A ........ Induction of vomiting .......................... 0.00 0.37 0.88 NA NA 0.10 XXX 

99183 .... ............ A ........ Hyperbaric oxygen therapy ................ 2.34 2.58 2.91 0.58 0.65 0.16 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38358 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

99185 .... ............ A ........ Regional hypothermia ......................... 0.00 1.63 1.14 NA NA 0.04 XXX 

99186 .... ............ A ........ Total body hypothermia ...................... 0.00 1.61 1.66 NA NA 0.45 XXX 

99195 .... ............ A ........ Phlebotomy ......................................... 0.00 2.54 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 0.30 0.31 0.05 XXX 

99203 .... ............ A ........ Office/outpatient visit, new ................. 1.34 1.10 1.12 0.43 0.46 0.09 XXX 

99204 .... ............ A ........ Office/outpatient visit, new ................. 2.30 1.48 1.49 0.71 0.71 0.12 XXX 

99205 .... ............ A ........ Office/outpatient visit, new ................. 3.00 1.77 1.78 0.91 0.94 0.15 XXX 

99211 .... ............ A ........ Office/outpatient visit, est ................... 0.17 0.32 0.35 0.06 0.06 0.01 XXX 

99212 .... ............ A ........ Office/outpatient visit, est ................... 0.45 0.55 0.54 0.15 0.16 0.03 XXX 

99213 .... ............ A ........ Office/outpatient visit, est ................... 0.92 0.76 0.73 0.28 0.26 0.03 XXX 

99214 .... ............ A ........ Office/outpatient visit, est ................... 1.42 1.09 1.06 0.44 0.43 0.05 XXX 

99215 .... ............ A ........ Office/outpatient visit, est ................... 2.00 1.37 1.35 0.61 0.63 0.08 XXX 

99217 .... ............ A ........ Observation care discharge ............... 1.28 NA NA 0.49 0.52 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 0.66 0.10 XXX 

99220 .... ............ A ........ Observation care ................................ 2.99 NA NA 0.84 0.94 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 0.73 0.10 XXX 

99223 .... ............ A ........ Initial hospital care .............................. 3.78 NA NA 1.07 1.06 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 0.43 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 0.84 0.13 XXX 

99235 .... ............ A ........ Observ/hosp same date ..................... 3.41 NA NA 0.98 1.07 0.16 XXX 

99236 .... ............ A ........ Observ/hosp same date ..................... 4.26 NA NA 1.21 1.34 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 1.92 1.88 1.08 1.01 0.16 XXX 

99245 .... ............ A ........ Office consultation .............................. 3.77 2.24 2.27 1.31 1.28 0.21 XXX 

99251 .... ............ A ........ Inpatient consultation .......................... 1.00 NA NA 0.31 0.28 0.05 XXX 

99252 .... ............ A ........ Inpatient consultation .......................... 1.50 NA NA 0.49 0.50 0.09 XXX 

99253 .... ............ A ........ Inpatient consultation .......................... 2.27 NA NA 0.80 0.75 0.11 XXX 

99254 .... ............ A ........ Inpatient consultation .......................... 3.29 NA NA 1.18 1.09 0.13 XXX 

99255 .... ............ A ........ Inpatient consultation .......................... 4.00 NA NA 1.38 1.37 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 0.16 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 0.47 0.47 0.14 XXX 

99285 .... ............ A ........ Emergency dept visit .......................... 3.80 NA NA 0.67 0.70 0.23 XXX 

99289 .... ............ A ........ Ped crit care transport ........................ 4.79 NA NA 1.08 1.27 0.24 XXX 

99290 .... ............ A ........ Ped crit care transport addl ................ 2.40 NA NA 0.87 0.80 0.12 ZZZ 

99291 .... ............ A ........ Critical care, first hour ........................ 4.50 2.24 2.41 1.10 1.20 0.21 XXX 

99292 .... ............ A ........ Critical care, addœl 30 min ................. 2.25 0.79 0.86 0.56 0.61 0.11 ZZZ 

99293 .... ............ A ........ Ped critical care, initial ....................... 15.98 NA NA 3.78 4.25 1.12 XXX 

99294 .... ............ A ........ Ped critical care, subseq .................... 7.99 NA NA 1.66 2.05 0.45 XXX 

99295 .... ............ A ........ Neonate crit care, initial ...................... 18.46 NA NA 4.61 4.96 1.16 XXX 

99296 .... ............ A ........ Neonate critical care subseq .............. 7.99 NA NA 2.07 2.26 0.32 XXX 

99298 .... ............ A ........ Ic for lbw infant < 1500 gm ................ 2.75 NA NA 0.68 0.81 0.17 XXX 

99299 .... ............ A ........ Ic, lbw infant 1500–2500 gm .............. 2.50 NA NA 0.59 0.76 0.16 XXX 

99300 .... ............ A ........ Ic, infant pbw 2501–5000 gm ............. 2.40 NA NA 0.71 0.78 0.15 XXX 

99304 .... ............ A ........ Nursing facility care, init ..................... 1.61 0.57 0.51 0.57 0.51 0.05 XXX 

99305 .... ............ A ........ Nursing facility care, init ..................... 2.30 0.74 0.66 0.74 0.66 0.07 XXX 

99306 .... ............ A ........ Nursing facility care, init ..................... 3.00 0.91 0.79 0.91 0.79 0.09 XXX 

99307 .... ............ A ........ Nursing fac care, subseq ................... 0.76 0.31 0.28 0.31 0.28 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 0.80 0.87 0.80 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 0.51 0.55 0.51 0.55 0.06 XXX 

99318 .... ............ A ........ Annual nursing fac assessmnt ........... 1.71 0.56 0.51 0.56 0.51 0.05 XXX 

99324 .... ............ A ........ Domicil/r-home visit new pat .............. 1.01 0.42 0.46 NA NA 0.05 XXX 

99325 .... ............ A ........ Domicil/r-home visit new pat .............. 1.52 0.54 0.62 NA NA 0.07 XXX 

99326 .... ............ A ........ Domicil/r-home visit new pat .............. 2.27 0.73 0.83 NA NA 0.10 XXX 

99327 .... ............ A ........ Domicil/r-home visit new pat .............. 3.03 0.92 1.05 NA NA 0.13 XXX 

99328 .... ............ A ........ Domicil/r-home visit new pat .............. 3.78 1.09 1.26 NA NA 0.16 XXX 

99334 .... ............ A ........ Domicil/r-home visit est pat ................ 0.76 0.35 0.38 NA NA 0.04 XXX 

99335 .... ............ A ........ Domicil/r-home visit est pat ................ 1.26 0.47 0.53 NA NA 0.06 XXX 

mstockstill on PROD1PC66 with PROPOSALS2

38359 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

99336 .... ............ A ........ Domicil/r-home visit est pat ................ 2.02 0.66 0.74 NA NA 0.09 XXX 

99337 .... ............ A ........ Domicil/r-home visit est pat ................ 3.03 0.90 1.03 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 0.76 0.76 NA NA 0.07 XXX 

99341 .... ............ A ........ Home visit, new patient ...................... 1.01 0.42 0.45 NA NA 0.05 XXX 

99342 .... ............ A ........ Home visit, new patient ...................... 1.52 0.54 0.62 NA NA 0.07 XXX 

99343 .... ............ A ........ Home visit, new patient ...................... 2.27 0.74 0.85 NA NA 0.10 XXX 

99344 .... ............ A ........ Home visit, new patient ...................... 3.03 0.91 1.05 NA NA 0.13 XXX 

99345 .... ............ A ........ Home visit, new patient ...................... 3.78 1.08 1.26 NA NA 0.16 XXX 

99347 .... ............ A ........ Home visit, est patient ........................ 0.76 0.35 0.38 NA NA 0.04 XXX 

99348 .... ............ A ........ Home visit, est patient ........................ 1.26 0.48 0.53 NA NA 0.06 XXX 

99349 .... ............ A ........ Home visit, est patient ........................ 2.02 0.66 0.75 NA NA 0.09 XXX 

99350 .... ............ A ........ Home visit, est patient ........................ 3.03 0.90 1.05 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 0.69 0.47 0.56 0.07 ZZZ 

99356 .... ............ A ........ Prolonged service, inpatient ............... 1.71 NA NA 0.50 0.57 0.07 ZZZ 

99357 .... ............ A ........ Prolonged service, inpatient ............... 1.71 NA NA 0.50 0.57 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 1.29 1.29 0.38 0.38 0.07 XXX 

99364 .... ............ B ........ Anticoag mgmt, subseq ...................... 0.63 0.38 0.38 0.15 0.15 0.04 XXX 

99374 .... ............ B ........ Home health care supervision ............ 1.10 0.54 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 0.54 0.62 0.25 0.34 0.05 XXX 

99378 .... ............ I .......... Hospice care supervision ................... 1.73 0.75 1.34 0.40 1.17 0.07 XXX 

99379 .... ............ B ........ Nursing fac care supervision .............. 1.10 0.54 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 0.99 1.24 0.27 0.36 0.05 XXX 

99382 .... ............ N ........ Init pm e/m, new pat 1–4 yrs ............. 1.36 1.03 1.28 0.31 0.42 0.05 XXX 

99383 .... ............ N ........ Prev visit, new, age 5–11 ................... 1.36 1.02 1.25 0.31 0.42 0.05 XXX 

99384 .... ............ N ........ Prev visit, new, age 12–17 ................. 1.53 1.06 1.31 0.35 0.47 0.06 XXX 

99385 .... ............ N ........ Prev visit, new, age 18–39 ................. 1.53 1.06 1.31 0.35 0.47 0.06 XXX 

99386 .... ............ N ........ Prev visit, new, age 40–64 ................. 1.88 1.14 1.44 0.43 0.58 0.07 XXX 

99387 .... ............ N ........ Init pm e/m, new pat 65+ yrs ............. 2.06 1.27 1.57 0.48 0.63 0.07 XXX 

99391 .... ............ N ........ Per pm reeval, est pat, inf .................. 1.02 0.85 0.94 0.24 0.31 0.04 XXX 

99392 .... ............ N ........ Prev visit, est, age 1–4 ....................... 1.19 0.89 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 0.93 1.04 0.31 0.42 0.05 XXX 

99396 .... ............ N ........ Prev visit, est, age 40–64 ................... 1.53 0.97 1.11 0.35 0.47 0.06 XXX 

99397 .... ............ N ........ Per pm reeval est pat 65+ yr ............. 1.71 1.11 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 0.47 0.67 0.22 0.30 0.02 XXX 

99403 .... ............ N ........ Preventive counseling, indiv ............... 1.46 0.58 0.83 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 

99411 .... ............ N ........ Preventive counseling, group ............. 0.15 0.22 0.20 0.03 0.04 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 

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 1.00 0.97 0.29 0.34 0.07 XXX 

99433 .... ............ A ........ Normal newborn care/hospital ............ 0.62 NA NA 0.17 0.18 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 

99499 .... ............ C ........ Unlisted e&m service .......................... 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 0.35 0.06 0.06 0.01 XXX 

G0104 ... ............ A ........ CA screen;flexi sigmoidscope ............ 0.96 2.50 2.39 0.62 0.56 0.08 000 

G0105 ... ............ A ........ Colorectal scrn; hi risk ind .................. 3.69 6.35 6.25 1.83 1.66 0.30 000 

G0105 ... 53 ....... A ........ Colorectal scrn; hi risk ind .................. 0.96 2.50 2.39 0.62 0.56 0.08 000 

G0106 ... ............ A ........ Colon CA screen;barium enema ........ 0.99 4.91 3.68 NA NA 0.17 XXX 

G0106 ... 26 ....... A ........ Colon CA screen;barium enema ........ 0.99 0.35 0.32 0.35 0.32 0.04 XXX 

G0106 ... TC ...... A ........ Colon CA screen;barium enema ........ 0.00 4.55 3.36 NA NA 0.13 XXX 

G0108 ... ............ A ........ Diab manage trn per indiv .................. 0.00 0.58 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 0.75 NA NA 0.01 XXX 

G0118 ... ............ T ......... Glaucoma scrn hgh risk direc ............ 0.17 0.71 0.64 NA NA 0.01 XXX 

G0120 ... ............ A ........ Colon ca scrn; barium enema ............ 0.99 4.91 3.68 NA NA 0.17 XXX 

G0120 ... 26 ....... A ........ Colon ca scrn; barium enema ............ 0.99 0.35 0.32 0.35 0.32 0.04 XXX 

G0120 ... TC ...... A ........ Colon ca scrn; barium enema ............ 0.00 4.55 3.36 NA NA 0.13 XXX 

G0121 ... ............ A ........ Colon ca scrn not hi rsk ind ............... 3.69 6.35 6.25 1.83 1.66 0.30 000 

mstockstill on PROD1PC66 with PROPOSALS2

38360 

——————————

1 CPT codes and descriptions are copyright 2007 American Medical Association. 

2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

G0121 ... 53 ....... A ........ Colon ca scrn not hi rsk ind ............... 0.96 2.50 2.39 0.62 0.56 0.08 000 

G0122 ... ............ N ........ Colon ca scrn; barium enema ............ 0.99 5.57 4.07 NA NA 0.18 XXX 

G0122 ... 26 ....... N ........ Colon ca scrn; barium enema ............ 0.99 0.23 0.30 0.23 0.30 0.05 XXX 

G0122 ... TC ...... N ........ Colon ca scrn; barium enema ............ 0.00 5.34 3.77 NA NA 0.13 XXX 

G0124 ... ............ A ........ Screen c/v thin layer by MD ............... 0.42 0.37 0.26 0.37 0.26 0.02 XXX 

G0127 ... ............ R ........ Trim nail(s) .......................................... 0.17 0.37 0.31 0.04 0.06 0.01 000 

G0128 ... ............ R ........ CORF skilled nursing service ............. 0.08 0.02 0.03 0.02 0.03 0.01 XXX 

G0130 ... ............ A ........ Single energy x-ray study ................... 0.22 0.55 0.71 NA NA 0.06 XXX 

G0130 ... 26 ....... A ........ Single energy x-ray study ................... 0.22 0.06 0.07 0.06 0.07 0.01 XXX 

G0130 ... TC ...... A ........ Single energy x-ray study ................... 0.00 0.49 0.64 NA NA 0.05 XXX 

G0141 ... ............ A ........ Scr c/v cyto,autosys and md .............. 0.42 0.37 0.26 0.37 0.26 0.02 XXX 

G0166 ... ............ A ........ Extrnl counterpulse, per tx ................. 0.07 4.35 3.99 NA NA 0.01 XXX 

G0168 ... ............ A ........ Wound closure by adhesive ............... 0.45 1.56 1.75 0.21 0.22 0.03 000 

G0179 ... ............ A ........ MD recertification HHA PT ................. 0.45 0.47 0.75 NA NA 0.02 XXX 

G0180 ... ............ A ........ MD certification HHA patient .............. 0.67 0.55 0.91 NA NA 0.03 XXX 

G0181 ... ............ A ........ Home health care supervision ............ 1.73 0.80 1.15 NA NA 0.07 XXX 

G0182 ... ............ A ........ Hospice care supervision ................... 1.73 0.82 1.25 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 2.81 2.76 NA NA 0.10 XXX 

G0202 ... 26 ....... A ........ Screeningmammographydigital .......... 0.70 0.24 0.23 0.24 0.23 0.03 XXX 

G0202 ... TC ...... A ........ Screeningmammographydigital .......... 0.00 2.57 2.54 NA NA 0.07 XXX 

G0204 ... ............ A ........ Diagnosticmammographydigital .......... 0.87 3.41 3.05 NA NA 0.11 XXX 

G0204 ... 26 ....... A ........ Diagnosticmammographydigital .......... 0.87 0.30 0.28 0.30 0.28 0.04 XXX 

G0204 ... TC ...... A ........ Diagnosticmammographydigital .......... 0.00 3.11 2.77 NA NA 0.07 XXX 

G0206 ... ............ A ........ Diagnosticmammographydigital .......... 0.70 2.67 2.43 NA NA 0.09 XXX 

G0206 ... 26 ....... A ........ Diagnosticmammographydigital .......... 0.70 0.24 0.23 0.24 0.23 0.03 XXX 

G0206 ... TC ...... A ........ Diagnosticmammographydigital .......... 0.00 2.43 2.20 NA NA 0.06 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 0.30 0.31 0.04 XXX 

G0246 ... ............ R ........ Followup eval of foot pt lop ................ 0.45 0.55 0.54 0.15 0.16 0.02 XXX 

G0247 ... ............ R ........ Routine footcare pt w lops ................. 0.50 0.66 0.59 0.16 0.19 0.02 ZZZ 

G0248 ... ............ R ........ Demonstrate use home inr mon ......... 0.00 3.37 4.99 NA NA 0.01 XXX 

G0249 ... ............ R ........ Provide test material,equipm .............. 0.00 2.72 3.29 NA NA 0.01 XXX 

G0250 ... ............ R ........ MD review interpret of test ................. 0.18 0.08 0.07 NA NA 0.01 XXX 

G0252 ... 26 ....... N ........ PET imaging initial dx ......................... 1.50 0.35 0.52 0.35 0.52 0.04 XXX 

G0268 ... ............ A ........ Removal of impacted wax md ............ 0.61 0.66 0.64 0.20 0.22 0.02 000 

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 0.13 NA NA 0.01 XXX 

G0283 ... ............ A ........ Elec stim other than wound ................ 0.18 0.14 0.13 NA NA 0.01 XXX 

G0288 ... ............ A ........ Recon, CTA for surg plan .................. 0.00 1.02 5.81 NA NA 0.18 XXX 

G0289 ... ............ A ........ Arthro, loose body + chondro ............. 1.48 NA NA 0.59 0.70 0.26 ZZZ 

G0308 ... ............ A ........ ESRD related svc 4+mo < 2yrs ......... 12.74 5.62 7.07 5.62 7.07 0.42 XXX 

G0309 ... ............ A ........ ESRD related svc 2–3mo <2yrs ......... 10.61 4.16 5.75 4.16 5.75 0.36 XXX 

G0310 ... ............ A ........ ESRD related svc 1 vst <2yrs ............ 8.49 2.78 4.25 2.78 4.25 0.28 XXX 

G0311 ... ............ A ........ ESRD related svs 4+mo 2–11yr ........ 9.73 3.55 4.15 3.55 4.15 0.34 XXX 

G0312 ... ............ A ........ ESRD relate svs 2–3 mo 2–11y ......... 8.11 2.71 3.32 2.71 3.32 0.29 XXX 

G0313 ... ............ A ........ ESRD related svs 1 mon 2–11y ......... 6.49 1.84 2.50 1.84 2.50 0.22 XXX 

G0314 ... ............ A ........ ESRD related svs 4+ mo 12–19 ........ 8.28 3.39 3.92 3.39 3.92 0.27 XXX 

G0315 ... ............ A ........ ESRD related svs 2–3mo/12–19 ........ 6.90 2.56 3.13 2.56 3.13 0.23 XXX 

G0316 ... ............ A ........ ESRD related svs 1vis/12–19y ........... 5.52 1.67 2.31 1.67 2.31 0.17 XXX 

G0317 ... ............ A ........ ESRD related svs 4+mo 20+yrs ......... 5.09 2.25 2.56 2.25 2.56 0.17 XXX 

G0318 ... ............ A ........ ESRD related svs 2–3 mo 20+y ........ 4.24 1.70 2.05 1.70 2.05 0.14 XXX 

G0319 ... ............ A ........ ESRD related svs 1visit 20+y ............ 3.39 1.14 1.53 1.14 1.53 0.11 XXX 

G0320 ... ............ A ........ ESD related svs home undr 2 ............ 10.61 2.71 4.91 2.71 4.91 0.36 XXX 

G0321 ... ............ A ........ ESRDrelatedsvs home mo 2–11y ...... 8.11 2.00 2.97 2.00 2.97 0.29 XXX 

G0322 ... ............ A ........ ESRD related svs hom mo12–19 ....... 6.90 1.72 2.70 1.72 2.70 0.23 XXX 

G0323 ... ............ A ........ ESRD related svs home mo 20+ ....... 4.24 1.15 1.77 1.15 1.77 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 

G0327 ... ............ A ........ ESRD relate home/dy 20+yrs ............ 0.14 0.06 0.07 0.06 0.07 0.01 XXX 

G0329 ... ............ A ........ Electromagntic tx for ulcers ................ 0.06 0.15 0.14 NA NA 0.01 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 2.42 0.48 000 

G0342 ... ............ A ........ Laparoscopy islet cell trans ................ 11.92 NA NA 5.05 5.18 1.46 090 

mstockstill on PROD1PC66 with PROPOSALS2

38361 

ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS

FOR 2008—Continued 

CPT 1/ 

HCPCS2 Mod Status Description 

Physician 

work 

RVUs 3

Fully implemented 

non-facility 

PE RVUs 3

Year 2008 

transitional 

non-facility 

PE RVUs 3

Fully implemented 

facility PE 

RVUs 3

Year 2008 

transitional 

facility PE 

RVUs 3

Malpractice 

RVUs 3

Global 

G0343 ... ............ A ........ Laparotomy islet cell transp ............... 19.85 NA NA 8.53 8.66 2.07 090 

G0344 ... ............ A ........ Initial preventive exam ........................ 1.34 1.10 1.12 0.43 0.46 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 5.16 4.57 NA NA 0.25 XXX 

G0365 ... 26 ....... A ........ Vessel mapping hemo access ........... 0.25 0.06 0.07 0.06 0.07 0.02 XXX 

G0365 ... TC ...... A ........ Vessel mapping hemo access ........... 0.00 5.09 4.50 NA NA 0.23 XXX 

G0366 ... ............ A ........ EKG for initial prevent exam .............. 0.17 0.33 0.42 0.33 0.42 0.03 XXX 

G0367 ... ............ A ........ EKG tracing for initial prev ................. 0.00 0.27 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 0.05 0.22 0.05 0.06 0.01 XXX 

G0375 ... ............ A ........ Smoke/tobacco counselng 3–10 ........ 0.24 0.07 0.08 0.07 0.08 0.01 XXX 

G0376 ... ............ A ........ Smoke/tobacco counseling >10 ......... 0.48 0.13 0.16 0.13 0.15 0.01 XXX 

G0389 ... ............ A ........ Ultrasound exam AAA screen ............ 0.58 2.40 1.98 NA NA 0.11 XXX 

G0389 ... 26 ....... A ........ Ultrasound exam AAA screen ............ 0.58 0.21 0.20 0.21 0.20 0.03 XXX 

G0389 ... TC ...... A ........ Ultrasound exam AAA screen ............ 0.00 2.19 1.78 NA NA 0.08 XXX 

G0392 ... ............ A ........ AV fistula or graft arterial ................... 9.48 48.02 51.97 NA NA 0.62 000 

G0393 ... ............ A ........ AV fistula or graft venous ................... 6.03 36.79 40.56 NA NA 0.34 000 

G9041 ... ............ A ........ Low vision rehab occupationa ............ 0.44 0.10 0.19 0.10 0.19 0.01 XXX 

G9042 ... ............ A ........ Low vision rehab orient/mobi ............. 0.10 0.02 0.15 0.02 0.15 0.01 XXX 

G9043 ... ............ A ........ Low vision lowvision therapi ............... 0.10 0.02 0.15 0.02 0.15 0.01 XXX 

G9044 ... ............ A ........ Low vision rehabilate teache .............. 0.10 0.02 0.13 0.02 0.13 0.01 XXX 

Gxxx1 .... ............ A ........ MD serv cardiac rehab wo ECG ........ 0.18 0.31 0.31 0.09 0.08 0.01 000 

Gxxx2 .... ............ A ........ MD serv cardiac rehab w ECG .......... 0.28 0.43 0.45 0.13 0.12 0.01 000 

M0064 ... ............ A ........ Visit for drug monitoring ..................... 0.37 0.90 0.62 0.07 0.10 0.01 XXX 

P3001 .... ............ A ........ Screening pap smear by phys ........... 0.42 0.37 0.26 0.37 0.26 0.02 XXX 

Q0035 ... ............ A ........ Cardiokymography .............................. 0.17 0.30 0.38 NA NA 0.03 XXX 

Q0035 ... 26 ....... A ........ Cardiokymography .............................. 0.17 0.05 0.06 0.05 0.06 0.01 XXX 

Q0035 ... TC ...... A ........ Cardiokymography .............................. 0.00 0.25 0.32 NA NA 0.02 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 0.39 0.47 0.39 0.01 XXX 

Q3001 ... ............ C ........ Brachytherapy Radioelements ........... 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 

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 Copyright 2007 American Dental Association. All rights reserved. 

3 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. 133 / Thursday, July 12, 2007 / Proposed Rules 

mstockstill on PROD1PC66 with PROPOSALS2

38362 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH WE RECEIVED PERC RECOMMENDATIONS ON PE DIRECT INPUTS

CPT 1 code Description CPT 1 code Description 

37205 ..................................... Transcath iv stent, percut .................... 58542 ..................................... Lsh w/t/o ut 250 g or less. 

37206 ..................................... Transcath iv stent/perc addl ................. 58543 ..................................... Lsh uterus above 250 g. 

38570 ..................................... Laparoscopy, lymph node biop ............ 58544 ..................................... Lsh w/t/o uterus above 250 g. 

38571 ..................................... Laparoscopy, lymphadenectomy ......... 58545 ..................................... Laparoscopic myomectomy. 

38572 ..................................... Laparoscopy, lymphadenectomy ......... 58546 ..................................... Laparo-myomectomy, complex. 

51840 ..................................... Attach bladder/urethra .......................... 58548 ..................................... Lap radical hyst. 

51841 ..................................... Attach bladder/urethra .......................... 58550 ..................................... Laparo-asst vag hysterectomy. 

51925 ..................................... Hysterectomy/bladder repair ................ 58552 ..................................... Laparo-vag hyst incl t/o. 

56405 ..................................... I & D of vulva/perineum ....................... 58553 ..................................... Laparo-vag hyst, complex. 

56420 ..................................... Drainage of gland abscess .................. 58554 ..................................... Laparo-vag hyst w/t/o, compl. 

56441 ..................................... Lysis of labial lesion(s) ......................... 58555 ..................................... Hysteroscopy, dx, sep proc. 

56501 ..................................... Destroy, vulva lesions, sim .................. 58558 ..................................... Hysteroscopy, biopsy. 

56515 ..................................... Destroy vulva lesion/s compl ............... 58562 ..................................... Hysteroscopy, remove fb. 

56605 ..................................... Biopsy of vulva/perineum ..................... 58563 ..................................... Hysteroscopy, ablation. 

56606 ..................................... Biopsy of vulva/perineum ..................... 58565 ..................................... Hysteroscopy, sterilization. 

56620 ..................................... Partial removal of vulva ....................... 58600 ..................................... Division of fallopian tube. 

56625 ..................................... Complete removal of vulva .................. 58605 ..................................... Division of fallopian tube. 

56630 ..................................... Extensive vulva surgery ....................... 58615 ..................................... Occlude fallopian tube(s). 

56631 ..................................... Extensive vulva surgery ....................... 58660 ..................................... Laparoscopy, lysis. 

56632 ..................................... Extensive vulva surgery ....................... 58661 ..................................... Laparoscopy, remove adnexa. 

56633 ..................................... Extensive vulva surgery ....................... 58662 ..................................... Laparoscopy, excise lesions. 

56634 ..................................... Extensive vulva surgery ....................... 58670 ..................................... Laparoscopy, tubal cautery. 

56637 ..................................... Extensive vulva surgery ....................... 58671 ..................................... Laparoscopy, tubal block. 

56640 ..................................... Extensive vulva surgery ....................... 58672 ..................................... Laparoscopy, fimbrioplasty. 

56700 ..................................... Partial removal of hymen ..................... 58673 ..................................... Laparoscopy, salpingostomy. 

56740 ..................................... Remove vagina gland lesion ................ 58700 ..................................... Removal of fallopian tube. 

56800 ..................................... Repair of vagina ................................... 58720 ..................................... Removal of ovary/tube(s). 

56805 ..................................... Repair clitoris ....................................... 58740 ..................................... Revise fallopian tube(s). 

56810 ..................................... Repair of perineum .............................. 58750 ..................................... Repair oviduct. 

56820 ..................................... Exam of vulva w/scope ........................ 58752 ..................................... Revise ovarian tube(s). 

56821 ..................................... Exam/biopsy of vulva w/scope ............. 58760 ..................................... Remove tubal obstruction. 

57000 ..................................... Exploration of vagina ........................... 58770 ..................................... Create new tubal opening. 

57010 ..................................... Drainage of pelvic abscess .................. 58800 ..................................... Drainage of ovarian cyst(s). 

57020 ..................................... Drainage of pelvic fluid ........................ 58805 ..................................... Drainage of ovarian cyst(s). 

57022 ..................................... I & vaginal hematoma, pp .................... 58820 ..................................... Drain ovary abscess, open. 

57023 ..................................... I & vag hematoma, non-ob .................. 58822 ..................................... Drain ovary abscess, percut. 

57061 ..................................... Destroy vag lesions, simple ................. 58825 ..................................... Transposition, ovary(s). 

57065 ..................................... Destroy vag lesions, complex .............. 58900 ..................................... Biopsy of ovary(s). 

57100 ..................................... Biopsy of vagina ................................... 58920 ..................................... Partial removal of ovary(s). 

57105 ..................................... Biopsy of vagina ................................... 58925 ..................................... Removal of ovarian cyst(s). 

57106 ..................................... Remove vagina wall, partial ................. 58940 ..................................... Removal of ovary(s). 

57107 ..................................... Remove vagina tissue, part ................. 58943 ..................................... Removal of ovary(s). 

57109 ..................................... Vaginectomy partial w/nodes ............... 58950 ..................................... Resect ovarian malignancy. 

57110 ..................................... Remove vagina wall, complete ............ 58951 ..................................... Resect ovarian malignancy. 

57111 ..................................... Remove vagina tissue, compl .............. 58952 ..................................... Resect ovarian malignancy. 

57112 ..................................... Vaginectomy w/nodes, compl .............. 58953 ..................................... Tah, rad dissect for debulk. 

57120 ..................................... Closure of vagina ................................. 58954 ..................................... Tah rad debulk/lymph remove. 

57130 ..................................... Remove vagina lesion .......................... 58956 ..................................... Bso, omentectomy w/tah. 

57135 ..................................... Remove vagina lesion .......................... 58957 ..................................... Resect recurrent gyn mal. 

57150 ..................................... Treat vagina infection ........................... 58958 ..................................... Resect recur gyn mal w/lym. 

57155 ..................................... Insert uteri tandems/ovoids .................. 58960 ..................................... Exploration of abdomen. 

57160 ..................................... Insert pessary/other device .................. 58970 ..................................... Retrieval of oocyte. 

57170 ..................................... Fitting of diaphragm/cap ...................... 58974 ..................................... Transfer of embryo. 

57180 ..................................... Treat vaginal bleeding .......................... 58976 ..................................... Transfer of embryo. 

57200 ..................................... Repair of vagina ................................... 59000 ..................................... Amniocentesis, diagnostic. 

57210 ..................................... Repair vagina/perineum ....................... 59015 ..................................... Chorion biopsy. 

57220 ..................................... Revision of urethra ............................... 59100 ..................................... Remove uterus lesion. 

57230 ..................................... Repair of urethral lesion ....................... 59120 ..................................... Treat ectopic pregnancy. 

57240 ..................................... Repair bladder & vagina ...................... 59121 ..................................... Treat ectopic pregnancy. 

57250 ..................................... Repair rectum & vagina ....................... 59130 ..................................... Treat ectopic pregnancy. 

57260 ..................................... Repair of vagina ................................... 59135 ..................................... Treat ectopic pregnancy. 

57265 ..................................... Extensive repair of vagina ................... 59136 ..................................... Treat ectopic pregnancy. 

57268 ..................................... Repair of bowel bulge .......................... 59140 ..................................... Treat ectopic pregnancy. 

57270 ..................................... Repair of bowel pouch ......................... 59150 ..................................... Treat ectopic pregnancy. 

57280 ..................................... Suspension of vagina ........................... 59151 ..................................... Treat ectopic pregnancy. 

57282 ..................................... Colpopexy, extraperitoneal .................. 59160 ..................................... D & c after delivery. 

57283 ..................................... Colpopexy, intraperitoneal ................... 59200 ..................................... Insert cervical dilator. 

57284 ..................................... Repair paravaginal defect .................... 59300 ..................................... Episiotomy or vaginal repair. 

57287 ..................................... Revise/remove sling repair .................. 59400 ..................................... Obstetrical care. 

57288 ..................................... Repair bladder defect ........................... 59410 ..................................... Obstetrical care. 

57289 ..................................... Repair bladder & vagina ...................... 59425 ..................................... Antepartum care only. 

57291 ..................................... Construction of vagina ......................... 59426 ..................................... Antepartum care only. 

mstockstill on PROD1PC66 with PROPOSALS2

Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38363 

ADDENDUM C.—CODES FOR WHICH WE RECEIVED PERC RECOMMENDATIONS ON PE DIRECT INPUTS—Continued 

CPT 1 code Description CPT 1 code Description 

57292 ..................................... Construct vagina with graft .................. 59430 ..................................... Care after delivery. 

57295 ..................................... Revise vag graft via vagina ................. 59510 ..................................... Cesarean delivery. 

57296 ..................................... Revise vag graft, open abd .................. 59515 ..................................... Cesarean delivery. 

57300 ..................................... Repair rectum-vagina fistula ................ 59610 ..................................... Vbac delivery. 

57305 ..................................... Repair rectum-vagina fistula ................ 59614 ..................................... Vbac care after delivery. 

57307 ..................................... Fistula repair & colostomy ................... 59618 ..................................... Attempted vbac delivery. 

57310 ..................................... Repair urethrovaginal lesion ................ 59622 ..................................... Attempted vbac after care. 

57311 ..................................... Repair urethrovaginal lesion ................ 59812 ..................................... Vbac delivery only. 

57320 ..................................... Repair bladder-vagina lesion ............... 59820 ..................................... Care of miscarriage. 

57330 ..................................... Repair bladder-vagina lesion ............... 59821 ..................................... Treatment of miscarriage. 

57335 ..................................... Repair vagina ....................................... 59830 ..................................... Treat uterus infection. 

57415 ..................................... Remove vaginal foreign body .............. 59840 ..................................... Abortion. 

57420 ..................................... Exam of vagina w/scope ...................... 59841 ..................................... Abortion. 

57421 ..................................... Exam/biopsy of vag w/scope ............... 59850 ..................................... Abortion. 

57425 ..................................... Laparoscopy, surg, colpopexy ............. 59851 ..................................... Abortion. 

57452 ..................................... Exam of cervix w/scope ....................... 59852 ..................................... Abortion. 

57454 ..................................... Bx/curett of cervix w/scope .................. 59855 ..................................... Abortion. 

57455 ..................................... Biopsy of cervix w/scope ..................... 59856 ..................................... Abortion. 

57456 ..................................... Endocerv curettage w/scope ................ 59857 ..................................... Abortion. 

57460 ..................................... Bx of cervix w/scope, leep ................... 59870 ..................................... Evacuate mole of uterus. 

57461 ..................................... Conz of cervix w/scope, leep ............... 64430 ..................................... N block inj, pudendal. 

57500 ..................................... Biopsy of cervix .................................... 64435 ..................................... N block inj, paracervical. 

57505 ..................................... Endocervical curettage ......................... 64360 ..................................... Injection treatment of nerve. 

57510 ..................................... Cauterization of cervix ......................... 75960 ..................................... Transcath iv stent rs&i. 

57511 ..................................... Cryocautery of cervix ........................... 77051 ..................................... Computer dx mammogram add-on. 

57513 ..................................... Laser surgery of cervix ........................ 77052 ..................................... Comp screen mammogram add-on. 

57520 ..................................... Conization of cervix .............................. 77080 ..................................... Dxa bone density, axial. 

57522 ..................................... Conization of cervix .............................. 77081 ..................................... Dxa bone density/peripheral. 

57530 ..................................... Removal of cervix ................................ 77082 ..................................... Dxa bone density, vert fx. 

57531 ..................................... Removal of cervix, radical .................... 78206 ..................................... Liver image (3d) with flow. 

57540 ..................................... Removal of residual cervix ................... 78600 ..................................... Brain imaging, ltd static. 

57545 ..................................... Remove cervix/repair pelvis ................. 78601 ..................................... Brain imaging, ltd w/flow. 

57550 ..................................... Removal of residual cervix ................... 78605 ..................................... Brain imaging, complete. 

57555 ..................................... Remove cervix/repair vagina ............... 78606 ..................................... Brain imaging, compl w/flow. 

57556 ..................................... Remove cervix, repair bowel ................ 78607 ..................................... Brain imaging (3D). 

57558 ..................................... D&c of cervical stump .......................... 78610 ..................................... Brain flow imaging only. 

57700 ..................................... Revision of cervix ................................. 78615 ..................................... Cerebral vascular flow image. 

57720 ..................................... Revision of cervix ................................. 78647 ..................................... Cerebrospinal fluid scan. 

57800 ..................................... Dilation of cervical canal ...................... 78803 ..................................... Tumor imaging (3D). 

58100 ..................................... Biopsy of uterus lining .......................... 78807 ..................................... Nuclear localization/abscess. 

58110 ..................................... Bx done w/colposcopy add-on ............. 93501 ..................................... Right heart catheterization. 

58120 ..................................... Dilation and curettage .......................... 93503 ..................................... Insert/place heart catheter. 

58140 ..................................... Myomectomy abdom method ............... 93505 ..................................... Biopsy of heart lining. 

58145 ..................................... Myomectomy vag method .................... 93508 ..................................... Cath placement, angiography. 

58146 ..................................... Myomectomy abdom complex ............. 93510 ..................................... Left heart catheterization. 

58150 ..................................... Total hysterectomy ............................... 93511 ..................................... Left heart catheterization. 

58152 ..................................... Total hysterectomy ............................... 93514 ..................................... Left heart catheterization. 

58180 ..................................... Partial hysterectomy ............................. 93524 ..................................... Left heart catheterization. 

58200 ..................................... Extensive hysterectomy ....................... 93526 ..................................... Rt & Lt heart catheters. 

58210 ..................................... Extensive hysterectomy ....................... 93527 ..................................... Rt & Lt heart catheters. 

58240 ..................................... Removal of pelvis contents .................. 93528 ..................................... Rt & Lt heart catheters. 

58260 ..................................... Vaginal hysterectomy ........................... 93529 ..................................... Rt, lt heart catheterization. 

58262 ..................................... Vag hyst including t/o ........................... 93530 ..................................... Rt heart cath, congenital. 

58263 ..................................... Vag hyst w/t/o & vag repair ................. 93531 ..................................... R & l heart cath, congenital. 

58267 ..................................... Vag hyst w/urinary repair ..................... 93532 ..................................... R & l heart cath, congenital. 

58270 ..................................... Vag hyst w/enterocele repair ............... 93533 ..................................... R & l heart cath, congenital. 

58275 ..................................... Hysterectomy/revise vagina ................. 93539 ..................................... Injection, cardiac cath. 

58280 ..................................... Hysterectomy/revise vagina ................. 93540 ..................................... Injection, cardiac cath. 

58285 ..................................... Extensive hysterectomy ....................... 93541 ..................................... Injection for lung angiogram. 

58290 ..................................... Vag hyst complex ................................. 93542 ..................................... Injection for heart x-rays. 

58291 ..................................... Vag hyst incl t/o, complex .................... 93543 ..................................... Injection for heart x-rays. 

58292 ..................................... Vag hyst t/o & repair, compl ................ 93544 ..................................... Injection for aortography. 

58293 ..................................... Vag hyst w/uro repair, compl ............... 93545 ..................................... Inject for coronary x-rays. 

58294 ..................................... Vag hyst w/enterocele, compl .............. 93555 ..................................... Imaging, cardiac cath. 

58340 ..................................... Catheter for hysterography .................. 93556 ..................................... Imaging, cardiac cath. 

58345 ..................................... Reopen fallopian tube .......................... 93561 ..................................... Cardiac output measurement. 

58346 ..................................... Insert heyman uteri capsule ................. 93562 ..................................... Cardiac output measurement. 

58350 ..................................... Reopen fallopian tube .......................... 93571 ..................................... Heart flow reserve measure. 

58353 ..................................... Endometr ablate, thermal ..................... 93572 ..................................... Heart flow reserve measure. 

58555 ..................................... Hysteroscopy, dx, sep proc.

58356 ..................................... Endometrial cryoablation.

58400 ..................................... Suspension of uterus.

mstockstill on PROD1PC66 with PROPOSALS2

38364 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH WE RECEIVED PERC RECOMMENDATIONS ON PE DIRECT INPUTS—Continued 

CPT 1 code Description CPT 1 code Description 

58410 ..................................... Suspension of uterus.

58520 ..................................... Repair of ruptured uterus.

58540 ..................................... Revision of uterus.

58541 ..................................... Lsh, uterus 250 g or less.

mstockstill on PROD1PC66 with PROPOSALS2

Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38365 

ADDENDUM D.—PROPOSED 2008 GEOGRAPHIC ADJUSTMENT FACTORS (GAFS) 

Carrier Locality Locality name 2008 

GAF 

2007 

GAF % change 

31140 ....... 06 San Mateo, CA .......................................................................................................... 1.231 1.259 ¥2.19% 

31140 ....... 05 San Francisco, CA .................................................................................................... 1.228 1.256 ¥2.19% 

31140 ....... 09 Santa Clara, CA ........................................................................................................ 1.206 1.265 ¥4.63% 

00803 ....... 01 Manhattan, NY ........................................................................................................... 1.174 1.184 ¥0.84% 

00803 ....... 02 NYC Suburbs/Long I., NY ......................................................................................... 1.171 1.18 ¥0.73% 

31140 ....... 07 Oakland/Berkley, CA ................................................................................................. 1.154 1.177 ¥1.94% 

31143 ....... 01 Metropolitan Boston ................................................................................................... 1.143 1.153 ¥0.85% 

14330 ....... 04 Queens, NY ............................................................................................................... 1.137 1.144 ¥0.62% 

31140 ....... 03 Marin/Napa/Solano, CA ............................................................................................. 1.133 1.154 ¥1.84% 

00805 ....... 01 Northern NJ ............................................................................................................... 1.130 1.126 0.39% 

00903 ....... 01 DC + MD/VA Suburbs ............................................................................................... 1.127 1.132 ¥0.47% 

31146 ....... 26 Anaheim/Santa Ana, CA ........................................................................................... 1.124 1.12 0.35% 

31146 ....... 17 Ventura, CA ............................................................................................................... 1.102 1.084 1.69% 

31146 ....... 18 Los Angeles, CA ........................................................................................................ 1.100 1.088 1.14% 

00591 ....... 00 Connecticut ................................................................................................................ 1.096 1.091 0.42% 

00952 ....... 12 Chicago, IL ................................................................................................................ 1.093 1.102 ¥0.78% 

00590 ....... 04 Miami, FL ................................................................................................................... 1.092 1.069 2.17% 

00953 ....... 01 Detroit, MI .................................................................................................................. 1.091 1.11 ¥1.71% 

00805 ....... 99 Rest of New Jersey ................................................................................................... 1.078 1.074 0.37% 

00952 ....... 16 Suburban Chicago, IL ................................................................................................ 1.074 1.085 ¥0.99% 

00865 ....... 01 Metropolitan Philadelphia, PA ................................................................................... 1.072 1.069 0.30% 

00836 ....... 02 Seattle (King Cnty), WA ............................................................................................ 1.046 1.058 ¥1.17% 

00831 ....... 01 Alaska ........................................................................................................................ 1.045 1.055 ¥0.94% 

00833 ....... 01 Hawaii/Guam ............................................................................................................. 1.044 1.044 ¥0.03% 

31143 ....... 99 Rest of Massachusetts .............................................................................................. 1.042 1.042 ¥0.03% 

00803 ....... 03 Poughkpsie/N NYC Suburbs, NY .............................................................................. 1.040 1.046 ¥0.54% 

00901 ....... 01 Baltimore/Surr. Cntys, MD ......................................................................................... 1.037 1.039 ¥0.21% 

00590 ....... 03 Fort Lauderdale, FL ................................................................................................... 1.033 1.015 1.79% 

00524 ....... 01 Rhode Island ............................................................................................................. 1.031 1.016 1.44% 

00511 ....... 01 Atlanta, GA ................................................................................................................ 1.024 1.043 ¥1.82% 

00900 ....... 11 Dallas, TX .................................................................................................................. 1.022 1.035 ¥1.24% 

00900 ....... 18 Houston, TX ............................................................................................................... 1.021 1.026 ¥0.49% 

00834 ....... 00 Nevada ...................................................................................................................... 1.020 1.023 ¥0.32% 

31140 ....... 99 Rest of California* ..................................................................................................... 1.014 1.017 ¥0.28% 

31146 ....... 99 Rest of California* ..................................................................................................... 1.014 1.017 ¥0.28% 

00902 ....... 01 Delaware .................................................................................................................... 1.012 1.011 0.10% 

00900 ....... 31 Austin, TX .................................................................................................................. 1.001 1.015 ¥1.40% 

00835 ....... 01 Portland, OR .............................................................................................................. 0.996 1.005 ¥0.88% 

00900 ....... 09 Brazoria, TX ............................................................................................................... 0.995 1.005 ¥0.98% 

00528 ....... 01 New Orleans, LA ....................................................................................................... 0.993 0.976 1.76% 

31144 ....... 40 New Hampshire ......................................................................................................... 0.993 1 ¥0.69% 

00952 ....... 15 East St. Louis, IL ....................................................................................................... 0.993 0.995 ¥0.24% 

00900 ....... 28 Fort Worth, TX ........................................................................................................... 0.989 0.996 ¥0.65% 

00973 ....... 50 Virgin Islands ............................................................................................................. 0.989 0.989 ¥0.03% 

00900 ....... 15 Galveston, TX ............................................................................................................ 0.986 0.985 0.07% 

00824 ....... 01 Colorado .................................................................................................................... 0.983 0.991 ¥0.81% 

00901 ....... 99 Rest of Maryland ....................................................................................................... 0.981 0.978 0.31% 

31142 ....... 03 Southern Maine ......................................................................................................... 0.981 0.981 ¥0.03% 

03102 ....... 00 Arizona ....................................................................................................................... 0.980 0.993 ¥1.29% 

00523 ....... 01 Metropolitan Kansas City, MO .................................................................................. 0.980 0.982 ¥0.23% 

00590 ....... 99 Rest of Florida ........................................................................................................... 0.978 0.968 0.98% 

00953 ....... 99 Rest of Michigan ........................................................................................................ 0.976 0.984 ¥0.81% 

00836 ....... 99 Rest of Washington ................................................................................................... 0.973 0.977 ¥0.37% 

00740 ....... 02 Metropolitan St. Louis, MO ........................................................................................ 0.971 0.974 ¥0.27% 

00883 ....... 00 Ohio ........................................................................................................................... 0.969 0.965 0.46% 

00954 ....... 00 Minnesota .................................................................................................................. 0.967 0.975 ¥0.85% 

00865 ....... 99 Rest of Pennsylvania ................................................................................................. 0.956 0.946 1.08% 

31145 ....... 50 Vermont ..................................................................................................................... 0.953 0.951 0.22% 

00904 ....... 00 Virginia ....................................................................................................................... 0.950 0.948 0.19% 

03502 ....... 09 Utah ........................................................................................................................... 0.948 0.947 0.08% 

00900 ....... 20 Beaumont, TX ............................................................................................................ 0.946 0.942 0.44% 

00801 ....... 99 Rest of New York ...................................................................................................... 0.946 0.95 ¥0.45% 

00884 ....... 16 Wisconsin .................................................................................................................. 0.943 0.95 ¥0.77% 

00952 ....... 99 Rest of Illinois ............................................................................................................ 0.941 0.938 0.29% 

05535 ....... 00 North Carolina ........................................................................................................... 0.937 0.936 0.13% 

00521 ....... 05 New Mexico ............................................................................................................... 0.937 0.932 0.49% 

00630 ....... 00 Indiana ....................................................................................................................... 0.935 0.93 0.58% 

00511 ....... 99 Rest of Georgia ......................................................................................................... 0.932 0.932 ¥0.03% 

00900 ....... 99 Rest of Texas ............................................................................................................ 0.931 0.929 0.23% 

00835 ....... 99 Rest of Oregon .......................................................................................................... 0.930 0.929 0.09% 

00951 ....... 00 West Virginia ............................................................................................................. 0.926 0.927 ¥0.09% 

mstockstill on PROD1PC66 with PROPOSALS2

38366 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM D.—PROPOSED 2008 GEOGRAPHIC ADJUSTMENT FACTORS (GAFS)—Continued 

Carrier Locality Locality name 2008 

GAF 

2007 

GAF % change 

00528 ....... 99 Rest of Louisiana ....................................................................................................... 0.923 0.919 0.45% 

05440 ....... 35 Tennessee ................................................................................................................. 0.923 0.921 0.20% 

00880 ....... 01 South Carolina ........................................................................................................... 0.920 0.917 0.37% 

00650 ....... 00 Kansas* ..................................................................................................................... 0.917 0.919 ¥0.20% 

00740 ....... 04 Kansas* ..................................................................................................................... 0.917 0.919 ¥0.20% 

31142 ....... 99 Rest of Maine ............................................................................................................ 0.915 0.916 ¥0.15% 

00660 ....... 00 Kentucky .................................................................................................................... 0.912 0.915 ¥0.31% 

00510 ....... 00 Alabama ..................................................................................................................... 0.910 0.914 ¥0.41% 

05130 ....... 00 Idaho .......................................................................................................................... 0.909 0.905 0.47% 

03602 ....... 21 Wyoming .................................................................................................................... 0.907 0.91 ¥0.32% 

00826 ....... 00 Iowa ........................................................................................................................... 0.906 0.905 0.10% 

00512 ....... 00 Mississippi ................................................................................................................. 0.903 0.898 0.54% 

00655 ....... 00 Nebraska ................................................................................................................... 0.902 0.903 ¥0.15% 

03202 ....... 01 Montana ..................................................................................................................... 0.898 0.902 ¥0.45% 

00522 ....... 00 Oklahoma .................................................................................................................. 0.898 0.894 0.40% 

00740 ....... 99 Rest of Missouri* ....................................................................................................... 0.890 0.883 0.78% 

03402 ....... 02 South Dakota ............................................................................................................. 0.890 0.891 ¥0.17% 

00523 ....... 99 Rest of Missouri* ....................................................................................................... 0.889 0.883 0.71% 

03302 ....... 01 North Dakota ............................................................................................................. 0.888 0.895 ¥0.82% 

00520 ....... 13 Arkansas .................................................................................................................... 0.887 0.884 0.39% 

00973 ....... 20 Puerto Rico ................................................................................................................ 0.789 0.79 ¥0.18% 

GAF equation: (0.52466*work GPCI)+(0.43669*pe GPCI)+(0.03865*mp GPCI) 

* designates multiple carriers 

GAF values do not contain a 1.000 floor on physician work GPCI. 

mstockstill on PROD1PC66 with PROPOSALS2

Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38367 

ADDENDUM E.—PROPOSED 2008 *** GEOGRAPHIC PRACTICE COST INDICES (GPCIS) BY STATE AND MEDICARE LOCALITY

Carrier Locality Locality name 

2007 

Work 

GPCI ** 

2008 

Work 

GPCI 

2009 

Work 

GPCI 

2007 

PE 

GPCI 

2008 

PE 

GPCI 

2009 

PE 

GPCI 

2007 

MP 

GPCI 

2008 

MP 

GPCI 

2009 

MP 

GPCI 

00510 ..... 00 ........... Alabama ................................................................... 0.982 0.982 0.982 0.847 0.850 0.852 0.740 0.622 0.504 

00831 ..... 01 ........... Alaska ...................................................................... 1.017 1.018 1.018 1.105 1.097 1.088 1.013 0.835 0.657 

03102 ..... 00 ........... Arizona ..................................................................... 0.987 0.988 0.988 0.994 0.975 0.955 1.052 0.944 0.836 

00520 ..... 13 ........... Arkansas .................................................................. 0.961 0.961 0.961 0.832 0.839 0.845 0.431 0.443 0.454 

31146 ..... 26 ........... Anaheim/Santa Ana, CA ......................................... 1.034 1.035 1.035 1.238 1.253 1.267 0.939 0.882 0.825 

31146 ..... 18 ........... Los Angeles, CA ...................................................... 1.041 1.042 1.042 1.158 1.191 1.223 0.939 0.879 0.818 

31140 ..... 03 ........... Marin/Napa/Solano, CA ........................................... 1.035 1.035 1.035 1.342 1.303 1.263 0.640 0.540 0.439 

31140 ..... 07 ........... Oakland/Berkley, CA ............................................... 1.054 1.055 1.055 1.373 1.329 1.284 0.640 0.536 0.432 

31140 ..... 05 ........... San Francisco, CA .................................................. 1.060 1.060 1.060 1.546 1.493 1.439 0.640 0.531 0.421 

31140 ..... 06 ........... San Mateo, CA ........................................................ 1.073 1.073 1.073 1.539 1.485 1.431 0.629 0.515 0.401 

31140 ..... 09 ........... Santa Clara, CA ...................................................... 1.083 1.084 1.084 1.543 1.418 1.292 0.595 0.489 0.383 

31146 ..... 17 ........... Ventura, CA ............................................................. 1.028 1.028 1.028 1.181 1.222 1.263 0.732 0.756 0.779 

31140 ..... 99 ........... Rest of California * ................................................... 1.007 1.008 1.008 1.054 1.055 1.056 0.721 0.640 0.558 

31146 ..... 99 ........... Rest of California * ................................................... 1.007 1.008 1.008 1.054 1.055 1.056 0.721 0.640 0.558 

00824 ..... 01 ........... Colorado .................................................................. 0.986 0.986 0.986 1.015 1.003 0.990 0.790 0.721 0.652 

00591 ..... 00 ........... Connecticut .............................................................. 1.038 1.039 1.039 1.172 1.178 1.183 0.886 0.942 0.997 

00903 ..... 01 ........... DC + MD/VA Suburbs ............................................. 1.048 1.048 1.048 1.252 1.234 1.216 0.911 0.981 1.050 

00902 ..... 01 ........... Delaware .................................................................. 1.012 1.012 1.012 1.020 1.032 1.044 0.877 0.784 0.690 

00590 ..... 03 ........... Fort Lauderdale, FL ................................................. 0.988 0.989 0.989 0.990 1.003 1.016 1.675 1.982 2.288 

00590 ..... 04 ........... Miami, FL ................................................................. 1.000 1.001 1.001 1.048 1.058 1.067 2.233 2.727 3.221 

00590 ..... 99 ........... Rest of Florida ......................................................... 0.973 0.973 0.973 0.936 0.937 0.937 1.251 1.502 1.753 

00511 ..... 01 ........... Atlanta, GA .............................................................. 1.010 1.010 1.010 1.091 1.052 1.012 0.950 0.900 0.850 

00511 ..... 99 ........... Rest of Georgia ....................................................... 0.979 0.979 0.979 0.874 0.878 0.882 0.950 0.897 0.843 

00833 ..... 01 ........... Hawaii/Guam ........................................................... 1.005 0.990 0.975 1.113 1.136 1.158 0.787 0.732 0.676 

05130 ..... 00 ........... Idaho ........................................................................ 0.968 0.967 0.967 0.869 0.876 0.882 0.452 0.504 0.555 

00952 ..... 12 ........... Chicago, IL .............................................................. 1.025 1.026 1.026 1.128 1.103 1.078 1.837 1.905 1.973 

00952 ..... 15 ........... East St. Louis, IL ..................................................... 0.988 0.989 0.989 0.940 0.929 0.917 1.722 1.773 1.824 

00952 ..... 16 ........... Suburban Chicago, IL .............................................. 1.018 1.018 1.018 1.117 1.092 1.066 1.626 1.642 1.657 

00952 ..... 99 ........... Rest of Illinois .......................................................... 0.974 0.975 0.975 0.874 0.877 0.879 1.174 1.207 1.240 

00630 ..... 00 ........... Indiana ..................................................................... 0.985 0.986 0.986 0.908 0.912 0.916 0.429 0.519 0.609 

00826 ..... 00 ........... Iowa ......................................................................... 0.967 0.966 0.965 0.869 0.869 0.869 0.579 0.510 0.441 

00650 ..... 00 ........... Kansas * ................................................................... 0.968 0.968 0.969 0.880 0.881 0.881 0.709 0.638 0.567 

00740 ..... 04 ........... Kansas * ................................................................... 0.968 0.968 0.969 0.880 0.881 0.881 0.709 0.638 0.567 

00660 ..... 00 ........... Kentucky .................................................................. 0.970 0.969 0.969 0.855 0.857 0.859 0.859 0.761 0.663 

00528 ..... 01 ........... New Orleans, LA ..................................................... 0.986 0.986 0.986 0.947 0.995 1.042 1.178 1.075 0.972 

00528 ..... 99 ........... Rest of Louisiana ..................................................... 0.970 0.970 0.970 0.848 0.863 0.877 1.041 0.974 0.907 

31142 ..... 03 ........... Southern Maine ....................................................... 0.980 0.980 0.980 1.014 1.019 1.023 0.626 0.563 0.500 

31142 ..... 99 ........... Rest of Maine .......................................................... 0.962 0.962 0.962 0.887 0.889 0.891 0.626 0.563 0.500 

00901 ..... 01 ........... Baltimore/Surr. Cntys, MD ....................................... 1.012 1.013 1.013 1.080 1.068 1.055 0.932 1.019 1.105 

00901 ..... 99 ........... Rest of Maryland ..................................................... 0.993 0.994 0.994 0.981 0.981 0.980 0.748 0.819 0.889 

31143 ..... 01 ........... Metropolitan Boston ................................................. 1.030 1.030 1.030 1.331 1.310 1.289 0.810 0.794 0.777 

31143 ..... 99 ........... Rest of Massachusetts ............................................ 1.007 1.008 1.008 1.105 1.105 1.104 0.810 0.794 0.777 

00953 ..... 01 ........... Detroit, MI ................................................................ 1.037 1.037 1.037 1.056 1.047 1.038 2.700 2.320 1.939 

00953 ..... 99 ........... Rest of Michigan ...................................................... 0.997 0.998 0.998 0.922 0.922 0.921 1.494 1.298 1.101 

00954 ..... 00 ........... Minnesota ................................................................ 0.991 0.992 0.992 1.006 0.994 0.981 0.404 0.327 0.249 

00512 ..... 00 ........... Mississippi ............................................................... 0.960 0.959 0.959 0.841 0.847 0.853 0.711 0.767 0.822 

00523 ..... 01 ........... Metropolitan Kansas City, MO ................................ 0.989 0.990 0.990 0.977 0.960 0.943 0.931 1.070 1.208 

00740 ..... 02 ........... Metropolitan St. Louis, MO ...................................... 0.992 0.993 0.993 0.956 0.943 0.929 0.926 1.010 1.093 

00523 ..... 99 ........... Rest of Missouri * ..................................................... 0.950 0.950 0.950 0.803 0.812 0.820 0.878 0.946 1.014 

00740 ..... 99 ........... Rest of Missouri * ..................................................... 0.950 0.951 0.952 0.803 0.812 0.820 0.878 0.946 1.014 

03202 ..... 01 ........... Montana ................................................................... 0.950 0.950 0.950 0.845 0.846 0.846 0.889 0.787 0.685 

00655 ..... 00 ........... Nebraska ................................................................. 0.959 0.959 0.959 0.876 0.882 0.888 0.447 0.348 0.249 

00834 ..... 00 ........... Nevada .................................................................... 1.003 1.003 1.003 1.045 1.035 1.024 1.050 1.076 1.102 

31144 ..... 40 ........... New Hampshire ....................................................... 0.981 0.982 0.982 1.029 1.033 1.037 0.927 0.699 0.470 

00805 ..... 01 ........... Northern NJ ............................................................. 1.058 1.059 1.059 1.222 1.224 1.226 0.958 1.047 1.135 

00805 ..... 99 ........... Rest of New Jersey ................................................. 1.043 1.043 1.043 1.121 1.123 1.124 0.958 1.047 1.135 

00521 ..... 05 ........... New Mexico ............................................................. 0.972 0.973 0.973 0.888 0.888 0.888 0.880 0.998 1.115 

00803 ..... 01 ........... Manhattan, NY ......................................................... 1.065 1.065 1.065 1.300 1.298 1.296 1.480 1.254 1.027 

00803 ..... 02 ........... NYC Suburbs/Long I., NY ....................................... 1.052 1.052 1.052 1.283 1.285 1.287 1.756 1.506 1.256 

00803 ..... 03 ........... Poughkpsie/N NYC Suburbs, NY ............................ 1.014 1.015 1.015 1.076 1.076 1.075 1.148 0.992 0.836 

14330 ..... 04 ........... Queens, NY ............................................................. 1.032 1.033 1.033 1.230 1.234 1.237 1.682 1.462 1.241 

00801 ..... 99 ........... Rest of New York .................................................... 0.997 0.997 0.997 0.919 0.919 0.919 0.666 0.549 0.432 

05535 ..... 00 ........... North Carolina ......................................................... 0.971 0.972 0.972 0.922 0.923 0.923 0.630 0.638 0.645 

03302 ..... 01 ........... North Dakota ........................................................... 0.946 0.946 0.947 0.861 0.852 0.843 0.593 0.494 0.394 

00883 ..... 00 ........... Ohio ......................................................................... 0.992 0.993 0.993 0.934 0.930 0.925 0.960 1.107 1.253 

00522 ..... 00 ........... Oklahoma ................................................................ 0.964 0.964 0.964 0.856 0.853 0.849 0.376 0.507 0.638 

00835 ..... 01 ........... Portland, OR ............................................................ 1.002 1.003 1.003 1.059 1.036 1.013 0.434 0.457 0.480 

00835 ..... 99 ........... Rest of Oregon ........................................................ 0.968 0.968 0.968 0.927 0.926 0.925 0.434 0.457 0.480 

00865 ..... 01 ........... Metropolitan Philadelphia, PA ................................. 1.016 1.017 1.017 1.106 1.101 1.095 1.364 1.505 1.645 

00865 ..... 99 ........... Rest of Pennsylvania ............................................... 0.992 0.993 0.993 0.904 0.914 0.923 0.793 0.946 1.099 

00973 ..... 20 ........... Puerto Rico .............................................................. 0.906 0.905 0.904 0.699 0.696 0.693 0.257 0.256 0.254 

00524 ..... 01 ........... Rhode Island ........................................................... 1.045 1.030 1.014 0.991 1.039 1.086 0.895 0.954 1.013 

00880 ..... 01 ........... South Carolina ......................................................... 0.975 0.975 0.975 0.894 0.899 0.904 0.388 0.421 0.454 

03402 ..... 02 ........... South Dakota ........................................................... 0.943 0.942 0.942 0.877 0.870 0.863 0.359 0.393 0.427 

05440 ..... 35 ........... Tennessee ............................................................... 0.977 0.978 0.978 0.881 0.884 0.887 0.621 0.620 0.618 

00900 ..... 31 ........... Austin, TX ................................................................ 0.991 0.991 0.991 1.048 1.015 0.981 0.970 0.978 0.986 

00900 ..... 20 ........... Beaumont, TX .......................................................... 0.983 0.984 0.984 0.862 0.868 0.874 1.277 1.323 1.369 

00900 ..... 09 ........... Brazoria, TX ............................................................. 1.020 1.020 1.020 0.963 0.942 0.920 1.277 1.261 1.244 

00900 ..... 11 ........... Dallas, TX ................................................................ 1.009 1.010 1.010 1.064 1.032 0.999 1.044 1.087 1.129 

00900 ..... 28 ........... Fort Worth, TX ......................................................... 0.997 0.998 0.998 0.991 0.971 0.951 1.044 1.087 1.129 

mstockstill on PROD1PC66 with PROPOSALS2

38368 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM E.—PROPOSED 2008 *** GEOGRAPHIC PRACTICE COST INDICES (GPCIS) BY STATE AND MEDICARE

LOCALITY—Continued 

Carrier Locality Locality name 

2007 

Work 

GPCI ** 

2008 

Work 

GPCI 

2009 

Work 

GPCI 

2007 

PE 

GPCI 

2008 

PE 

GPCI 

2009 

PE 

GPCI 

2007 

MP 

GPCI 

2008 

MP 

GPCI 

2009 

MP 

GPCI 

00900 ..... 15 ........... Galveston, TX .......................................................... 0.990 0.991 0.991 0.954 0.956 0.957 1.277 1.261 1.244 

00900 ..... 18 ........... Houston, TX ............................................................. 1.016 1.017 1.017 1.016 1.000 0.983 1.276 1.322 1.368 

00900 ..... 99 ........... Rest of Texas .......................................................... 0.968 0.968 0.968 0.866 0.872 0.878 1.120 1.102 1.083 

03502 ..... 09 ........... Utah ......................................................................... 0.977 0.977 0.977 0.938 0.922 0.905 0.651 0.848 1.044 

31145 ..... 50 ........... Vermont ................................................................... 0.968 0.968 0.968 0.970 0.976 0.981 0.505 0.501 0.497 

00904 ..... 00 ........... Virginia ..................................................................... 0.981 0.982 0.982 0.942 0.941 0.940 0.569 0.619 0.668 

00973 ..... 50 ........... Virgin Islands ........................................................... 0.967 0.982 0.997 1.015 0.996 0.976 0.987 1.007 1.026 

00836 ..... 02 ........... Seattle (King Cnty), WA .......................................... 1.014 1.015 1.015 1.133 1.108 1.083 0.805 0.762 0.718 

00836 ..... 99 ........... Rest of Washington ................................................. 0.987 0.987 0.988 0.980 0.976 0.972 0.805 0.755 0.705 

00951 ..... 00 ........... West Virginia ........................................................... 0.973 0.974 0.974 0.820 0.823 0.826 1.522 1.449 1.376 

00884 ..... 16 ........... Wisconsin ................................................................ 0.987 0.988 0.988 0.920 0.920 0.919 0.777 0.597 0.416 

03602 ..... 21 ........... Wyoming .................................................................. 0.956 0.956 0.956 0.855 0.848 0.841 0.920 0.912 0.904 

* Indicates multiple carriers. 

** 2007 work GPCI does not reflect the 1.000 floor. 

*** 2008 GPCIs are the first year of the update transition, 2009 GPCIs are the fully implemented updated GPCI. 

2008 GPCIs: 1⁄2 the difference between 2007 and 2009 GPCIs. 

mstockstill on PROD1PC66 with PROPOSALS2

Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38369 

ADDENDUM F—CPT/HCPCS IMAGING CODES DEFINED BY SECTION

5102(B) OF THE DRA 

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. 

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. 

ADDENDUM F—CPT/HCPCS IMAGING CODES DEFINED BY SECTION

5102(B) OF THE DRA—Continued 

HCPCS/ 

CPT* Short Descriptor 

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. 

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. 

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. 

ADDENDUM F—CPT/HCPCS IMAGING CODES DEFINED BY SECTION

5102(B) OF THE DRA—Continued 

HCPCS/ 

CPT* Short Descriptor 

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. 

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. 

mstockstill on PROD1PC66 with PROPOSALS2

38370 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM F—CPT/HCPCS IMAGING CODES DEFINED BY SECTION

5102(B) OF THE DRA—Continued 

HCPCS/ 

CPT* Short Descriptor 

73719 ........ Mri lower extremity w/dye. 

73720 ........ Mri lwr extremity w/o&w/dye. 

73721 ........ Mri jnt of lwr extre w/o dye. 

73722 ........ Mri joint of lwr extr w/dye. 

73723 ........ Mri joint lwr extr w/o&w/dye. 

73725 ........ Mr ang lwr ext w or w/o dye. 

74000 ........ X-ray exam of abdomen. 

74010 ........ X-ray exam of abdomen. 

74020 ........ X-ray exam of abdomen. 

74022 ........ X-ray exam series, abdomen. 

74150 ........ Ct abdomen w/o dye. 

74160 ........ Ct abdomen w/dye. 

74170 ........ Ct abdomen w/o & w/dye. 

74175 ........ Ct angio abdom w/o & w/dye. 

74181 ........ Mri abdomen w/o dye. 

74182 ........ Mri abdomen w/dye. 

74183 ........ Mri abdomen w/o & w/dye. 

74185 ........ Mri angio, abdom w orw/o dye. 

74190 ........ X-ray exam of peritoneum. 

74210 ........ Contrst 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 ........ 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. 

74251 ........ X-ray exam of small bowel. 

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. 

74350 ........ X-ray guide, stomach tube. 

74355 ........ X-ray guide, intestinal tube. 

74360 ........ X-ray guide, GI dilation. 

74363 ........ X-ray, bile duct dilation. 

74400 ........ Contrst x-ray, urinary tract. 

74410 ........ Contrst x-ray, urinary tract. 

74415 ........ Contrst x-ray, urinary tract. 

74420 ........ Contrst x-ray, urinary tract. 

74425 ........ Contrst 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. 

ADDENDUM F—CPT/HCPCS IMAGING CODES DEFINED BY SECTION

5102(B) OF THE DRA—Continued 

HCPCS/ 

CPT* Short Descriptor 

75552 ........ Heart mri for morph w/o dye. 

75553 ........ Heart mri for morph w/dye. 

75554 ........ Cardiac MRI/function. 

75555 ........ Cardiac MRI/limited study. 

75556 ........ Cardiac MRI/flow mapping. 

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. 

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 ........ Xray, endovasc thor ao repr. 

75957 ........ Xray, endovasc thor ao repr. 

ADDENDUM F—CPT/HCPCS IMAGING CODES DEFINED BY SECTION

5102(B) OF THE DRA—Continued 

HCPCS/ 

CPT* Short Descriptor 

75958 ........ Xray, place prox ext thor ao. 

75959 ........ Xray, 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 xray exam bile duct. 

75982 ........ Contrast xray exam bile duct. 

75984 ........ Xray 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. 

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, 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. 

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. 

mstockstill on PROD1PC66 with PROPOSALS2

Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38371 

ADDENDUM F—CPT/HCPCS IMAGING CODES DEFINED BY SECTION

5102(B) OF THE DRA—Continued 

HCPCS/ 

CPT* Short Descriptor 

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. 

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. 

ADDENDUM F—CPT/HCPCS IMAGING CODES DEFINED BY SECTION

5102(B) OF THE DRA—Continued 

HCPCS/ 

CPT* Short Descriptor 

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 ........ Meckel?s divert exam. 

78291 ........ Leveen/shunt patency exam. 

78300 ........ Bone imaging, limited area. 

78305 ........ Bone imaging, multiple areas. 

78306 ........ Bone imaging, whole body. 

78315 ........ Bone imaging, 3 phase. 

78320 ........ Bone imaging (3D). 

78350 ........ Bone mineral, single photon. 

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. 

ADDENDUM F—CPT/HCPCS IMAGING CODES DEFINED BY SECTION

5102(B) OF THE DRA—Continued 

HCPCS/ 

CPT* Short Descriptor 

78605 ........ Brain imaging, complete. 

78606 ........ Brain imaging, compl w/flow. 

78607 ........ Brain imaging (3D). 

78608 ........ Brain imaging (PET). 

78609 ........ Brain imaging (PET). 

78610 ........ Brain flow imaging only. 

78615 ........ Cerebral vascular flow image. 

78630 ........ Cerebrospinal fluid scan. 

78635 ........ CSF ventriculography. 

78645 ........ CSF shunt evaluation. 

78647 ........ Cerebrospinal fluid scan. 

78650 ........ CSF leakage imaging. 

78660 ........ Nuclear exam of tear flow. 

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 ........ Opthalmic dx imagingt. 

92235 ........ Eye exam with photos. 

92240 ........ Icg angiography. 

92250 ........ Eye exam with photos. 

92285 ........ Eye photography. 

92286 ........ Internal eye 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. 

93571 ........ Heart flow reserve measure. 

93572 ........ Heart flow reserve measure. 

93880 ........ Extracranial study. 

93882 ........ Extracranial study. 

93886 ........ Intracranial study. 

mstockstill on PROD1PC66 with PROPOSALS2

38372 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM F—CPT/HCPCS IMAGING CODES DEFINED BY SECTION

5102(B) OF THE DRA—Continued 

HCPCS/ 

CPT* Short Descriptor 

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. 

ADDENDUM F—CPT/HCPCS IMAGING CODES DEFINED BY SECTION

5102(B) OF THE DRA—Continued 

HCPCS/ 

CPT* Short Descriptor 

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. 

ADDENDUM F—CPT/HCPCS IMAGING CODES DEFINED BY SECTION

5102(B) OF THE DRA—Continued 

HCPCS/ 

CPT* Short Descriptor 

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 and descriptions only are copyright 2006 American Medical Association. All 

rights reserved. Applicable FARS/DFARS 

apply. 

mstockstill on PROD1PC66 with PROPOSALS2

Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38373 

ADDENDUM G.—FY 2008 WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

10180 ....... Abilene, TX ................................................................................................................................................................................ 0.8395 

Callahan County, TX.

Jones County, TX.

Taylor County, TX.

10380 ....... Aguadilla-Isabela-San Sebastia ́n, PR ....................................................................................................................................... 0.7912 

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 .................................................................................................................................................................................. 0.9278 

Portage County, OH.

Summit County, OH.

10500 ....... Albany, GA ................................................................................................................................................................................ 0.8983 

Baker County, GA.

Dougherty County, GA.

Lee County, GA.

Terrell County, GA.

Worth County, GA.

10580 ....... Albany-Schenectady-Troy, NY .................................................................................................................................................. 0.9061 

Albany County, NY.

Rensselaer County, NY.

Saratoga County, NY.

Schenectady County, NY.

Schoharie County, NY.

10740 ....... Albuquerque, NM ...................................................................................................................................................................... 1.0095 

Bernalillo County, NM.

Sandoval County, NM.

Torrance County, NM.

Valencia County, NM.

10780 ....... Alexandria, LA ........................................................................................................................................................................... 0.8420 

Grant Parish, LA.

Rapides Parish, LA.

10900 ....... Allentown-Bethlehem-Easton, PA-NJ ........................................................................................................................................ 1.0410 

Warren County, NJ.

Carbon County, PA.

Lehigh County, PA.

Northampton County, PA.

11020 ....... Altoona, PA ............................................................................................................................................................................... 0.9094 

Blair County, PA.

11100 ....... Amarillo, TX ............................................................................................................................................................................... 0.9601 

Armstrong County, TX.

Carson County, TX.

Potter County, TX.

Randall County, TX.

11180 ....... Ames, IA .................................................................................................................................................................................... 1.0600 

Story County, IA.

11260 ....... Anchorage, AK .......................................................................................................................................................................... 1.2570 

Anchorage Municipality, AK.

Matanuska-Susitna Borough, AK.

11300 ....... Anderson, IN ............................................................................................................................................................................. 0.9313 

Madison County, IN.

11340 ....... Anderson, SC ............................................................................................................................................................................ 0.9587 

Anderson County, SC.

11460 ....... Ann Arbor, MI ............................................................................................................................................................................ 1.1120 

Washtenaw County, MI.

11500 ....... Anniston-Oxford, AL .................................................................................................................................................................. 0.8363 

Calhoun County, AL.

11540 ....... Appleton, WI .............................................................................................................................................................................. 1.0161 

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 ........................................................................................................................................................ 1.1695 

Clarke County, GA.

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CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Madison County, GA.

Oconee County, GA.

Oglethorpe County, GA.

12060 ....... Atlanta-Sandy Springs-Marietta, GA ......................................................................................................................................... 1.0401 

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 ......................................................................................................................................................................... 1.2870 

Atlantic County, NJ.

12220 ....... Auburn-Opelika, AL ................................................................................................................................................................... 0.8544 

Lee County, AL.

12260 ....... Augusta-Richmond County, GA-SC .......................................................................................................................................... 1.0173 

Burke County, GA.

Columbia County, GA.

McDuffie County, GA.

Richmond County, GA.

Aiken County, SC.

Edgefield County, SC.

12420 ....... Austin-Round Rock, TX ............................................................................................................................................................. 1.0082 

Bastrop County, TX.

Caldwell County, TX.

Hays County, TX.

Travis County, TX.

Williamson County, TX.

12540 ....... Bakersfield, CA .......................................................................................................................................................................... 1.1840 

Kern County, CA.

12580 ....... Baltimore-Towson, MD .............................................................................................................................................................. 1.0770 

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 ............................................................................................................................................................................... 1.0499 

Penobscot County, ME.

12700 ....... Barnstable Town, MA ................................................................................................................................................................ 1.3298 

Barnstable County, MA.

12940 ....... Baton Rouge, LA ....................................................................................................................................................................... 0.8478 

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.

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CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

West Baton Rouge Parish, LA.

West Feliciana Parish, LA.

12980 ....... Battle Creek, MI ........................................................................................................................................................................ 1.0723 

Calhoun County, MI.

13020 ....... Bay City, MI ............................................................................................................................................................................... 0.9388 

Bay County, MI.

13140 ....... Beaumont-Port Arthur, TX ......................................................................................................................................................... 0.8966 

Hardin County, TX.

Jefferson County, TX.

Orange County, TX.

13380 ....... Bellingham, WA ......................................................................................................................................................................... 1.2107 

Whatcom County, WA.

13460 ....... Bend, OR ................................................................................................................................................................................... 1.1545 

Deschutes County, OR.

13644 ....... Bethesda-Frederick-Gaithersburg, MD ..................................................................................................................................... 1.1091 

Frederick County, MD.

Montgomery County, MD.

13740 ....... Billings, MT ................................................................................................................................................................................ 0.9146 

Carbon County, MT.

Yellowstone County, MT.

13780 ....... Binghamton, NY ........................................................................................................................................................................ 0.9443 

Broome County, NY.

Tioga County, NY.

13820 ....... Birmingham-Hoover, AL ............................................................................................................................................................ 0.9401 

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 ............................................................................................................................................................................ 0.7912 

Burleigh County, ND.

Morton County, ND.

13980 ....... Blacksburg-Christiansburg-Radford, VA ................................................................................................................................... 0.8583 

Giles County, VA.

Montgomery County, VA.

Pulaski County, VA.

Radford City, VA.

14020 ....... Bloomington, IN ......................................................................................................................................................................... 0.9406 

Greene County, IN.

Monroe County, IN.

Owen County, IN.

14060 ....... Bloomington-Normal, IL ............................................................................................................................................................. 0.9839 

McLean County, IL.

14260 ....... Boise City-Nampa, ID ................................................................................................................................................................ 0.9987 

Ada County, ID.

Boise County, ID.

Canyon County, ID.

Gem County, ID.

Owyhee County, ID.

14484 ....... Boston-Quincy, MA ................................................................................................................................................................... 1.2289 

Norfolk County, MA.

Plymouth County, MA.

Suffolk County, MA.

14500 ....... Boulder, CO ............................................................................................................................................................................... 1.1004 

Boulder County, CO.

14540 ....... Bowling Green, KY .................................................................................................................................................................... 0.8608 

Edmonson County, KY.

Warren County, KY.

14740 ....... Bremerton-Silverdale, WA ......................................................................................................................................................... 1.1505 

Kitsap County, WA.

14860 ....... Bridgeport-Stamford-Norwalk, CT ............................................................................................................................................. 1.3544 

Fairfield County, CT.

15180 ....... Brownsville-Harlingen, TX ......................................................................................................................................................... 0.9794 

Cameron County, TX.

15260 ....... Brunswick, GA ........................................................................................................................................................................... 0.9997 

Brantley County, GA.

Glynn County, GA.

McIntosh County, GA.

15380 ....... Buffalo-Niagara Falls, NY .......................................................................................................................................................... 1.0089 

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CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Erie County, NY.

Niagara County, NY.

15500 ....... Burlington, NC ........................................................................................................................................................................... 0.9229 

Alamance County, NC.

15540 ....... Burlington-South Burlington, VT ................................................................................................................................................ 1.0193 

Chittenden County, VT.

Franklin County, VT.

Grand Isle County, VT.

15764 ....... Cambridge-Newton-Framingham, MA ....................................................................................................................................... 1.1783 

Middlesex County, MA.

15804 ....... Camden, NJ .............................................................................................................................................................................. 1.0967 

Burlington County, NJ.

Camden County, NJ.

Gloucester County, NJ.

15940 ....... Canton-Massillon, OH ............................................................................................................................................................... 0.9426 

Carroll County, OH.

Stark County, OH.

15980 ....... Cape Coral-Fort Myers, FL ....................................................................................................................................................... 0.9913 

Lee County, FL.

16180 ....... Carson City, NV ........................................................................................................................................................................ 0.9868 

Carson City, NV.

16220 ....... Casper, WY ............................................................................................................................................................................... 0.9902 

Natrona County, WY.

16300 ....... Cedar Rapids, IA ....................................................................................................................................................................... 0.9340 

Benton County, IA.

Jones County, IA.

Linn County, IA.

16580 ....... Champaign-Urbana, IL .............................................................................................................................................................. 0.9908 

Champaign County, IL.

Ford County, IL.

Piatt County, IL.

16620 ....... Charleston, WV ......................................................................................................................................................................... 0.8746 

Boone County, WV.

Clay County, WV.

Kanawha County, WV.

Lincoln County, WV.

Putnam County, WV.

16700 ....... Charleston-North Charleston, SC ............................................................................................................................................. 0.9662 

Berkeley County, SC.

Charleston County, SC.

Dorchester County, SC.

16740 ....... Charlotte-Gastonia-Concord, NC-SC ........................................................................................................................................ 1.0046 

Anson County, NC.

Cabarrus County, NC.

Gaston County, NC.

Mecklenburg County, NC.

Union County, NC.

York County, SC.

16820 ....... Charlottesville, VA ..................................................................................................................................................................... 1.0206 

Albemarle County, VA.

Fluvanna County, VA.

Greene County, VA.

Nelson County, VA.

Charlottesville City, VA.

16860 ....... Chattanooga, TN-GA ................................................................................................................................................................. 0.9489 

Catoosa County, GA.

Dade County, GA.

Walker County, GA.

Hamilton County, TN.

Marion County, TN.

Sequatchie County, TN.

16940 ....... Cheyenne, WY .......................................................................................................................................................................... 0.9821 

Laramie County, WY.

16974 ....... Chicago-Naperville-Joliet, IL ..................................................................................................................................................... 1.1156 

Cook County, IL.

DeKalb County, IL.

DuPage County, IL.

Grundy County, IL.

Kane County, IL.

Kendall County, IL.

McHenry County, IL.

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CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Will County, IL.

17020 ....... Chico, CA .................................................................................................................................................................................. 1.1911 

Butte County, CA.

17140 ....... Cincinnati-Middletown, OH-KY-IN ............................................................................................................................................. 1.0310 

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 ..................................................................................................................................................................... 0.8705 

Christian County, KY.

Trigg County, KY.

Montgomery County, TN.

Stewart County, TN.

17420 ....... Cleveland, TN ............................................................................................................................................................................ 0.8497 

Bradley County, TN.

Polk County, TN.

17460 ....... Cleveland-Elyria-Mentor, OH .................................................................................................................................................... 0.9869 

Cuyahoga County, OH.

Geauga County, OH.

Lake County, OH.

Lorain County, OH.

Medina County, OH.

17660 ....... Coeur d’Alene, ID ...................................................................................................................................................................... 1.0057 

Kootenai County, ID.

17780 ....... College Station-Bryan, TX ......................................................................................................................................................... 0.9873 

Brazos County, TX.

Burleson County, TX.

Robertson County, TX.

17820 ....... Colorado Springs, CO ............................................................................................................................................................... 1.0255 

El Paso County, CO.

Teller County, CO.

17860 ....... Columbia, MO ........................................................................................................................................................................... 0.9138 

Boone County, MO.

Howard County, MO.

17900 ....... Columbia, SC ............................................................................................................................................................................ 0.9239 

Calhoun County, SC.

Fairfield County, SC.

Kershaw County, SC.

Lexington County, SC.

Richland County, SC.

Saluda County, SC.

17980 ....... Columbus, GA-AL ..................................................................................................................................................................... 0.9211 

Russell County, AL.

Chattahoochee County, GA.

Harris County, GA.

Marion County, GA.

Muscogee County, GA.

18020 ....... Columbus, IN ............................................................................................................................................................................. 1.0063 

Bartholomew County, IN.

18140 ....... Columbus, OH ........................................................................................................................................................................... 1.0660 

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 ..................................................................................................................................................................... 0.9061 

Aransas County, TX.

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CBSA 

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Wage 

index 

Nueces County, TX.

San Patricio County, TX.

18700 ....... Corvallis, OR ............................................................................................................................................................................. 1.1563 

Benton County, OR.

19060 ....... Cumberland, MD-WV ................................................................................................................................................................ 0.8752 

Allegany County, MD.

Mineral County, WV.

19124 ....... Dallas-Plano-Irving, TX ............................................................................................................................................................. 1.0467 

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 ................................................................................................................................................................................. 0.9242 

Murray County, GA.

Whitfield County, GA.

19180 ....... Danville, IL ................................................................................................................................................................................. 0.9452 

Vermilion County, IL.

19260 ....... Danville, VA ............................................................................................................................................................................... 0.8889 

Pittsylvania County, VA.

Danville City, VA.

19340 ....... Davenport-Moline-Rock Island, IA-IL ........................................................................................................................................ 0.9316 

Henry County, IL.

Mercer County, IL.

Rock Island County, IL.

Scott County, IA.

19380 ....... Dayton, OH ................................................................................................................................................................................ 0.9697 

Greene County, OH.

Miami County, OH.

Montgomery County, OH.

Preble County, OH.

19460 ....... Decatur, AL ............................................................................................................................................................................... 0.8431 

Lawrence County, AL.

Morgan County, AL.

19500 ....... Decatur, IL ................................................................................................................................................................................. 0.8519 

Macon County, IL.

19660 ....... Deltona-Daytona Beach-Ormond Beach, FL ............................................................................................................................ 0.9529 

Volusia County, FL.

19740 ....... Denver-Aurora, CO ................................................................................................................................................................... 1.1340 

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 ............................................................................................................................................ 0.9735 

Dallas County, IA.

Guthrie County, IA.

Madison County, IA.

Polk County, IA.

Warren County, IA.

19804 ....... Detroit-Livonia-Dearborn, MI ..................................................................................................................................................... 1.0539 

Wayne County, MI.

20020 ....... Dothan, AL ................................................................................................................................................................................ 0.7912 

Geneva County, AL.

Henry County, AL.

Houston County, AL.

20100 ....... Dover, DE .................................................................................................................................................................................. 1.0656 

Kent County, DE.

20220 ....... Dubuque, IA .............................................................................................................................................................................. 0.9551 

Dubuque County, IA.

20260 ....... Duluth, MN-WI ........................................................................................................................................................................... 1.0592 

Carlton County, MN.

St. Louis County, MN.

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ADDENDUM G.—FY 2008 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 .............................................................................................................................................................................. 1.0432 

Chatham County, NC.

Durham County, NC.

Orange County, NC.

Person County, NC.

20740 ....... Eau Claire, WI ........................................................................................................................................................................... 0.9982 

Chippewa County, WI.

Eau Claire County, WI.

20764 ....... Edison, NJ ................................................................................................................................................................................. 1.1789 

Middlesex County, NJ.

Monmouth County, NJ.

Ocean County, NJ.

Somerset County, NJ.

20940 ....... El Centro, CA ............................................................................................................................................................................ 0.9405 

Imperial County, CA.

21060 ....... Elizabethtown, KY ..................................................................................................................................................................... 0.9191 

Hardin County, KY.

Larue County, KY.

21140 ....... Elkhart-Goshen, IN .................................................................................................................................................................... 1.0026 

Elkhart County, IN.

21300 ....... Elmira, NY ................................................................................................................................................................................. 0.8719 

Chemung County, NY.

21340 ....... El Paso, TX ............................................................................................................................................................................... 0.9485 

El Paso County, TX.

21500 ....... Erie, PA ..................................................................................................................................................................................... 0.8964 

Erie County, PA.

21660 ....... Eugene-Springfield, OR ............................................................................................................................................................ 1.1535 

Lane County, OR.

21780 ....... Evansville, IN-KY ....................................................................................................................................................................... 0.9139 

Gibson County, IN.

Posey County, IN.

Vanderburgh County, IN.

Warrick County, IN.

Henderson County, KY.

Webster County, KY.

21820 ....... Fairbanks, AK ............................................................................................................................................................................ 1.1659 

Fairbanks North Star Borough, AK.

21940 ....... Fajardo, PR ............................................................................................................................................................................... 0.7912 

Ceiba Municipio, PR.

Fajardo Municipio, PR.

Luquillo Municipio, PR.

22020 ....... Fargo, ND-MN ........................................................................................................................................................................... 0.8485 

Cass County, ND.

Clay County, MN.

22140 ....... Farmington, NM ......................................................................................................................................................................... 1.0118 

San Juan County, NM.

22180 ....... Fayetteville, NC ......................................................................................................................................................................... 0.9889 

Cumberland County, NC.

Hoke County, NC.

22220 ....... Fayetteville-Springdale-Rogers, AR-MO ................................................................................................................................... 0.9225 

Benton County, AR.

Madison County, AR.

Washington County, AR.

McDonald County, MO.

22380 ....... Flagstaff, AZ .............................................................................................................................................................................. 1.2330 

Coconino County, AZ.

22420 ....... Flint, MI ...................................................................................................................................................................................... 1.1903 

Genesee County, MI.

22500 ....... Florence, SC ............................................................................................................................................................................. 0.8689 

Darlington County, SC.

Florence County, SC.

22520 ....... Florence-Muscle Shoals, AL ..................................................................................................................................................... 0.8433 

Colbert County, AL.

Lauderdale County, AL.

22540 ....... Fond du Lac, WI ........................................................................................................................................................................ 1.0200 

Fond du Lac County, WI.

22660 ....... Fort Collins-Loveland, CO ......................................................................................................................................................... 1.0442 

Larimer County, CO.

22744 ....... Fort Lauderdale-Pompano Beach-Deerfield Beach, FL ............................................................................................................ 1.0793 

Broward County, FL.

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CBSA 

code 

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(constituent counties) 

Wage 

index 

22900 ....... Fort Smith, AR-OK .................................................................................................................................................................... 0.8370 

Crawford County, AR.

Franklin County, AR.

Sebastian County, AR.

Le Flore County, OK.

Sequoyah County, OK.

23020 ....... Fort Walton Beach-Crestview-Destin, FL .................................................................................................................................. 0.9222 

Okaloosa County, FL.

23060 ....... Fort Wayne, IN .......................................................................................................................................................................... 0.9795 

Allen County, IN.

Wells County, IN.

Whitley County, IN.

23104 ....... Fort Worth-Arlington, TX ........................................................................................................................................................... 1.0232 

Johnson County, TX.

Parker County, TX.

Tarrant County, TX.

Wise County, TX.

23420 ....... Fresno, CA ................................................................................................................................................................................ 1.1597 

Fresno County, CA.

23460 ....... Gadsden, AL ............................................................................................................................................................................. 0.8590 

Etowah County, AL.

23540 ....... Gainesville, FL ........................................................................................................................................................................... 0.9702 

Alachua County, FL.

Gilchrist County, FL.

23580 ....... Gainesville, GA .......................................................................................................................................................................... 0.9725 

Hall County, GA.

23844 ....... Gary, IN ..................................................................................................................................................................................... 0.9732 

Jasper County, IN.

Lake County, IN.

Newton County, IN.

Porter County, IN.

24020 ....... Glens Falls, NY ......................................................................................................................................................................... 0.8711 

Warren County, NY.

Washington County, NY.

24140 ....... Goldsboro, NC ........................................................................................................................................................................... 0.9801 

Wayne County, NC.

24220 ....... Grand Forks, ND-MN ................................................................................................................................................................ 0.8316 

Polk County, MN.

Grand Forks County, ND.

24300 ....... Grand Junction, CO .................................................................................................................................................................. 1.0407 

Mesa County, CO.

24340 ....... Grand Rapids-Wyoming, MI ...................................................................................................................................................... 0.9828 

Barry County, MI.

Ionia County, MI.

Kent County, MI.

Newaygo County, MI.

24500 ....... Great Falls, MT ......................................................................................................................................................................... 0.9151 

Cascade County, MT.

24540 ....... Greeley, CO .............................................................................................................................................................................. 1.0191 

Weld County, CO.

24580 ....... Green Bay, WI ........................................................................................................................................................................... 1.0263 

Brown County, WI.

Kewaunee County, WI.

Oconto County, WI.

24660 ....... Greensboro-High Point, NC ...................................................................................................................................................... 0.9507 

Guilford County, NC.

Randolph County, NC.

Rockingham County, NC.

24780 ....... Greenville, NC ........................................................................................................................................................................... 0.9920 

Greene County, NC.

Pitt County, NC.

24860 ....... Greenville, SC ........................................................................................................................................................................... 1.0456 

Greenville County, SC.

Laurens County, SC.

Pickens County, SC.

25020 ....... Guayama, PR ............................................................................................................................................................................ 0.7912 

Arroyo Municipio, PR.

Guayama Municipio, PR.

Patillas Municipio, PR.

25060 ....... Gulfport-Biloxi, MS .................................................................................................................................................................... 0.9263 

Hancock County, MS.

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ADDENDUM G.—FY 2008 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 ............................................................................................................................................ 0.9510 

Washington County, MD.

Berkeley County, WV.

Morgan County, WV.

25260 ....... Hanford-Corcoran, CA ............................................................................................................................................................... 1.1074 

Kings County, CA.

25420 ....... Harrisburg-Carlisle, PA .............................................................................................................................................................. 0.9797 

Cumberland County, PA.

Dauphin County, PA.

Perry County, PA.

25500 ....... Harrisonburg, VA ....................................................................................................................................................................... 0.9436 

Rockingham County, VA.

Harrisonburg City, VA.

25540 ....... Hartford-West Hartford-East Hartford, CT ................................................................................................................................ 1.1487 

Hartford County, CT.

Litchfield County, CT.

Middlesex County, CT.

Tolland County, CT.

25620 ....... Hattiesburg, MS ......................................................................................................................................................................... 0.7912 

Forrest County, MS.

Lamar County, MS.

Perry County, MS.

25860 ....... Hickory-Lenoir-Morganton, NC .................................................................................................................................................. 0.9526 

Alexander County, NC.

Burke County, NC.

Caldwell County, NC.

Catawba County, NC.

25980 ....... Hinesville-Fort Stewart, GA1 ..................................................................................................................................................... 0.9745 

Liberty County, GA.

Long County, GA.

26100 ....... Holland-Grand Haven, MI ......................................................................................................................................................... 0.9501 

Ottawa County, MI.

26180 ....... Honolulu, HI ............................................................................................................................................................................... 1.2169 

Honolulu County, HI.

26300 ....... Hot Springs, AR ........................................................................................................................................................................ 0.9611 

Garland County, AR.

26380 ....... Houma-Bayou Cane-Thibodaux, LA ......................................................................................................................................... 0.8327 

Lafourche Parish, LA.

Terrebonne Parish, LA.

26420 ....... Houston-Sugar Land-Baytown, TX ........................................................................................................................................... 1.0536 

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 .............................................................................................................................................. 0.9499 

Boyd County, KY.

Greenup County, KY.

Lawrence County, OH.

Cabell County, WV.

Wayne County, WV.

26620 ....... Huntsville, AL ............................................................................................................................................................................ 0.9814 

Limestone County, AL.

Madison County, AL.

26820 ....... Idaho Falls, ID ........................................................................................................................................................................... 0.9774 

Bonneville County, ID.

Jefferson County, ID.

26900 ....... Indianapolis-Carmel, IN ............................................................................................................................................................. 1.0387 

Boone County, IN.

Brown County, IN.

Hamilton County, IN.

Hancock County, IN.

Hendricks County, IN.

Johnson County, IN.

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ADDENDUM G.—FY 2008 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 .............................................................................................................................................................................. 1.0095 

Johnson County, IA.

Washington County, IA.

27060 ....... Ithaca, NY .................................................................................................................................................................................. 1.0149 

Tompkins County, NY.

27100 ....... Jackson, MI ............................................................................................................................................................................... 0.9844 

Jackson County, MI.

27140 ....... Jackson, MS .............................................................................................................................................................................. 0.8546 

Copiah County, MS.

Hinds County, MS.

Madison County, MS.

Rankin County, MS.

Simpson County, MS.

27180 ....... Jackson, TN .............................................................................................................................................................................. 0.9149 

Chester County, TN.

Madison County, TN.

27260 ....... Jacksonville, FL ......................................................................................................................................................................... 0.9535 

Baker County, FL.

Clay County, FL.

Duval County, FL.

Nassau County, FL.

St. Johns County, FL.

27340 ....... Jacksonville, NC ........................................................................................................................................................................ 0.8525 

Onslow County, NC.

27500 ....... Janesville, WI ............................................................................................................................................................................ 1.0190 

Rock County, WI.

27620 ....... Jefferson City, MO .................................................................................................................................................................... 0.8945 

Callaway County, MO.

Cole County, MO.

Moniteau County, MO.

Osage County, MO.

27740 ....... Johnson City, TN ....................................................................................................................................................................... 0.8152 

Carter County, TN.

Unicoi County, TN.

Washington County, TN.

27780 ....... Johnstown, PA .......................................................................................................................................................................... 0.7959 

Cambria County, PA.

27860 ....... Jonesboro, AR ........................................................................................................................................................................... 0.8219 

Craighead County, AR.

Poinsett County, AR.

27900 ....... Joplin, MO ................................................................................................................................................................................. 0.9547 

Jasper County, MO.

Newton County, MO.

28020 ....... Kalamazoo-Portage, MI ............................................................................................................................................................. 1.1008 

Kalamazoo County, MI.

Van Buren County, MI.

28100 ....... Kankakee-Bradley, IL ................................................................................................................................................................ 1.2428 

Kankakee County, IL.

28140 ....... Kansas City, MO-KS ................................................................................................................................................................. 1.0025 

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 ............................................................................................................................................... 1.0630 

Benton County, WA.

Franklin County, WA.

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ADDENDUM G.—FY 2008 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 .................................................................................................................................................. 0.8703 

Bell County, TX.

Coryell County, TX.

Lampasas County, TX.

28700 ....... Kingsport-Bristol-Bristol, TN-VA ................................................................................................................................................ 0.8099 

Hawkins County, TN.

Sullivan County, TN.

Bristol City, VA.

Scott County, VA.

Washington County, VA.

28740 ....... Kingston, NY ............................................................................................................................................................................. 1.0014 

Ulster County, NY.

28940 ....... Knoxville, TN ............................................................................................................................................................................. 0.8508 

Anderson County, TN.

Blount County, TN.

Knox County, TN.

Loudon County, TN.

Union County, TN.

29020 ....... Kokomo, IN ................................................................................................................................................................................ 1.0119 

Howard County, IN.

Tipton County, IN.

29100 ....... La Crosse, WI-MN ..................................................................................................................................................................... 1.0218 

Houston County, MN.

La Crosse County, WI.

29140 ....... Lafayette, IN .............................................................................................................................................................................. 0.9357 

Benton County, IN.

Carroll County, IN.

Tippecanoe County, IN.

29180 ....... Lafayette, LA ............................................................................................................................................................................. 0.8698 

Lafayette Parish, LA.

St. Martin Parish, LA.

29340 ....... Lake Charles, LA ....................................................................................................................................................................... 0.8205 

Calcasieu Parish, LA.

Cameron Parish, LA.

29404 ....... Lake County-Kenosha County, IL-WI ....................................................................................................................................... 1.0857 

Lake County, IL.

Kenosha County, WI.

29420 ....... Lake Havasu City—Kingman, AZ ............................................................................................................................................. 0.9847 

Mohave, County, AZ.

29460 ....... Lakeland, FL .............................................................................................................................................................................. 0.9139 

Polk County, FL.

29540 ....... Lancaster, PA ............................................................................................................................................................................ 0.9768 

Lancaster County, PA.

29620 ....... Lansing-East Lansing, MI .......................................................................................................................................................... 1.0676 

Clinton County, MI.

Eaton County, MI.

Ingham County, MI.

29700 ....... Laredo, TX ................................................................................................................................................................................. 0.8520 

Webb County, TX.

29740 ....... Las Cruces, NM ........................................................................................................................................................................ 0.9154 

Dona Ana County, NM.

29820 ....... Las Vegas-Paradise, NV ........................................................................................................................................................... 1.2426 

Clark County, NV.

29940 ....... Lawrence, KS ............................................................................................................................................................................ 0.8716 

Douglas County, KS.

30020 ....... Lawton, OK ................................................................................................................................................................................ 0.8465 

Comanche County, OK.

30140 ....... Lebanon, PA .............................................................................................................................................................................. 0.8644 

Lebanon County, PA.

30300 ....... Lewiston, ID-WA ........................................................................................................................................................................ 0.9976 

Nez Perce County, ID.

Asotin County, WA.

30340 ....... Lewiston-Auburn, ME ................................................................................................................................................................ 0.9700 

Androscoggin County, ME.

30460 ....... Lexington-Fayette, KY ............................................................................................................................................................... 0.9719 

Bourbon County, KY.

Clark County, KY.

Fayette County, KY.

Jessamine County, KY.

Scott County, KY.

Woodford County, KY.

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38384 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM G.—FY 2008 WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

30620 ....... Lima, OH ................................................................................................................................................................................... 0.9944 

Allen County, OH.

30700 ....... Lincoln, NE ................................................................................................................................................................................ 1.0560 

Lancaster County, NE.

Seward County, NE.

30780 ....... Little Rock-North Little Rock, AR .............................................................................................................................................. 0.9351 

Faulkner County, AR.

Grant County, AR.

Lonoke County, AR.

Perry County, AR.

Pulaski County, AR.

Saline County, AR.

30860 ....... Logan, UT-ID ............................................................................................................................................................................. 0.9689 

Franklin County, ID.

Cache County, UT.

30980 ....... Longview, TX ............................................................................................................................................................................. 0.9196 

Gregg County, TX.

Rusk County, TX.

Upshur County, TX.

31020 ....... Longview, WA ........................................................................................................................................................................... 1.1424 

Cowlitz County, WA.

31084 ....... Los Angeles-Long Beach-Glendale, CA ................................................................................................................................... 1.2399 

Los Angeles County, CA.

31140 ....... Louisville, KY-IN ........................................................................................................................................................................ 0.9576 

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 .............................................................................................................................................................................. 0.9193 

Crosby County, TX.

Lubbock County, TX.

31340 ....... Lynchburg, VA ........................................................................................................................................................................... 0.9065 

Amherst County, VA.

Appomattox County, VA.

Bedford County, VA.

Campbell County, VA.

Bedford City, VA.

Lynchburg City, VA.

31420 ....... Macon, GA ................................................................................................................................................................................ 1.0064 

Bibb County, GA.

Crawford County, GA.

Jones County, GA.

Monroe County, GA.

Twiggs County, GA.

31460 ....... Madera, CA ............................................................................................................................................................................... 0.8515 

Madera County, CA.

31540 ....... Madison, WI .............................................................................................................................................................................. 1.1538 

Columbia County, WI.

Dane County, WI.

Iowa County, WI.

31700 ....... Manchester-Nashua, NH ........................................................................................................................................................... 1.0622 

Hillsborough County, NH.

Merrimack County, NH.

31900 ....... Mansfield, OH 1 ......................................................................................................................................................................... 0.9783 

Richland County, OH.

32420 ....... Mayagua ́ez, PR ......................................................................................................................................................................... 0.7912 

Hormigueros Municipio, PR.

Mayagu ̈ez Municipio, PR.

32580 ....... McAllen-Edinburg-Pharr, TX ..................................................................................................................................................... 0.9625 

Hidalgo County, TX.

32780 ....... Medford, OR .............................................................................................................................................................................. 1.0887 

Jackson County, OR.

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ADDENDUM G.—FY 2008 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 ................................................................................................................................................................ 0.9731 

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 ............................................................................................................................................................................... 1.2766 

Merced County, CA.

33124 ....... Miami-Miami Beach-Kendall, FL ............................................................................................................................................... 1.0553 

Miami-Dade County, FL.

33140 ....... Michigan City-La Porte, IN ........................................................................................................................................................ 0.9406 

LaPorte County, IN.

33260 ....... Midland, TX ............................................................................................................................................................................... 1.0893 

Midland County, TX.

33340 ....... Milwaukee-Waukesha-West Allis, WI ........................................................................................................................................ 1.0772 

Milwaukee County, WI.

Ozaukee County, WI.

Washington County, WI.

Waukesha County, WI.

33460 ....... Minneapolis-St. Paul-Bloomington, MN-WI ............................................................................................................................... 1.1767 

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 ............................................................................................................................................................................. 0.9439 

Missoula County, MT.

33660 ....... Mobile, AL ................................................................................................................................................................................. 0.8473 

Mobile County, AL.

33700 ....... Modesto, CA .............................................................................................................................................................................. 1.2581 

Stanislaus County, CA.

33740 ....... Monroe, LA ................................................................................................................................................................................ 0.8263 

Ouachita Parish, LA.

Union Parish, LA.

33780 ....... Monroe, MI ................................................................................................................................................................................ 0.9932 

Monroe County, MI.

33860 ....... Montgomery, AL ........................................................................................................................................................................ 0.8793 

Autauga County, AL.

Elmore County, AL.

Lowndes County, AL.

Montgomery County, AL.

34060 ....... Morgantown, WV ....................................................................................................................................................................... 0.8779 

Monongalia County, WV.

Preston County, WV.

34100 ....... Morristown, TN .......................................................................................................................................................................... 0.7912 

Grainger County, TN.

Hamblen County, TN.

Jefferson County, TN.

34580 ....... Mount Vernon-Anacortes, WA .................................................................................................................................................. 1.1110 

Skagit County, WA.

34620 ....... Muncie, IN ................................................................................................................................................................................. 0.8666 

Delaware County, IN.

34740 ....... Muskegon-Norton Shores, MI ................................................................................................................................................... 1.0338 

Muskegon County, MI.

34820 ....... Myrtle Beach-Conway-North Myrtle Beach, SC ........................................................................................................................ 0.9112 

Horry County, SC.

34900 ....... Napa, CA ................................................................................................................................................................................... 1.5120 

Napa County, CA.

34940 ....... Naples-Marco Island, FL ........................................................................................................................................................... 1.0148 

Collier County, FL.

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ADDENDUM G.—FY 2008 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 ...................................................................................................................................... 1.0278 

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 ................................................................................................................................................................... 1.3260 

Nassau County, NY.

Suffolk County, NY.

35084 ....... Newark-Union, NJ-PA ............................................................................................................................................................... 1.2516 

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 ............................................................................................................................................ 0.9405 

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 .................................................................................................................................... 1.3817 

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 ............................................................................................................................................................ 0.9645 

Berrien County, MI.

35980 ....... Norwich-New London, CT ......................................................................................................................................................... 1.2125 

New London County, CT.

36084 ....... Oakland-Fremont-Hayward, CA ................................................................................................................................................ 1.6478 

Alameda County, CA.

Contra Costa County, CA.

36100 ....... Ocala, FL ................................................................................................................................................................................... 0.9102 

Marion County, FL.

36140 ....... Ocean City, NJ .......................................................................................................................................................................... 1.1246 

Cape May County, NJ.

36220 ....... Odessa, TX ............................................................................................................................................................................... 1.0596 

Ector County, TX.

36260 ....... Ogden-Clearfield, UT ................................................................................................................................................................ 0.9501 

Davis County, UT.

Morgan County, UT.

Weber County, UT.

36420 ....... Oklahoma City, OK ................................................................................................................................................................... 0.9307 

Canadian County, OK.

Cleveland County, OK.

Grady County, OK.

Lincoln County, OK.

Logan County, OK.

McClain County, OK.

Oklahoma County, OK.

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ADDENDUM G.—FY 2008 WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

36500 ....... Olympia, WA ............................................................................................................................................................................. 1.2187 

Thurston County, WA.

36540 ....... Omaha-Council Bluffs, NE-IA .................................................................................................................................................... 1.0025 

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, FL ............................................................................................................................................................................... 0.9832 

Lake County, FL.

Orange County, FL.

Osceola County, FL.

Seminole County, FL.

36780 ....... Oshkosh-Neenah, WI ................................................................................................................................................................ 1.0094 

Winnebago County, WI.

36980 ....... Owensboro, KY ......................................................................................................................................................................... 0.9233 

Daviess County, KY.

Hancock County, KY.

McLean County, KY.

37100 ....... Oxnard-Thousand Oaks-Ventura, CA ....................................................................................................................................... 1.2478 

Ventura County, CA.

37340 ....... Palm Bay-Melbourne-Titusville, FL ........................................................................................................................................... 0.9839 

Brevard County, FL.

37380 ....... Palm Coast, FL ......................................................................................................................................................................... 0.9438 

Flagler County, FL.

37460 ....... Panama City-Lynn Haven, FL ................................................................................................................................................... 0.8620 

Bay County, FL.

37620 ....... Parkersburg-Marietta, WV-OH .................................................................................................................................................. 0.8548 

Washington County, OH.

Pleasants County, WV.

Wirt County, WV.

Wood County, WV.

37700 ....... Pascagoula, MS ........................................................................................................................................................................ 0.9124 

George County, MS.

Jackson County, MS.

37764 ....... Peabody, MA ............................................................................................................................................................................. 1.0822 

Essex County, MA.

37860 ....... Pensacola-Ferry Pass-Brent, FL ............................................................................................................................................... 0.8738 

Escambia County, FL.

Santa Rosa County, FL.

37900 ....... Peoria, IL ................................................................................................................................................................................... 0.9795 

Marshall County, IL.

Peoria County, IL.

Stark County, IL.

Tazewell County, IL.

Woodford County, IL.

37964 ....... Philadelphia, PA ........................................................................................................................................................................ 1.1536 

Bucks County, PA.

Chester County, PA.

Delaware County, PA.

Montgomery County, PA.

Philadelphia County, PA.

38060 ....... Phoenix-Mesa-Scottsdale, AZ ................................................................................................................................................... 1.0832 

Maricopa County, AZ.

Pinal County, AZ.

38220 ....... Pine Bluff, AR ............................................................................................................................................................................ 0.8271 

Cleveland County, AR.

Jefferson County, AR.

Lincoln County, AR.

38300 ....... Pittsburgh, PA ........................................................................................................................................................................... 0.8988 

Allegheny County, PA.

Armstrong County, PA.

Beaver County, PA.

Butler County, PA.

Fayette County, PA.

Washington County, PA.

Westmoreland County, PA.

38340 ....... Pittsfield, MA ............................................................................................................................................................................. 1.0661 

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ADDENDUM G.—FY 2008 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 .............................................................................................................................................................................. 0.9946 

Bannock County, ID.

Power County, ID.

38660 ....... Ponce, PR ................................................................................................................................................................................. 0.7912 

Juana D ́ıaz Municipio, PR.

Ponce Municipio, PR.

Villalba Municipio, PR.

38860 ....... Portland-South Portland-Biddeford, ME .................................................................................................................................... 1.0596 

Cumberland County, ME.

Sagadahoc County, ME.

York County, ME.

38900 ....... Portland-Vancouver-Beaverton, OR-WA ................................................................................................................................... 1.2132 

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-Fort Pierce, FL ................................................................................................................................................... 1.0569 

Martin County, FL.

St. Lucie County, FL.

39100 ....... Poughkeepsie-Newburgh-Middletown, NY ................................................................................................................................ 1.1445 

Dutchess County, NY.

Orange County, NY.

39140 ....... Prescott, AZ ............................................................................................................................................................................... 1.0572 

Yavapai County, AZ.

39300 ....... Providence-New Bedford-Fall River, RI-MA ............................................................................................................................. 1.1314 

Bristol County, MA.

Bristol County, RI.

Kent County, RI.

Newport County, RI.

Providence County, RI.

Washington County, RI.

39340 ....... Provo-Orem, UT ........................................................................................................................................................................ 1.0083 

Juab County, UT.

Utah County, UT.

39380 ....... Pueblo, CO ................................................................................................................................................................................ 0.9338 

Pueblo County, CO.

39460 ....... Punta Gorda, FL ........................................................................................................................................................................ 0.9764 

Charlotte County, FL.

39540 ....... Racine, WI ................................................................................................................................................................................. 1.0022 

Racine County, WI.

39580 ....... Raleigh-Cary, NC ...................................................................................................................................................................... 1.0060 

Franklin County, NC.

Johnston County, NC.

Wake County, NC.

39660 ....... Rapid City, SD ........................................................................................................................................................................... 0.9296 

Meade County, SD.

Pennington County, SD.

39740 ....... Reading, PA .............................................................................................................................................................................. 0.9871 

Berks County, PA.

39820 ....... Redding, CA .............................................................................................................................................................................. 1.4298 

Shasta County, CA.

39900 ....... Reno-Sparks, NV ...................................................................................................................................................................... 1.1556 

Storey County, NV.

Washoe County, NV.

40060 ....... Richmond, VA ........................................................................................................................................................................... 0.9945 

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.

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ADDENDUM G.—FY 2008 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 ..................................................................................................................................... 1.1532 

Riverside County, CA.

San Bernardino County, CA.

40220 ....... Roanoke, VA ............................................................................................................................................................................. 0.9092 

Botetourt County, VA.

Craig County, VA.

Franklin County, VA.

Roanoke County, VA.

Roanoke City, VA.

Salem City, VA.

40340 ....... Rochester, MN .......................................................................................................................................................................... 1.1639 

Dodge County, MN.

Olmsted County, MN.

Wabasha County, MN.

40380 ....... Rochester, NY ........................................................................................................................................................................... 0.9322 

Livingston County, NY.

Monroe County, NY.

Ontario County, NY.

Orleans County, NY.

Wayne County, NY.

40420 ....... Rockford, IL ............................................................................................................................................................................... 1.0191 

Boone County, IL.

Winnebago County, IL.

40484 ....... Rockingham County-Strafford County, NH ............................................................................................................................... 1.0669 

Rockingham County, NH.

Strafford County, NH.

40580 ....... Rocky Mount, NC ...................................................................................................................................................................... 0.9503 

Edgecombe County, NC.

Nash County, NC.

40660 ....... Rome, GA .................................................................................................................................................................................. 0.9537 

Floyd County, GA.

40900 ....... Sacramento-Arden-Arcade-Roseville, CA ................................................................................................................................. 1.4166 

El Dorado County, CA.

Placer County, CA.

Sacramento County, CA.

Yolo County, CA.

40980 ....... Saginaw-Saginaw Township North, MI ..................................................................................................................................... 0.9297 

Saginaw County, MI.

41060 ....... St. Cloud, MN ............................................................................................................................................................................ 1.1131 

Benton County, MN.

Stearns County, MN.

41100 ....... St. George, UT .......................................................................................................................................................................... 0.9880 

Washington County, UT.

41140 ....... St. Joseph, MO-KS ................................................................................................................................................................... 0.9246 

Doniphan County, KS.

Andrew County, MO.

Buchanan County, MO.

DeKalb County, MO.

41180 ....... St. Louis, MO-IL ........................................................................................................................................................................ 0.9413 

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.

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ADDENDUM G.—FY 2008 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 ................................................................................................................................................................................. 1.1154 

Marion County, OR.

Polk County, OR.

41500 ....... Salinas, CA ................................................................................................................................................................................ 1.5382 

Monterey County, CA.

41540 ....... Salisbury, MD ............................................................................................................................................................................ 0.9489 

Somerset County, MD.

Wicomico County, MD.

41620 ....... Salt Lake City, UT ..................................................................................................................................................................... 0.9921 

Salt Lake County, UT.

Summit County, UT.

Tooele County, UT.

41660 ....... San Angelo, TX ......................................................................................................................................................................... 0.9053 

Irion County, TX.

Tom Green County, TX.

41700 ....... San Antonio, TX ........................................................................................................................................................................ 0.9337 

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 ...................................................................................................................................... 1.2045 

San Diego County, CA.

41780 ....... Sandusky, OH ........................................................................................................................................................................... 0.9309 

Erie County, OH.

41884 ....... San Francisco-San Mateo-Redwood City, CA .......................................................................................................................... 1.5987 

Marin County, CA.

San Francisco County, CA.

San Mateo County, CA.

41900 ....... San Germaa ́n-Cabo Rojo, PR .................................................................................................................................................. 0.7912 

Cabo Rojo Municipio, PR.

Lajas Municipio, PR.

Sabana Grande Municipio, PR.

San Germ ́ın Municipio, PR.

41940 ....... San Jose-Sunnyvale-Santa Clara, CA ...................................................................................................................................... 1.6498 

San Benito County, CA.

Santa Clara County, CA.

41980 ....... San Juan-Caguas-Guaynabo, PR ............................................................................................................................................. 0.7912 

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.

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Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38391 

ADDENDUM G.—FY 2008 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 ........................................................................................................................................... 1.3126 

San Luis Obispo County, CA.

42044 ....... Santa Ana-Anaheim-Irvine, CA ................................................................................................................................................. 1.2390 

Orange County, CA.

42060 ....... Santa Barbara-Santa Maria-Goleta, CA ................................................................................................................................... 1.2340 

Santa Barbara County, CA.

42100 ....... Santa Cruz-Watsonville, CA ...................................................................................................................................................... 1.7003 

Santa Cruz County, CA.

42140 ....... Santa Fe, NM ............................................................................................................................................................................ 1.1325 

Santa Fe County, NM.

42220 ....... Santa Rosa-Petaluma, CA ........................................................................................................................................................ 1.5278 

Sonoma County, CA.

42260 ....... Sarasota-Bradenton-Venice, FL ................................................................................................................................................ 1.0462 

Manatee County, FL.

Sarasota County, FL.

42340 ....... Savannah, GA ........................................................................................................................................................................... 0.9733 

Bryan County, GA.

Chatham County, GA.

Effingham County, GA.

42540 ....... Scranton–Wilkes-Barre, PA ....................................................................................................................................................... 0.8924 

Lackawanna County, PA.

Luzerne County, PA.

Wyoming County, PA.

42644 ....... Seattle-Bellevue-Everett, WA .................................................................................................................................................... 1.2191 

King County, WA.

Snohomish County, WA.

42680 ....... Sebastian-Vero Beach, FL ........................................................................................................................................................ 0.9931 

Indian River County, FL.

43100 ....... Sheboygan, WI .......................................................................................................................................................................... 0.9470 

Sheboygan County, WI.

43300 ....... Sherman-Denison, TX ............................................................................................................................................................... 0.8778 

Grayson County, TX.

43340 ....... Shreveport-Bossier City, LA ...................................................................................................................................................... 0.9004 

Bossier Parish, LA.

Caddo Parish, LA.

De Soto Parish, LA.

43580 ....... Sioux City, IA-NE-SD ................................................................................................................................................................ 0.9899 

Woodbury County, IA.

Dakota County, NE.

Dixon County, NE.

Union County, SD.

43620 ....... Sioux Falls, SD .......................................................................................................................................................................... 1.0091 

Lincoln County, SD.

McCook County, SD.

Minnehaha County, SD.

Turner County, SD.

43780 ....... South Bend-Mishawaka, IN-MI ................................................................................................................................................. 1.0147 

St. Joseph County, IN.

Cass County, MI.

43900 ....... Spartanburg, SC ........................................................................................................................................................................ 0.9942 

Spartanburg County, SC.

44060 ....... Spokane, WA ............................................................................................................................................................................ 1.1018 

Spokane County, WA.

44100 ....... Springfield, IL ............................................................................................................................................................................ 0.9437 

Menard County, IL.

Sangamon County, IL.

44140 ....... Springfield, MA .......................................................................................................................................................................... 1.0709 

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38392 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM G.—FY 2008 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 .......................................................................................................................................................................... 0.9595 

Christian County, MO.

Dallas County, MO.

Greene County, MO.

Polk County, MO.

Webster County, MO.

44220 ....... Springfield, OH .......................................................................................................................................................................... 0.9141 

Clark County, OH.

44300 ....... State College, PA ...................................................................................................................................................................... 0.9252 

Centre County, PA.

44700 ....... Stockton, CA ............................................................................................................................................................................. 1.2422 

San Joaquin County, CA.

44940 ....... Sumter, SC ................................................................................................................................................................................ 0.9073 

Sumter County, SC.

45060 ....... Syracuse, NY ............................................................................................................................................................................ 1.0410 

Madison County, NY.

Onondaga County, NY.

Oswego County, NY.

45104 ....... Tacoma, WA .............................................................................................................................................................................. 1.1664 

Pierce County, WA.

45220 ....... Tallahassee, FL ......................................................................................................................................................................... 0.9522 

Gadsden County, FL.

Jefferson County, FL.

Leon County, FL.

Wakulla County, FL.

45300 ....... Tampa-St. Petersburg-Clearwater, FL ...................................................................................................................................... 0.9516 

Hernando County, FL.

Hillsborough County, FL.

Pasco County, FL.

Pinellas County, FL.

45460 ....... Terre Haute, IN ......................................................................................................................................................................... 0.9290 

Clay County, IN.

Sullivan County, IN.

Vermillion County, IN.

Vigo County, IN.

45500 ....... Texarkana, TX-Texarkana, AR ................................................................................................................................................. 0.8574 

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 ................................................................................................................................................................................ 0.9009 

Jackson County, KS.

Jefferson County, KS.

Osage County, KS.

Shawnee County, KS.

Wabaunsee County, KS.

45940 ....... Trenton-Ewing, NJ ..................................................................................................................................................................... 1.1288 

Mercer County, NJ.

46060 ....... Tucson, AZ ................................................................................................................................................................................ 0.9824 

Pima County, AZ.

46140 ....... Tulsa, OK .................................................................................................................................................................................. 0.8801 

Creek County, OK.

Okmulgee County, OK.

Osage County, OK.

Pawnee County, OK.

Rogers County, OK.

Tulsa County, OK.

Wagoner County, OK.

46220 ....... Tuscaloosa, AL .......................................................................................................................................................................... 0.8760 

Greene County, AL.

Hale County, AL.

Tuscaloosa County, AL.

46340 ....... Tyler, TX .................................................................................................................................................................................... 0.9261 

Smith County, TX.

46540 ....... Utica-Rome, NY ........................................................................................................................................................................ 0.8949 

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Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38393 

ADDENDUM G.—FY 2008 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 ............................................................................................................................................................................. 0.8544 

Brooks County, GA.

Echols County, GA.

Lanier County, GA.

Lowndes County, GA.

46700 ....... Vallejo-Fairfield, CA ................................................................................................................................................................... 1.5432 

Solano County, CA.

47020 ....... Victoria, TX ................................................................................................................................................................................ 0.8762 

Calhoun County, TX.

Goliad County, TX.

Victoria County, TX.

47220 ....... Vineland-Millville-Bridgeton, NJ ................................................................................................................................................. 1.0691 

Cumberland County, NJ.

47260 ....... Virginia Beach-Norfolk-Newport News, VA-NC ........................................................................................................................ 0.9308 

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 ................................................................................................................................................................ 1.0647 

Tulare County, CA.

47380 ....... Waco, TX ................................................................................................................................................................................... 0.8988 

McLennan County, TX.

47580 ....... Warner Robins, GA ................................................................................................................................................................... 0.9632 

Houston County, GA.

47644 ....... Warren-Troy-Farmington Hills, MI ............................................................................................................................................. 1.0554 

Lapeer County, MI.

Livingston County, MI.

Macomb County, MI.

Oakland County, MI.

St. Clair County, MI.

47894 ....... Washington-Arlington-Alexandria, DC-VA-MD-WV ................................................................................................................... 1.1441 

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 ........................................................................................................................................................... 0.8988 

Black Hawk County, IA.

Bremer County, IA.

Grundy County, IA.

48140 ....... Wausau, WI ............................................................................................................................................................................... 1.0212 

Marathon County, WI.

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38394 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 

ADDENDUM G.—FY 2008 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 ................................................................................................................................................... 0.8361 

Jefferson County, OH.

Brooke County, WV.

Hancock County, WV.

48300 ....... Wenatchee, WA ........................................................................................................................................................................ 1.2101 

Chelan County, WA.

Douglas County, WA.

48424 ....... West Palm Beach-Boca Raton-Boynton Beach, FL ................................................................................................................. 1.0270 

Palm Beach County, FL.

48540 ....... Wheeling, WV-OH ..................................................................................................................................................................... 0.7912 

Belmont County, OH.

Marshall County, WV.

Ohio County, WV.

48620 ....... Wichita, KS ................................................................................................................................................................................ 0.9631 

Butler County, KS.

Harvey County, KS.

Sedgwick County, KS.

Sumner County, KS.

48660 ....... Wichita Falls, TX ....................................................................................................................................................................... 0.8642 

Archer County, TX.

Clay County, TX.

Wichita County, TX.

48700 ....... Williamsport, PA ........................................................................................................................................................................ 0.8486 

Lycoming County, PA.

48864 ....... Wilmington, DE-MD-NJ ............................................................................................................................................................. 1.1419 

New Castle County, DE.

Cecil County, MD.

Salem County, NJ.

48900 ....... Wilmington, NC ......................................................................................................................................................................... 0.9937 

Brunswick County, NC.

New Hanover County, NC.

Pender County, NC.

49020 ....... Winchester, VA-WV ................................................................................................................................................................... 1.0459 

Frederick County, VA.

Winchester City, VA.

Hampshire County, WV.

49180 ....... Winston-Salem, NC ................................................................................................................................................................... 0.9621 

Davie County, NC.

Forsyth County, NC.

Stokes County, NC.

Yadkin County, NC.

49340 ....... Worcester, MA ........................................................................................................................................................................... 1.1887 

Worcester County, MA.

49420 ....... Yakima, WA ............................................................................................................................................................................... 1.0832 

Yakima County, WA.

49500 ....... Yauco, PR ................................................................................................................................................................................. 0.7912 

Gu ́ınica Municipio, PR.

Guayanilla Municipio, PR.

Pen ̃uelas Municipio, PR.

Yauco Municipio, PR.

49620 ....... York-Hanover, PA ..................................................................................................................................................................... 0.9499 

York County, PA.

0.9745.

49660 ....... Youngstown-Warren-Boardman, OH-PA .................................................................................................................................. 0.9499 

Mahoning County, OH.

Trumbull County, OH.

Mercer County, PA.

49700 ....... Yuba City, CA ............................................................................................................................................................................ 1.1349 

Sutter County, CA.

Yuba County, CA.

49740 ....... Yuma, AZ .................................................................................................................................................................................. 1.0010 

Yuma County, AZ.

1At this time, there are no hospitals located in this urban area on which to base a wage index. 

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Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38395 

ADDENDUM H.— FY 2008 WAGE

INDEX BASED ON CBSA LABOR

MARKET AREAS FOR RURAL AREAS

CBSA 

code Nonurban area Wage index 

1 ......... Alabama ....................... 0.7975 

2 ......... Alaska .......................... 1.2476 

3 ......... Arizona ......................... 0.9131 

4 ......... Arkansas ...................... 0.7912 

5 ......... California ...................... 1.2540 

6 ......... Colorado ...................... 1.0236 

7 ......... Connecticut .................. 1.2106 

8 ......... Delaware ...................... 1.0190 

10 ....... Florida .......................... 0.8935 

11 ....... Georgia ........................ 0.8080 

12 ....... Hawaii .......................... 1.1202 

13 ....... Idaho ............................ 0.8420 

14 ....... Illinois ........................... 0.8800 

15 ....... Indiana ......................... 0.9077 

16 ....... Iowa ............................. 0.9039 

17 ....... Kansas ......................... 0.8423 

18 ....... Kentucky ...................... 0.8220 

19 ....... Louisiana ...................... 0.7912 

20 ....... Maine ........................... 0.8942 

21 ....... Maryland ...................... 0.9532 

22 ....... Massachusetts1 ........... 1.2306 

23 ....... Michigan ....................... 0.9432 

24 ....... Minnesota .................... 0.9690 

ADDENDUM H.— FY 2008 WAGE

INDEX BASED ON CBSA LABOR

MARKET AREAS FOR RURAL

AREAS—Continued 

CBSA 

code Nonurban area Wage index 

25 ....... Mississippi .................... 0.8305 

26 ....... Missouri ........................ 0.8319 

27 ....... Montana ....................... 0.8838 

28 ....... Nebraska ...................... 0.9334 

29 ....... Nevada ......................... 0.9763 

30 ....... New Hampshire ........... 1.1462 

31 ....... New Jersey1 ................ ------ 

32 ....... New Mexico ................. 0.9428 

33 ....... New York ..................... 0.8715 

34 ....... North Carolina .............. 0.9077 

35 ....... North Dakota ................ 0.7912 

36 ....... Ohio ............................. 0.9194 

37 ....... Oklahoma ..................... 0.7912 

38 ....... Oregon ......................... 1.0439 

39 ....... Pennsylvania ................ 0.8852 

40 ....... Puerto Rico1 ................ 0.7912 

41 ....... Rhode Island 1 ............. ------ 

42 ....... South Carolina ............. 0.9225 

43 ....... South Dakota ............... 0.9007 

44 ....... Tennessee ................... 0.8142 

45 ....... Texas ........................... 0.8408 

ADDENDUM H.— FY 2008 WAGE

INDEX BASED ON CBSA LABOR

MARKET AREAS FOR RURAL

AREAS—Continued 

CBSA 

code Nonurban area Wage index 

46 ....... Utah ............................. 0.8635 

47 ....... Vermont ....................... 1.0463 

48 ....... Virgin Islands ............... 0.7912 

49 ....... Virginia ......................... 0.8350 

50 ....... Washington .................. 1.0826 

51 ....... West Virginia ................ 0.7912 

52 ....... Wisconsin ..................... 1.0142 

53 ....... Wyoming ...................... 0.9798 

65 ....... Guam ........................... 0.9611 

1 All 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. The rural Massachusetts wage index is calculated as the average of all contiguous CBSAs. The Puerto Rico 

wage index is the same as FY 2007. 

[FR Doc. 07–3274 Filed 7–2–07; 8:55 am] 

BILLING CODE 4120–01–P 

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