# Thursday, August 5, 2004



# Part II



# Department of Health and Human
Services

Centers for Medicare and Medicaid

Services

42 CFR Parts 405, 410, 411, et al. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2005; Proposed Rule


## 47488 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

**DEPARTMENT OF HEALTH AND HUMAN SERVICES** 

**Centers for Medicare & Medicaid Services** 

**42 CFR Parts 405, 410, 411, 414, 418, 424, 484, and 486** 

**[CMS–1429–P]**

**RIN 0938–AM90**



### Medicare Program; Revisions to **Payment Policies Under the Physician Fee Schedule for Calendar Year 2005** 

**AGENCY** 

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

**ACTION** 

### : Proposed rule.

**SUMMARY** 

### : This proposed rule would refine the resource-based practice expense relative value units (RVUs) and make other changes to Medicare Part B payment policy. The proposed policy changes concern: supplemental survey data for practice expense, updated geographic practice cost indices for physician work and practice expense, updated malpractice RVUs, revised requirements for supervision of therapy assistants, revised payment rules for low osmolar contrast media, changes to payment policies for physicians and practitioners managing dialysis patients, clarification of care plan oversight requirements, revised requirements for supervision of diagnostic psychological testing services, clarifications to the policies affecting therapy services, revised requirements for assignment of Medicare claims, addition to the list of telehealth services, and several coding
issues.

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. We solicit comments on these proposed policy changes.

This proposed rule also addresses the following provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA): coverage of an initial preventive physical examination; coverage of cardiovascular screening blood tests; coverage of diabetes screening tests; incentive payment improvements for physicians in shortage areas; payment for covered outpatient drugs and biologicals; payment for renal dialysis services; coverage of routine costs associated with certain clinical trials of category A devices as defined by the Food and Drug Administration; hospice consultation service; indexing the Part B deductible to inflation; extension of coverage of intravenous immune globulin (IVIG) for the treatment in the home of primary immune deficiency diseases; revisions to reassignment provisions; clinical conditions for payment of covered items of durable medical equipment; and payment for diagnostic mammograms.

In addition, we discuss physicians’ services associated with drug administration services and payment for set-up of portable x-ray equipment.

**DATES** 

### : To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on September 24, 2004.

**ADDRESSES** 

### : In commenting, please refer to file code CMS–1429–P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX)
transmission.

You may submit comments in one of three ways (no duplicates, please):

1. Electronically. You may submit electronic comments on specific issues in this regulation to http:// www.cms.hhs.gov/regulations/

ecomments . (Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word.)

2. By mail. You may mail written comments (one original and two copies) to the following address ONLY:
Centers for Medicare & Medicaid

Services, Department of Health and Human Services, Attention: CMS– 1429–P, P.O. Box 8012, Baltimore,
MD 21244–8012.
Please allow sufficient time for mailed

comments to be received before the close of the comment period.

3. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to one of the following addresses. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786– 7197 in advance to schedule your arrival with one of our staff members. Room 445–G, Hubert H. Humphrey

Building, 200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD

21244–1850. (Because access to the interior of the HHH Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)

Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.

Submission of comments on paperwork requirements. You may submit comments on this document’s paperwork requirements by mailing your comments to the addresses provided at the end of the ‘‘Collection of Information Requirements’’ section in this document.

For information on viewing public comments, see the beginning of the

**SUPPLEMENTARY INFORMATION** 

### section.

**FOR FURTHER INFORMATION CONTACT** 

### : Pam West (410) 786–2302 (for issues

related to Practice Expense, Respiratory Therapy Coding, and Therapy Supervision). Rick Ensor (410) 786–5617 (for issues

related to Geographic Practice Cost Index (GPCI) and malpractice RVUs). Craig Dobyski (410) 786–4584 (for issues

related to list of telehealth services or payments for physicians and practitioners managing dialysis patients). Bill Larson or Tiffany Sanders (410)

786–7176 (for issues related to coverage of an initial preventive physical examination). Cathleen Scally (410) 786–5714 (for

issues related to payment of an initial preventive physical examination). Joyce Eng (410) 786–7176 (for issues

related to coverage of cardiovascular screening tests). Betty Shaw (410) 786–7176 (for issues

related to coverage of diabetes screening tests). Anita Greenberg (410) 786–0548 (for

issues related to payment of cardiovascular and diabetes screening tests). David Worgo (410) 786–5919, (for issues

related to incentive payment improvements for physicians practicing in shortage areas). Angela Mason or Jennifer Fan (410)

786–0548 (for issues related to payment for covered outpatient drugs and biologicals). David Walczak (410) 786–4475 (for

issues related to reassignment provisions). Henry Richter (410) 786–4562 (for

issues related to payments for ESRD facilities). Steve Berkowitz (410) 786–7176 (for

issues related to coverage of routine costs associated with certain clinical trials of category A devices). Terri Deutsch (410) 786–9462 (for issues

related to hospice consultation services). Karen Daily (410) 786–7176 (for issues

related to clinical conditions for payment of covered items of durable medical equipment).


## 47489 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

Dorothy Shannon (410) 786

– 3396 (for

issues related to outpatient therapy services performed ‘‘ incident to ’’ physicians ’ services). Roberta Epps (410) 786

– 5919 (for issues

related to low osmolar contrast media or supervision of diagnostic psychological testing services). Gail Addis (410) 786

– 4522 (for issues

related to care plan oversight). 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

– 1429-P and the specific ‘‘ issue identifier ’’ that precedes the section on which you choose to comment.

Inspection of Public Comments: Comments received timely will be available for public inspection as they are processed, 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 (410) 786

– 7197.

Copies: To order copies of the Federal Register containing this document, send your request to: New Orders, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250

– 7954. Specify the date of the issue requested and enclose a check or money order payable to the Superintendent of Documents, or enclose your Visa or Master Card number and expiration date. Credit card orders can also be placed by calling the order desk at (202)

512

– 1800 (or toll-free at 1

– 888

– 293

– 6498) or by faxing to (202) 512

– 2250. The cost for each copy is $10. As an alternative, you can view and photocopy the Federal Register document at most libraries designated as Federal Depository Libraries and at many other public and academic libraries throughout the country that receive the Federal Register

.

This Federal Register document is also available from the Federal Register online database through GPO Access , a service of the U.S. Government Printing Office. The web site address is: http:// www.access.gpo.gov/nara/index.html

.

Information on the physician fee schedule can be found on the CMS homepage. You can access this data by using the following directions: 1. Go to the CMS homepage ( http:// www.cms.hhs.gov ). 2. Place your cursor over the word

‘‘ Professionals ’’ in the blue area near the top of the page. Select ‘‘ physicians ’’ from the drop-down menu.

3. Under ‘‘ Policies/Regulations ’’ select

‘‘ Physician Fee Schedule. ’’

To assist readers in referencing sections contained in this preamble, we are providing the following table of contents. Some of the issues discussed in this preamble affect the payment policies but do not require changes to the regulations in the Code of Federal Regulations. Information on the regulation ’ s impact appears throughout the preamble and is not exclusively in
section VII.

Table of Contents I. Background

A. Legislative History B. Published Changes to the Fee Schedule II. Provisions of the Proposed Regulation Related to the Physician Fee Schedule A. Resource-Based Practice Expense

Relative Value Units (RVUs) B. Geographic Practice Cost Indices (GPCIs) C. Malpractice Work RVUs D. Coding Issues III. Provisions Related to the Medicare Modernization Act of 2003
A. Section 611

— Preventive Physical

Examination
B. Section 613

— Diabetes Screening
C. Section 612

— Cardiovascular Screening
D. Section 413

— Incentive Payment for

Physician Scarcity
E. Section 303

— Payment for Covered

Outpatient Drugs and Biologicals
F. Section 952

— Revision to Reassignment

Provisions
G. Section 642

— Extension of Coverage of

IVIG for the Treatment in the Home of Primary Immune Deficiency Diseases
H. Section 623

— Payment for Renal

Dialysis Services
I. Section 731

— Coverage of Routine Costs

for Category A Clinical Trials J. Section 629

— Part B Deductible
K. Section 512

— Hospice Consultation

Service
L. Section 302

— Clinical Conditions for

Coverage of Durable Medical Equipment (DME)
M. Section 614

— Payment for Certain

Mammography Services
N. Section 305

— Payment for Inhalation

Drugs IV. Other Issues

A. Provisions Related to Therapy Services 1. Outpatient Therapy Services Performed

‘‘ Incident to ’’ Physicians ’’ Services 2. Supervision Requirements for Therapy

Assistants in Private Practice 3. Other Technical Revisions B. Low Osmolar Contrast Media C. Payments for Physicians and

Practitioners Managing Dialysis Patients D. Technical Revision —§ 411.404 E. Supervision of Clinical Psychological

Testing F. Care Plan Oversight G. Assignment of Medicare Claims

— Payment to the Supplier V. Collection of Information Requirements VI. Response to Comments VII. Regulatory Impact Analysis Addendum A

— Explanation and Use of Addendum B. Addendum B

— 2005 Relative Value Units and Related Information Used in Determining Medicare Payments for

2005. Addendum C

— Codes for Which We Received PEAC Recommendations on Practice Expense Direct Cost Inputs. Addendum D

— Proposed Changes to Practice Expense Equipment Description and Pricing. Addendum E

— Revised 2005 Office Rental Index Versus Current Office Rental Index by 2004 Fee Schedule Area Addendum F

— Current Geographic Practice Cost Indices by Medicare Carrier and Locality Addendum G

— Proposed 2005 Geographic Practice Cost Indices by Medicare Carrier and Locality Addendum H

— Proposed 2006 Geographic Practice Cost Indices by Medicare Carrier and Locality Addendum I

— Comparison of Current 2004 Geographic Adjustment Factors (GAFs) to Proposed 2005 GAFS Addendum J

— Comparison of Current 2004 GAFs to Proposed 2006 GAFs 

### In addition, because of the many organizations and terms to which we refer by acronym in this proposed rule, we are listing these acronyms and their corresponding terms in alphabetical order below:
ACC American College of Cardiology ACR American College of Radiology AMA American Medical Association APA American Psychological Association ASP Average Sales Price ATA American Telemedicine Association BBA Balanced Budget Act of 1997 BBRA Balanced Budget Refinement Act of

1999 BIPA Benefits Improvement and Protection

Act of 2000 BLS Bureau of Labor Statistics CAH Critical Access Hospital CF Conversion factor CFR Code of Federal Regulations CMS Centers for Medicare & Medicaid

Services CNS Clinical Nurse Specialist CPT [Physicians ’ ] Current Procedural

Terminology [4th Edition, 2002, copyrighted by the American Medical Association] CPEP Clinical Practice Expert Panel CY Calendar Year E/M Evaluation and management ESRD End-Stage Renal Disease FMR Fair market rental FY Fiscal Year GAF Geographic adjustment factor GPCI Geographic practice cost index HCPCS Healthcare Common Procedure

Coding System HHA Home health agency HHS [Department of] Health and Human

Services


## 47490 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

HOCM High osmolar contrast media HPSA Health Professional Shortage Area HRSA Health Resources and Services

Administration IDTFs Independent Diagnostic Testing

Facilities IPPS Inpatient prospective payment system IOM Internet Only Manual ISO Insurance Services Office LOCM Low osmolar contrast media MCM Medicare Carrier Manual MCP Monthly Capitation Payment MedPAC Medicare Payment Advisory

Commission MEI Medicare Economic Index MGMA Medical Group Management

Association MMA Medicare Prescription Drug,

Improvement, and Modernization Act of

2003 MPFS Medicare Physician Fee Schedule MSA Metropolitan Statistical Area NAMCS National Ambulatory Medical Care

Survey
NP Nurse Practitioner OBRA Omnibus Budget Reconciliation Act OMB Office of Management and Budget OPPS Outpatient prospective payment

system PA Physician Assistant PC Professional component PCF Patient compensation fund PEAC Practice Expense Advisory

Committee PET Positron Emission Tomography PHSA Public Health Services Act PPS Prospective payment system PSA Physician Scarcity Area RN Registered Nurse RUC [AMA ’ s Specialty Society] Relative

[Value] Update Committee RUCA Rural-Urban Commuting Area RVU Relative value unit SCHIP State Child Health Insurance

Program SGR Sustainable growth rate SLP Speech language pathology SMS [AMA ’ s] Socioeconomic Monitoring

System TC Technical component USPSTF U.S. Preventive Services Task

Force



### I. Background
A. Legislative History

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 fee schedule 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, and malpractice expense. Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments in RVUs may not cause total physician fee schedule payments to differ by more than $20 million from what they would have been had the adjustments not been made. If adjustments to RVUs cause expenditures to change by more than $20 million, we must make adjustments to ensure that they do not increase or decrease by more than $20 million.
B. Published Changes to the Fee Schedule

The July 2000 and August 2003 proposed rules ((65 FR 44177) and (68 FR 49030), respectively), include a summary of the final physician fee schedule rules published through February 2003.

In the November 7, 2003 final rule, we refined the resource-based practice expense RVUs and made other changes to Medicare Part B payment policy. The specific policy changes concerned: The Medicare Economic Index; practice expense for professional component services; definition of diabetes for diabetes self-management training; supplemental survey data for practice expense; geographic practice cost indices; and several coding issues. In addition, this rule updated the codes subject to the physician self-referral prohibition. We also made revisions to the sustainable growth rate, the anesthesia conversion factor and finalized the CY 2003 interim RVUs and issued interim RVUs for new and revised procedure codes for CY 2004.

As required by the statute, we announced that the physician fee schedule update for CY 2004 would be

¥ 4.5 percent; the initial estimate of the sustainable growth rate for CY 2004 was 7.4 percent; and the conversion factor for CY 2004 was $35.1339.

Subsequent to the November 7, 2003 final rule, the Congress enacted the MMA (Pub. L. 108

– 17). On January 7, 2004, an interim final rule was published to implement provisions of the MMA applicable in 2004 to Medicare payment for covered drugs and physician fee schedule services. These provisions included

—

• Revising the current payment methodology for Part B covered drugs and biologicals that are not paid on a cost or prospective payment basis;

• Making changes to Medicare payment for furnishing or administering drugs and biologicals;

• Revising the geographic practice cost indices;

• Changing the physician fee schedule conversion factor. The 2004 physician fee schedule conversion factor is $37.3374; and

• Extending the ‘‘ opt-out ’’ provisions of section 1802(b)(5)(3) of the Act to dentists, podiatrists, and optometrists.

The information contained in the January 7, 2004 interim final rule concerning payment under the physician fee schedule superceded information contained in the November 7, 2003 final rule to the extent that the
two are inconsistent.
II. Provisions of the Proposed Rule

This proposed rule would affect the regulations set forth at Part 405, Federal Health Insurance for the Aged and Disabled; Part 410, Supplementary Medical Insurance (SMI) Benefits; Part 411, Exclusions from Medicare and Limitations on Medicare Payment; Part 414, Payment for Part B Medical and Other Health Services; Part 418, Hospice Care; Part 424, Conditions for Medicare Payment; Part 484, Home Health Services; and Part 486, Conditions for Coverage of Specialized Services Furnished by Suppliers.
A. Resource-Based Practice Expense Relative Value Units [If you choose to comment on issues in this section, please include the caption

‘‘ Practice Expense ’’ at the beginning of your comments.]
1. Resource-Based Practice Expense Legislation

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 Social Security Act and required us to develop a methodology for a resource-based system for determining practice expense RVUs for each physician ’ s service beginning in 1998. Until that time, physicians ’ practice expenses were established based on historical allowed charges.

In developing the methodology, we were to consider the staff, equipment, and supplies used in providing medical and surgical services in various settings. The legislation specifically required that, in implementing the new system of practice expense RVUs, we apply the same budget-neutrality provisions that we apply to other adjustments under the physician fee schedule.

Section 4505(a) of the Balanced Budget Act of 1997 (BBA) (Pub. L. 105

– 33), enacted on August 5, 1997, amended section 1848(c)(2)(C)(ii) of the Act and delayed the effective date of the resource-based practice expense RVU system until January 1, 1999. In addition, section 4505(b) of the BBA provided for a 4-year transition period from charge-based practice expense RVUs to resource-based RVUs.

Further legislation affecting resourcebased practice expense RVUs was included in the Medicare, Medicaid and State Child Health Insurance Program (SCHIP) Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106

– 113)


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enacted on November 29, 1999. Section 212 of the BBRA amended section 1848(c)(2)(C)(ii) of the Act by directing us 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. These data would supplement the data we normally collect in determining the practice expense component of the physician fee schedule for payments in CY 2001 and CY 2002. (The 1999 and 2003 final rules (64 FR 59380 and 68 FR 63196, respectively, extended the period during which we would accept supplemental data.)
2. Current Methodology for Computing the Practice Expense Relative Value Unit System

In the November 2, 1998 final rule (63 FR 58910), effective with services furnished on or after January 1, 1999, we established at 42 CFR 414.22(b)(5) a new methodology for computing resource-based practice expense RVUs that used the two significant sources of actual practice expense data we have available

— the Clinical Practice Expert Panel (CPEP) data and the American Medical Association ’ s (AMA) Socioeconomic Monitoring System (SMS) data. The CPEP data were collected from panels of physicians, practice administrators, and nonphysicians (for example registered nurses) nominated by physician specialty societies and other groups. The CPEP panels identified the direct inputs required for each physician service in both the office setting and out-of-office setting. The AMA ’ s SMSdata provided aggregate specialtyspecific information on hours worked and practice expenses. The methodology was based on an assumption that current aggregate specialty practice costs are a reasonable way to establish initial estimates of relative resource costs for physicians ’ services across specialties. The methodology allocated these aggregate specialty practice costs to specific procedures and, thus, can be seen as a

‘‘ top-down ’’ approach.

Also in the November 2, 1998 final rule, in response to comments, we discussed the establishment of the Practice Expense Advisory Committee (PEAC) of the AMA ’ s Specialty Society Relative Value Update Committee(RUC), which would review codespecific CPEP data during the refinement period. This committee would include representatives from all major specialty societies and would make recommendations to us on suggested changes to the CPEP data. As directed by the BBRA, we also established a process ( see 65 FR 65380) under which we would accept and use, to the maximum extent practicable and consistent with sound data practices, data collected by entities and organizations to supplement the data we normally collect in determining the practice expense component of the physician fee schedule.

a. Major Steps

A brief discussion of the major steps involved in the determination of the practice expense RVUs follows. (Please see the November 1, 2001 final rule (66 FR 55249) for a more detailed explanation of the top-down methodology.)

• Step 1

— Determine the specialty specific practice expense per hour of physician direct patient care. We used the AMA ’ s SMS survey of actual aggregate cost data by specialty to determine the practice expenses per hour for each specialty. We calculated the practice expenses per hour for the specialty by dividing the aggregate practice expenses for the specialty by the total number of hours spent in patient care activities.

• Step 2

— Create a specialty-specific practice expense pool of practice expense costs for treating Medicare patients. To calculate the total number of hours spent treating Medicare patients for each specialty, we used the physician time assigned to each procedure code and the Medicare utilization data. The primary sources for the physician time data were surveys submitted to the AMA ’ s RUC and surveys done by Harvard for the establishment of the work RVUs. We then multiplied the physician time assigned per procedure code by the number of times that code was billed by each specialty, and summed the products for each code, by specialty, to get the total physician hours spent treating Medicare patients for that specialty. We then calculated the specialty specific practice expense pools by multiplying the specialty practice expenses per hour (from step 1) by the total Medicare physician hours for the specialty.

• Step 3

— Allocate the specialty specific practice expense pool to the specific services (procedure codes) performed by each specialty. For each specialty, we divided the practice expense pool into two groups based on whether direct or indirect costs were involved and used a different allocation basis for each group.

(i) Direct costs

— For direct costs (which include clinical labor, medical supplies, and medical equipment), we used the procedure-specific CPEP data on the staff time, supplies, and equipment as the allocation basis. For the separate practice expense pool for services without physician work RVUs, we have used, on an interim basis, 1998 practice expense RVUs to allocate the direct cost pools.

(ii) Indirect costs

— To allocate the cost pools for indirect costs, including administrative labor, office expenses, and all other expenses, we used the total direct costs, or the 1998 practice expense RVUs, in combination with the physician fee schedule work RVUs. We converted the work RVUs to dollars using the Medicare CF (expressed in 1995 dollars for consistency with the SMS survey years).

• Step 4

— The direct and indirect costs are then added together to attain the practice expense for each procedure, by specialty. For procedures performed by more than one specialty, the final practice expense allocation was a weighted average of practice expense allocations for the specialties that perform the procedure, based on the frequency with which each specialty performs the procedure on Medicare patients.
b. Other Methodological Issues
i. Nonphysician Work Pool

As an interim measure, until we couldfurther analyze the effect of the topdown methodology on the Medicare payment for services with physician work RVUs equal to zero (including the technical components of radiology services and other diagnostic tests), we created a separate practice expense pool. We first used the average clinical staff time from the CPEP data and the

‘‘ all physicians ’’ practice expense per hour to create the pool. In the December 2002 final rule, we changed this policy and now use the total clinical staff time and the weighted average specialty

– specific practice expense per hour for specialties with services in this pool. In the next step, we used the adjusted 1998 practice expense RVUs to allocate this pool to each service. Also, for all radiology services that are assigned physician work RVUs, we used the adjusted 1998 practice expense RVUs for radiology services as an interim measure to allocate the direct practice expense cost pool for radiology.

A specialty society may request that its services be removed from the nonphysician workpool. We have removed services from the nonphysician work pool if the requesting specialty predominates utilization of the service.


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ii. Crosswalks for Specialties Without Practice Expense Survey Data

Since many specialties identified in our claims data did not correspond exactly to the specialties included in the SMS survey data, it was necessary to crosswalk these specialties to the most appropriate SMS specialty.
iii. Physical Therapy Services

Because we believe that most physical therapy services furnished in physicians ’ offices are performed by physical therapists, we crosswalked all utilization for therapy services in the CPT 97000 series to the physical and occupational therapy practice expense pool.
3. Practice Expense Proposals for Calendar Year 2005 a. Supplemental Practice Expense Surveys i. Survey Criteria and Submission Dates

As required by the BBRA, we established criteria to evaluate survey data collected by organizations to supplement the SMS survey data normally used in the calculation of the practice expense component of the physician fee schedule. By regulation (see 68 FR 63200), we provided that, beginning this year, supplemental survey data must be submitted by March 1 to be considered for use in computing practice expense RVUs for the following year. This allows us to publish our decisions regarding survey data in the proposed rule and provides the opportunity for public comment on these results before implementation.

To continue to ensure the maximum opportunity for specialties to submit supplemental practice expense data, we extended until 2005 the period that we would accept survey data that meet the criteria set forth in the November 2000 final rule. We will no longer accept supplemental practice expense data after that point. The deadline for submission of supplemental data to be considered in CY 2006 is March 1, 2005.
ii. Survey by the College of American Pathologists (CAP)

In the June 28, 2002 Federal Register (67 FR 43849), we proposed a technical change to the practice expense methodology that calculated the technical component as the difference between the global and professional component RVUs for services not included in the nonphysician work pool. In the December 31, 2002 final rule (67 FR 79979), we established a 1- year moratorium on the technical change for pathology services to allow CAP to do a survey of independent laboratories. Consistent with last year ’ s rules, CAP submitted its supplemental survey by August 1, 2003 for use in determining the 2004 practice expense RVUs. Our contractor, The Lewin Group, evaluated the data and recommended that we accept the survey to supplement the data on PE. However, because we changed the survey deadline to March 1, CAP requested that we delay incorporation of the survey data until this year ’ s proposed rule. CAP also requested that we extend the moratorium on calculating the technical component as the difference between the global and professional component RVUs for pathology services for one additional year to allow us to evaluate in a proposed rule the combined effects of the use of the new survey data along with other proposed technical changes. In the November 7, 2003 final rule, in response to the CAP comment, we agreed to extend the moratorium by an additional year. In this proposed rule, we propose to incorporate the CAP survey data into the practice expense methodology and to end the moratorium on calculating the technical component as the difference between the global and professional component RVUs for pathology services. We propose to use the following practice expense per hour figures for specialty 69

— Independent Laboratory.



### T ABLE 

### 1.—P RACTICE 

### E XPENSE 

### P ER 

### H OUR 

### F IGURES FOR 

### S PECIALTY 

### 69—I NDEPENDENT 

### L ABORATORY

Specialty Clinical staff Admin. staff Office expense Medical supplies Medical equipment Other Total

Independent Laboratory ........................... $39.7 $37.5 $40.1 $19.3 $11.1 $16.1 $163.8



### iii. Submission of Supplemental Surveys

We received surveys from the American College of Cardiology (ACC), the American College of Radiology (ACR), and the American Society for Therapeutic Radiation Oncology (ASTRO). Our contractor, The Lewin Group, evaluated the data and made recommendations to us regarding use of the data in a report on May 26, 2004. We have made The Lewin Group report available on the CMS Web site at http://www.cms.hhs.gov/physicians/ pfs/ . The Lewin Group is recommending that we accept the data from ACC and ACR but indicated that the survey from ASTRO does not meet the precision criteria we have established for supplemental surveys. As a result, The Lewin Group is not recommending that we use the ASTRO survey results at this time. We agree with this recommendation and are proposing not using the ASTRO survey data at this
time.

Many of the procedures that are performed by radiology, cardiology, and radiation oncology are affected by the nonphysician work pool calculations. We created the nonphysician work pool as an interim measure because of a concern that the top-down methodology was having a large adverse impact on payment for services that do not have physician work RVUs. As we stated in the December 31, 2002 final rule (67 FR 79979), we believe a relatively low practice expense per hour explains the adverse impact on diagnostic and other services that would occur from eliminating the nonphysician work pool. The ACR, ACC, and ASTRO began undertaking surveys in 2003 following our analysis of options for eliminating the nonphysician work pool in the December 31, 2002 final rule. CMS ’ interest is in using the supplemental survey data to eliminate the nonphysician work pool and use a single methodology to establish payments for all physician fee schedule
services.

We appreciate the efforts of these three specialties to undertake surveys and assist CMS in finding a permanent resolution of issues related to the nonphysician work pool. While the radiology survey data do meet the criteria we have established for use of supplemental surveys, the ACR has written to us asking that we not use the data until we have a stable and global solution that is workable for all specialties that are currently paid using the nonphysician work pool. The ACC also requested that we use the supplemental survey for services that are in the cardiology pool. However, ACC also indicated if CMS determines that it would only be appropriate to use the survey data if cardiology services are removed from the nonphysician work pool or if the nonphysician work pool


## 47493 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

is eliminated, we should delay using the data until the issues involved can be discussed further.

At this time, we are not proposing to eliminate the nonphysician work pool or to remove selected radiology and cardiology codes from it. Since our interest is in using supplemental data in conjunction with pricing all services under the top-down methodology, we agree with the request from ACR to delay use of its supplemental survey until issues related to the nonphysician work pool can be addressed. Furthermore, we believe the high practice expense per hour for cardiology from the supplemental survey results from the inclusion of practices that do very high cost office-based cardiology services. Because the RVUs for these office-based cardiology services are currently determined using the nonphysician work pool methodology, we believe the ACC supplemental survey data should only be used in conjunction with removing cardiology services from the nonphysician work pool. For this reason, we are also delaying use of the ACC survey data as we continue to analyze elimination of the nonphysician work pool in conjunction with using supplemental survey data. As we complete our analysis, we look forward to working with the medical community to find a permanent resolution of this issue.
b. Practice Expense Advisory Committee (PEAC) Recommendations on CPEP Inputs for 2005

Since 1999, the PEAC, an advisory committee of the RUC, has been providing us with recommendations for refining the direct practice expense inputs (clinical staff, supplies, and equipment) for existing CPT codes. As we did last year, we are including our proposals regarding the PEAC recommendations in the proposed rule, to enable specialty groups to assess the impact of the proposed changes on their services and to make comments on them before the final rule.

These PEAC recommendations are the result of meetings held in March and August 2003 and January and March 2004, and account for over 2,200 codes from many specialties. (A list of these codes can be found in Addendum C.)

The PEAC held its last meeting in March 2004, and these are the last recommendations we will be receiving from the committee. The AMA established the PEAC to assist the RUC in refining the direct input data used in calculating the practice expense RVUs for established codes. Since its inception, the PEAC has provided recommendations on over 7,600 codes, which leaves only a few hundred physician fee schedule codes that we believe are still unrefined. The PEAC has also recommended standard times for many clinical staff activities and has established several supply and equipment packages that can be applied across wide ranges of codes. This has helped us ensure that the CPEP inputs have been assigned equitably across procedures performed by different specialties. The work of the PEAC has, therefore, contributed greatly to the refinement of the practice expense inputs, and we appreciate the 5 years of hard work by the specialty societies and the AMA that helped make the PEAC so successful. Future practice expense issues, including the refinement of the remaining codes not addressed by the PEAC, will be handled by the RUC. We anticipate the RUC will formulate the specific process at a future meeting, possibly as soon as October 2004. If possible, additional information on this process will be included in the final fee schedule rule.

We have reviewed the PEACsubmitted recommendations and propose to adopt nearly all of them. We have worked with the PEAC staff to correct any typographical errors and to make certain that the recommendations are in line with previously accepted standards. In addition, in order to prevent rank order anomalies, we reviewed those codes that are currently unrefined or that were refined early in the PEAC process to apply some of the major PEAC-agreed standards. For the unrefined 10-day global services, we are proposing to substitute for the original CPEP times the PEAC-agreed standard post-service office visit clinical staff times used for all 90-day and refined 10- day global services. We also are proposing to eliminate the discharge management clinical staff time from all but the 10 and 90-day global codes, substituting one post-service phone call if not already in the earlier data. Lastly, we are proposing to delete any extra clinical staff time for post-visit phone calls because that time is already included in the time allotted for the
visits.

The complete PEAC recommendations and the revised practice expense database can be found on our web site. (See the

‘‘ Supplementary Information ’’ section of this proposed rule for directions on accessing our website.)

We disagree with the PEAC recommendation for clinical labor time for CPT 99183, Hyperbaric oxygen (HBO) therapy. During last year ’ s rulemaking, we assigned, on an interim basis, 135 minutes of total clinical labor. The PEAC however, recommended 42 minutes of total clinical labor time, which allows for 20 minutes for the HBO chamber treatment (intra) time. We believe that 90 minutes is a more appropriate estimation of the clinical staff time actually needed for the intra time because, according to our data, a typical HBO treatment session billed under the outpatient prospective payment system is 90 minutes and the clinical staff is in constant attendance. Therefore, we are proposing a total clinical labor time of 112 minutes for this service.

The PEAC recommendations for CPT codes 91011 and 91052 included a supply input for methacholine chloride as the injected stimulant for these two services. In discussions with representatives from the gastroenterology specialty subsequent to receipt of the PEAC recommendations, we learned this is incorrect, since an injected form of methacholine chloride is not currently available. For CPT 91011, esophageal motility study, we are proposing to include edrophonium, 1 ml, as the drug typically used in this procedure. For CPT 91052, gastric analysis study, we were unable to identify the single drug that is most typically used with this procedure. We have added the edrophonium to the list of supplies where we need information from the specialty in order to price appropriately (see Table 3). We are also requesting that commenters, particularly the specialty organizations, provide us with information on the drug that is most typically used for CPT 91052, including drug dosage and price, so that it can be included in the practice expense database.

In last year ’ s final rule, we indicated that we would not go forward with the 2003 PEAC recommendations on eight E/M codes for nursing home services, CPT codes 99301 through 99316 and on two E/M codes for home visits, CPT codes 99348 and 99350, to allow the PEAC to reconsider the clinical staff time for these codes based on the specific input from the representatives of the nursing home and home visit specialties. This year ’ s PEAC recommendations for the E/M nursing home services included the views of the long-term care physicians and represent an overall decrease in clinical labor inputs for these codes. However, the home care physicians subsequently withdrew these codes from further PEAC consideration, which leaves the 2003 PEAC recommendation for these services unchanged. Therefore, we are proposing to adopt the direct practice expense input recommendations from


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the March 2003 PEAC meeting for CPT codes 99348 and 99350.
c. Repricing of Clinical Practice Expense Inputs

— Equipment

We use the practice expense inputs (the clinical staff, supplies, and equipment assigned to each procedure) to allocate the specialty-specific practice expense cost pools to the procedures performed by each specialty. The costs of the original equipment inputs assigned by the CPEP panels were determined in 1997 by our contractor, Abt Associates, based primarily on list prices from equipment suppliers. Subsequent to the CPEP panels, equipment has also been added to the CPEP data, with the costs of the inputs provided by the relevant specialty society. We only include equipment with costs equal to or exceeding $500 in our practice expense database because the cost per use for equipment costing less than $500 would be negligible. We also considered the useful life of the equipment in establishing an equipment cost per minute of use. This was discussed in our proposed rule published June 18, 1997 (62 FR 33164). The primary source of this information was the ‘‘ Estimated Useful Lives of Depreciable Hospital Assets ’’ (1993 edition) from the American Hospital Association (AHA).

We proposed updates and revisions to the clinical staff salary data and supply inputs and finalized these in the rules published November 1, 2001 (66 FR 55255) and November 7, 2003 (68 FR 63196), respectively. We also indicated that, in future rulemaking, we would be proposing updates to the equipment inputs that are used in the CPEP database.

We contracted with a consultant to assist us in obtaining the current price for each equipment item in our CPEP database. The consultant has been able to determine the current prices for most of the equipment inputs and, to ensure that accurate information was obtained, has submitted documentation from vendor catalogs or websites for nearly 600 equipment items.

Our contractor also clarified the specific composition of each of the various packaged and standardized rooms or ophthalmology ‘‘ lanes ’’ currently identified in the equipment practice expense database (for example,

‘‘ mammography room ’’ or ‘‘ exam lane ’’ ). We are proposing to delete the current

‘‘ room ’’ designation for the radiopharmaceutical receiving area and, in its place, list separately the equipment necessary for each procedure as individual line items because there does not appear to be a standard configuration for such a room across the nuclear medicine codes.

Although individual equipment items valued under $500 are not included in the equipment database, we do include instrument packs or surgical trays that are maintained, stored, and used as a unit, where the aggregate cost of individual items equals or exceeds $500. We have adopted the PEAC recommendation based on consensus among specialties to establish two generic instrument packages rather than list a myriad of different packages for each specialty. The basic instrument pack, assigned a value of $500, includes instrument aggregate costs ranging from $500 to $1,499. The medium pack was assigned $1,500, for instrument packages priced at or above $1,500. We are proposing to replace all surgical packs and trays in the practice expense database with the appropriate standardized packs described above.

Our consultant worked closely with the specialty societies to obtain accurate information to identify equipment and applicable prices. The useful life for each equipment item has also been reviewed and updated as necessary. This update is primarily based on the
AHA ’ s ‘‘ Estimated Useful Lives of Depreciable Hospital Assets ’’ (1998 edition) by direct association with a listed item in the publication or by crosswalking from a reasonably similar item. We understand that AHA will publish updated guidelines this summer, and we plan to reflect any updates in our final rule.

Addendum D lists the proposed new prices for equipment items, instrument packs, and rooms/lanes, as well as new descriptions when needed. A more detailed spreadsheet can be found on our website, http://www.cms.hhs.gov/ physicians/pfs. This spreadsheet contains additional information regarding the sources used to price each equipment item.

Additionally, there are specific equipment items for which a source has not yet been identified or for which pricing information has not yet been found and documented. These are included in Table 2 below. In this table, we have identified the equipment code (if assigned), the existing description for the equipment item and current price, the procedures or specialties associated with the item, as well as the proposed new description and standardized life for the equipment ’ s use, where this could be identified. We have also identified equipment for deletion from the database, such as equipment items less than $500 and items that have become obsolete. We are requesting that commenters, particularly the relevant specialty groups, provide us with the needed pricing information, including appropriate documentation. Whenever possible, commenters should provide multiple sources of documentation so that a typical price can be determined. If we are not able to obtain any verified pricing information for an item, we may eliminate it from the database.



### T ABLE 

### 2.

— E QUIPMENT 

### I TEMS 

### N EEDING 

### S PECIALTY 

### I NPUT FOR 

### P RICING AND 

### P ROPOSED 

### D ELETIONS

Code 2005 description Price Primary specialties associated with item *CPT code(s) associated with item Status of item

Ambulatory blood pressure

monitor. 3,000.00 Cardiology ......................... 93784, 93786, 93788 See Note A.

Biofeedback equipment ..... ........................ Psychology ........................ 90875 ........................ See Note A.CAD processor unit (mammography). 210,000.00 Radiology ........................... 76082, 76083, 76085 See Note A (Need system components). E53005 ......... Camera system, cardiac,
nuclear. 675,000.00 Anesthesia, IM, cardiology 78414 ........................ See Note A.

E53026 ......... Collimator, cardiofocal set 29,990.00 Radiology ........................... 78206, 78607, 78647, 78803, 78807. See Note A.

E71013 ......... Computer and VDT and software. 9,000.00 Ophthalmology, optometry 92060, 92065 ............ See Notes A and C.

Computer software, MR/

PET/CT fusion. 60,000.00 Radiation oncology ............ 77301 ........................ See Note A.

E51022 ......... Computer system, record and verify. 60,000.00 Radiation oncology ............ 77418 ........................ See Note A.


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### P RICING AND 

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### D ELETIONS



### — Continued

Code 2005 description Price Primary specialties associated with item *CPT code(s) associated with item Status of item

E51050 ......... Computer workstation, 3D teletherapy treatment planning. 221,500.00 Radiation oncology ............ 77300, 77305, 77310, 77315, 77321,
77331. See Note A.

Computer workstation,

MRA post processing. ........................ Radiology ........................... 71555, 72159, 72198, 73225, 73725,
74185. See Note A.

Computer, server ............... ........................ Radiation oncology ............ 77301 ........................ See Note A. ( Need system components). Cortical bipolar-biphasic

stimulating equipment. ........................ Neurosurgery, neurology ... 95961, 95962 ............ See Note A.

CPAP/BiPAP remote clinical unit. ........................ Pulmonary disease, neurology. 95811 ........................ See Note A.

Cryo-thermal unit ............... ........................ Anesthesia ......................... 64620 ........................ See Not es A and C. E53034 ......... Densitometry unit, whole body, DPA. 65,000.00 Radiology ........................... 78351 ........................ See Notes A and C.

E53032 ......... Densitometry unit, whole body, SPA. 22,500.00 Radiology ........................... 78350 ........................ See Notes A and C.

E53036 ......... Detector (Probe) ................ 14,000.00 Radiology, cardiology ........ 78455 ........................ See Notes A a nd C.Dialysis access flow monitor. 10,000.00 Nephrology ........................ 90940 ........................ See Note A.

Diathermy, microwave ....... ........................ Anesthesia, GP, podiatry .. 97020 ........................ See Notes A and C. DNA image analyzer

(ACIS). 200,000.00 Lab, pathology ................... 88358, 88361 ............ See Note A.

Drill, ophthalmology ........... ........................ Ophthalmology .................. 65125 ........................ See Note A.E55035 ......... ECG signal averaging system. 8,250.00 Cardiology, IM ................... 93278 ........................ See Note A.

EEG monitor, digital, portable. ........................ 95953 ................................. Neurology ................. See Note A.

E54008 ......... EEG recorder, ambulatory 6,940.00 Neurology .......................... 95950 ........................ See Note A.E54009 ......... EEG review station, ambulatory. 44,950.00 Neurology .......................... 95950 ........................ See Note A.

Electroconvulsive therapy

machine. ........................ Psychiatry .......................... 90870 ........................ See Note A.

Electromagnetic therapy

machine. 25,000.00 Physical therapy ................ G0329 ....................... See Note A.

E54012 ......... EMG botox ........................ 1,500.00 Critical care, pulmonary, ophthalmology. 92265 ........................ See Note A.

E52002 ......... Fetal monitor software ....... 35,000.00 Ob-gyn, radiology .............. 76818, 76819 ............ See Note A. Film alternator (motorized

film viewbox). 27,500.00 Radiology ........................... 329 codes ................. See Note B.

Generator, constant current. 950.00 Neurology, NP ................... 95923 ........................ See Note A.

E51072 ......... HDR Afterload System,
Nucletron

— Oldelft. 375,000.00 Radiation oncology ............ 77781

– 84 .................. See Note A.

Hyperbaric chamber .......... 125,000.00 FP, IM, EM ........................ 99183 ........................ See Note A. Hyperthermia system,

ultrasound, external. 360,000.00 Radiation oncology ............ 77600 ........................ See Note A.

Hyperthermia system,

ultrasound, intracavitary. 250,000.00 Radiation oncology ............ 77620 ........................ See Note A.

Hysteroscopy ablation system. 19,500.00 Ob-gyn ............................... 58563 ........................ See Note A.

E13652 ......... image analyzer (CAS system). 92,000.00 Pathology, neurology ......... 88355, 88356 ............ See Note A.

IMRT physics tools ............ 55,485.00 Radiation oncology ............ 77301, 77418 ............ See Note A. E91008 ......... IVAC Injection Automatic Pump. 2,500.00 Radiology ........................... 78206, 78607, 78647, 78803, 78807. See Note A.

Mammography reporting

software. ........................ Radiology ........................... 76090, 76091, 76092 See Note A.

E12002 ......... Neurobehavioral status instrument-average. 717.00 Psychology, IM .................. 96115, 96117 ............ See Note A.

Orthovoltage radiotherapy

system. 140,000.00 Radiation oncology ............ 77401 ........................ See Note A.

OSHA ventilated hood ....... 5,000.00 Radiation oncology ............ 77334 ........................ See Note B. E91011 ......... Plasma pheresis machine w/UV light source. 37,900.00 Radiology, dermatology ..... 36481, 36510, 36522 See Note A.

E55013 ......... Programmer, pacemaker ... 10,000.00 Cardiology, cardiothoracic surgery, general surgery. 33200

– 01, 33206

– 08,
33212

– 18, 33220, 33222, 33240,
33245

– 46, 33249,
33282. See Note A.


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### N EEDING 

### S PECIALTY 

### I NPUT FOR 

### P RICING AND 

### P ROPOSED 

### D ELETIONS



### — Continued

Code 2005 description Price Primary specialties associated with item *CPT code(s) associated with item Status of item

Pulse oxymetry recording

software (prolonged monitoring). 3,660.00 Pulmonary disease, IM ...... 94762 ........................ See Note A.

Radiation treatment vault .. 550,670.00 Radiation oncology ............ 774XX ....................... See Note B.
Radiation virtual simulation

system. ........................ Radiation oncology ............ 77280, 77285, 77290,
77402

– 16. See Note A.

Remote monitoring service

(neurodiagnostics). 9,500.00 Neurology .......................... 95955 ........................ See Note A.

E54010 ......... Review master ................... 23,500.00 Pulmonary disease, neurology. 95805, 95807

– 11, 95816, 95822,
95955

– 56. See Note A.

E51004 ......... Room, basic radiology ....... 150,000.00 Radiology ........................... 103 codes ................. See Note A. E51016 ......... Room, mammography ....... 130,000.00 Radiology ........................... 19030, 19290

– 91, 19295, 76086

– 92,
76096. See Note A.

E51005 ......... Room, radiographicfluoroscopic. 475,000.00 ............................................ 123 codes ................. See Note A.

Source, 10 Ci Ir 192 .......... 22,000.00 Radiation oncology ............ 77781

– 84 .................. See Note A. Strontium-90 applicator ..... 8,599.00 Radiation oncology ............ 77789 ........................ See Note A. Table, cystoscopy .............. ........................ urology ............................... 52204

– 24, 52265-75
52310

– 17, 52327

– 32. See Note A.

E52001 ......... Ultrasound color doppler, transducers and vaginal probe. 155,000.00 Ob-gyn ............................... 59070, 59074,
76818

– 19. See Note A.

E52007 ......... Ultrasound, echocardiography digital acquisition (Novo Microsonics, TomTec). 29,900.00 Ob-gyn, cardiology, pediatrics. 76825

– 28, 93303-12, 93314, 93320, 93325, 93350. See Note A.

Vacuum cart ...................... ........................ Anesthesia ......................... 64620 ........................ See No tes A and C. E13635 ......... Video camera .................... 1,000.00 Radiation oncology ............ 77418 ........................ See Note A. Water chiller (radiation

treatment). 28,000.00 Radiation oncology ............ 77402

– 16 .................. See Note B.

E51076 ......... Well counter ...................... ........................ Radiology ........................... 78160

– 72, 78282 ...... See Note A.

*CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS ap ply. **Notes:** A. Additional information required. Need detailed description (including system components as specified), source, and current p ricing information.

B. Proposed deletion as indirect expense. C. Item may no longer be available.



### In addition to reviewing and updating the cost information for equipment items in the database, our contractor also recommended the following revisions to provide uniformity and consistency in the CPEP equipment database. All of the following recommendations are noted in Addendum D:

Assignment of equipment categories. In the original CPEP data, a number was assigned to each item of equipment. The contractor has recommended that each equipment item also be assigned a

‘‘ category ’’ to allow for easier identification and sorting of items. We agree and are proposing that equipment be assigned to one of the following six categories: documentation, laboratory,scopes, radiology, furniture, roomslanes, and other equipment.

These categories could also be used to establish a new numbering system for equipment that would more clearly identify them for practice expense purposes. We would assign a letter to each category and use this in conjunction with a number (000 through 999) to identify each item of equipment. This would enable specialty groups to identify more easily whether an item of equipment has already been included in the practice expense database and would help avoid duplication of references to the same item of equipment under different descriptions. If we proceed in the final rule with this proposed method for categorizing equipment, we will assign new identifying numbers to each equipment input item and these will be available on our website.

Consolidation/standardization of item descriptions.

When items appear to be duplicative, we are proposing to combine the items. For example, for two cervical endoscopy procedures, our contractor identified that the price of the LEEP system includes a smoke evacuation system but that system is also listed separately. We propose to merge these two line items and reflect both prices in the price of the LEEP system. All proposed changes are specifically referenced in Addendum D.

We welcome any comments on the proposed pricing and all other proposed revisions. To help us evaluate the information provided, comments should include documentation from more than one source, where available, such as information from a vendor catalog or website or from a current invoice.
d. Miscellaneous Practice Expense
Issues i. Pricing for Seldinger Needle

We received comments from a specialty organization on our November 7, 2003 rule stating that the $72.90 price assigned to the Seldinger needle, which is used in certain radiological procedures, is too high. The organization estimated that the cost is actually closer to $7.00; however, documentation was not provided to


## 47497 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

support this price estimate. Our contractor was able to confirm pricing information from two sources, including a price of $3.50 from a hospital supplier and a price of $6.85 from a cardiology supplier. Based on this pricing variability, we are proposing to average the two prices of this supply item to reflect a cost of $5.175. If a commenter disagrees with this proposed change in price, the comment should provide documentation to support the recommended price, as well as the specific type of needle that is most commonly used.
ii. Hysteroscopic Endometrial Ablation

We received requests from a manufacturer and physicians to price CPT code 56853, Hysteroscopy with endometrial ablation, in the office setting so that physicians providing this service in the nonfacility setting could receive an appropriate payment. (This service is currently valued only in the facility setting.) We have worked with the specialty society, the American College of Obstetricians and Gynecologists, to identify the required resources based on the typical practice. We propose to assign on an interim basis, the following direct practice expense inputs in the nonfacility setting for this service.

• Clinical Staff: RN/LPN/MTA

— 72 minutes (18 pre-service and 54 service)

• Supplies: PEAC multispecialty visit supply package, Post-op incision care kit, pelvic exam package, irrigation tubing, sterile impervious gown, surgical cap, shoe cover, surgical mask with face shield, 3x3 sterile gauze (20), cotton tip applicator, cotton balls (4), irrigation 0.9 percent sodium chloride

500

– 1000ml(3), maxi-pad, mini-pad, 3- pack betadine swab (4), Monsel ’ s solution (10ml), lidocaine jelly (1000ml), disposable speculum, spinal needle, 18

– 24g needle, 20 ml syringe, bupivicaine 0.25 percent (10ml), 1 percent xylocaine (20ml), cidex (10ml), Polaroid film

– type 667 (2), endosheath, and hysteroscopic ablation device kit.

• Equipment: power table, fiberoptic exam light, endoscopic-rigid hysteroscope, endoscopy video system, and hysteroscopic ablation system.

We will request that the RUC review these inputs along with inputs of other codes still in need of refinement. iii. Photopheresis

We received a request from a supplier to review the direct practice expense inputs currently in our database for the photopheresis service, CPT code 36522. These inputs are based on the original CPEP panel recommendations and the supplier does not believe they are reflective of the resources now being used. This service was not reviewed by the PEAC during the refinement process, and we agree that the direct inputs need to be revised for this service. We propose to assign, on an interim basis, the following nonfacility practice expense inputs, and we will request that the RUC review them as part of the practice expense refinement

process. • Clinical Staff: RN

— 223 minutes (treatment is for approximately 4 hours)

• Supplies: multispecialty visit supply package, photopheresis procedural kit, blood filter (filter iv set), IV blood administration set, 0.9 percent irrigation sodium chloride 500

– 1000 ml (2), heparin 1,000 units-ml (10), povidone solution-betadine,methoxsalen (UVADEX) sterile solution10 ml vial, 1 percent-2 percent lidocaine-xylocaine, paper surgical tape (12), 2x3 underpad (chux), nonsterile drapesheet 40 inches x 60 inches, nonsterile Kling bandage, bandage strip, 3x3 sterile gauze, 4x4 sterile gauze, alcohol swab pad (3), impervious staff gown, 19

– 25 g butterfly needle, 14

– 24g angiocatheter, 18

– 27 g needle, 20 ml syringe, 10

– 12 ml syringe, 1 ml syringe,

22

– 26 g syringe needle-3 ml.

• Equipment: plasma pheresis machine with ultraviolet light source, medical recliner.
iv. Pricing of New Supply Items

As part of last year ’ s rulemaking process, we reviewed and updated the prices for supply items in our practice expense database. During subsequent meetings of both the PEAC and the RUC, supply items were added that were not included in the supply pricing update. The following table, Proposed Practice Expense Supply Item Additions for 2005, lists these additional supply items and the proposed associated prices that we will use in the practice expense calculation.



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### P RACTICE 

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### S UPPLY 

### I TEM 

### A DDITIONS FOR 

### 2004

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

Acrylic tray-base material ................. 1.775 oz ...................... 21421, 21452 .................................... Lab. Adapter, luer lock .............................. 1.249 Item .................. 36515 .............................................. .. Hypodermic, IV. Adapter, spike (for syringe) .............. 4.558 Item .................. 36515 ................................................ Hypo dermic, IV. Adhesive, conductive (silver, liquid) 3.000 gm ..................... 88349 ................................................ Lab. Adhesive, cyanoacrylate (2ml

uou).doc. 28.988 Item .................. 65286 ................................................ Pharmacy, Rx.

Airway adapter .................................. 12.500 Item .................. 94770 ............................................. ... Accessory, Procedure. Albuterol inhal soln (3ml vial) ........... 0.436 Item .................. 95070 ................................................ Phar macy, Rx. Alcohol ethyl 100% ........................... 0.028 ml ...................... 88348 ............................................... . Lab. Applicator, cotton-tipped, sterile, 6in 0.056 Item .................. 127 codes ......................................... Wound Car e, Dressings. Applicator, wood, 6.5in ..................... 0.008 Item .................. 99348

– 49 .......................................... Lab. Bag system, 1000ml (for

angiography waste fluids). 8.925 Item .................. 93501, 93505

– 10 .............................. Accessory, Procedure.

Balanced salt soln (BSS) (15ml uou) 1.600 Item .................. 59 codes ........................................... Pharmacy, Rx

. Battery, AA ........................................ 0.450 Item .................. 95250 ........................................... ..... Office Supply, Grocery. Blade, surgical, super-sharp ............. 4.167 Item .................. 14 codes ........................................... Cutters , Closures, Cautery. Blade, urethrotome ........................... 85.030 Item .................. 52270 ................................................ Cutters, Closures, Cautery.
Blood collection tube holder ............. 0.163 Item .................. 78110

– 11, 78120

– 22, 78130, 78191,
78725. Hypodermic, IV.

Blood collection tube needle ............. 0.142 Item .................. 36514

– 16, 78110

– 11, 78120

– 22, 78130, 78191, 78725. Hypodermic, IV.

Blood pressure recording form, average. 0.310 Item .................. 93784, 93786, 93788 ....................... Office Supply, Grocery.

Brush, protected airway specimen ... 13.000 Item .................. 31623, 31717 .................................... Accessory, Proc edure. Bur, surgical, sterile (drill) ................. 4.792 Item .................. 28289 ............................................... . Accessory, Procedure. Canned air (Dust-Off) ....................... 1.021 oz ...................... 88348 ................................................ Office Supply, Grocery. Cannula, anterior chamber, 18

– 27g 2.688 Item .................. 65815, 66020, 66030, 66250 ........... Accessory, Procedure.


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— Continued

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

Catheter percutaneous fastener

(Percu-Stay). 12.745 Item .................. 32201, 44901, 47525, 47530, 48511, 49021, 49041, 49061, 49423, 49424, 50021, 58823. Accessory, Procedure.

Catheter, (Glide) ............................... 62.000 Item .................. 36218, 36248 .................................... Ac cessory, Procedure. Catheter, (SIM2F1) ........................... 17.000 Item .................. 36011

– 15, 36215

– 17, 36245

– 47 ..... Accessory, Procedure. Catheter, angiographic ...................... 16.200 Item .................. 93508, 93510, 93526 ....................... Hypodermic, IV. Catheter, balloon inflation device ..... 24.900 Item .................. 35470

– 76 .......................................... Accessory, Procedure. Catheter, balloon ureteral (Dowd) .... 65.000 Item .................. 52330 ................................................ Accessor y, Procedure. Catheter, balloon, low profile PTA .... 431.500 Item .................. 35470, 35471, 35474 ....................... Accessory, Proced ure. Catheter, balloon, PTA ..................... 243.500 Item .................. 35472

– 73, 35475

– 76 ........................ Accessory, Procedure. Catheter, curved ............................... 17.775 Item .................. 36218 .............................................. .. Accessory, Produce. Catheter, hyperthermia, closed-end ........................ Item .................. 77600

– 20 .......................................... Hypodermic, IV. Catheter, hyperthermia, open-end .... ........................ Item .................. 77600 ........................................ ........ Hypodermic, IV. Catheter, microcatheter (selective

3rd order). 337.880 Item .................. 36217, 36247 .................................... Accessory, Procedure.

Catheter, Swan Ganz ....................... 65.000 Item .................. 93501, 93526 .................................... Accessor y, Procedure. Catheter, ureteral, acorn tip .............. 9.550 Item .................. 52007, 52010, 52327, 52330 ........... Accessory, Procedur e. Clamp, circumcision .......................... 7.500 Item .................. 54150 ................................................ C utters, Closures, Cautery. Collagen, dermal implant (2.5ml uou)

(Contigen). 317.000 Item .................. 52327, 52330 .................................... Pharmacy, Rx.

Conformer, sterile, acrylic ................. 20.000 Item .................. 68340 ................................................ A ccessory, Procedure. Contact lens (hard) care kit .............. 7.950 Item .................. 92325

– 26 .......................................... Pharmacy, NonRx. Contact lens (hard) extra strength

cleaning solution. 0.158 ml ...................... 92325

– 26 .......................................... Pharmacy, NonRx.

Contact lends (RGP) polishing soln

(Silo2 Care). 0.077 ml ...................... 92325 ................................................ Pharmacy, NonRx.

Container, 2000ml, transfer pack ..... 7.120 Item .................. 36515 ................................................ Accessory , Procedure. Container, 600ml, transfer pack ....... 3.360 Item .................. 36515 ................................................ Accessor y Procedure. Cotton balls, sterile ........................... 0.022 Item .................. 115 codes ......................................... W ound Care, Dressings. Cup, sterile, 12

– 16 oz ....................... 0.760 Item .................. 32201, 44901, 48511, 49021, 49041, 49061, 50021, 58823, 93501, 93505, 93508, 93510,
93526. Lab.

Cup, sterile, 8 oz ............................... 0.542 Item .................. 32201, 44901, 48511, 49021, 49041, 49061, 50021, 58823. Lab.

Cuvette, whole blood oximeter ......... 115.000 Item .................. 93501, 93526 .................................... Hypodermic, IV. Diamond knife cleaning rod .............. 1.000 Item .................. 99348 ................................................ Lab. Drainage catheter, all purpose ......... 88.430 Item .................. 44901, 47525, 47530, 48511, 49021, 49041, 49061, 49423, 50021, 50398, 58823. Accessory, Procedure.

Drainage catheter, chest ................... 88.890 Item .................. 32201 ................................................ Acc essory, Procedure. Drainage pouch, nephrostomy-biliary 13.250 Item .................. 32201, 44901, 47525, 47530, 48511, 49021, 49041, 49061, 49423, 50021, 50398, 58823. Accessory, Procedure.

Drape, sterile, incise, ophthalmic ...... 4,900 ...................... 67025, 67028, 67110, 67120 ........... Gown, Drape. Drape, sterile, split-sheet .................. 10,243 Item .................. 212 codes ......................................... Gown , Drape. Drape, sterile, table 44 in x 76 in ..... 5.250 Item .................. 93501

– 10, 93526 .............................. Gown, Drape. Electrode, Bugbee ............................ 115.000 Item .................. 52204, 52214, 52224, 52265, 52275, 55200, 55250. Accessory, Procedure.

Electrode, EEG (single) .................... 1.638 Item .................. 95961, 95816 .................................... Accessory , Procedure. Electrode, EGG (single) .................... 2.917 Item .................. 91132, 95925

– 27, 95930 ................. Accessory, Procedure. Endoscopic deflecting brush ............. 73.500 Item .................. 52007 ................................................ Access ory, Procedure. Film, x-ray, laser print ....................... 1.437 Item .................. 146 codes ......................................... Off ice Supply, Grocery. Floxin 0.3% otic soln ......................... 2.354 ml ...................... 69145, 69620 .................................... Phar macy, Rx. Forceps, endomyocardial biopsy ...... 250.000 Item .................. 93505 ................................................ Accessory , Procedure. Forceps, Kelly ................................... 2.335 Item .................. 93501

– 10, 93526 .............................. Accessory, Procedure. Gas, nitrogen .................................... 2.708 cu ft .................. 88348

– 49 .......................................... Lab. Glass knife boat ................................ 0.200 Item .................. 88348 ............................................... . Lab. Grid storage box (holds 50 grids) ..... 3.750 Item .................. 88348 ................................................ Lab. Guidewire bowl w-lid, sterile ............. 3.000 Item .................. 93501

– 10, 93526 .............................. Accessory, Procedure. Guidewire, cerebral (Bentson) .......... 14.500 Item .................. 36011

– 15, 36215

– 17, 36245

– 47 ..... Accessory, Procedure. Guidewire, low profile (SpartaCore) 101.250 Item .................. 35470

– 71, 35474 .............................. Accessory, Procedure. Guidewire, steerable (Hi-Torque) ..... 90.000 Item .................. 35470

– 76, 37203 .............................. Accessory, Procedure. Guidewire, steerable (Transcend) .... 180.000 Item .................. 36217, 32647 .................................... Accessory, Pro cedure. Guidewire, torque .............................. 41.000 Item .................. 35470

– 76 .......................................... Accessory, Procedure. Heparin 5,000 units-mi inj ................. 0.509 ml ...................... 36514

– 15 .......................................... Pharmacy, Rx. Hyaluronic acid viscoelastic inj

(Amvisc, 0.5ml uou. 61.000 Item .................. 65286, 65815, 66250 ....................... Pharmacy, Rx.

Hysteroscope ablation device ........... 1,146.000 Item .................. 58563 ................................................ Acce ssory, Procedure. Jessner ’ s soln ................................... 0.240 ml ...................... 15788

– 89, 15792

– 93 ........................ Pharmacy, Rx. Kenalog 40 inj ................................... 1.830 ml ...................... 31830 ............................................ .... Pharmacy, Rx.


## 47499 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 3.

— P ROPOSED 

### P RACTICE 

### E XPENSE 

### S UPPLY 

### I TEM 

### A DDITIONS FOR 

### 2004

— Continued

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

Kit, AccuStick II Introducer system

with RO Marker. 82.620 Kit ..................... 26 codes ........................................... Kit, Pack, Tray.

Kit, apheresis treatment .................... 140.000 Kit ..................... 36515 ............................................... . Kit, Pack, Tray. Kit, barium enema ............................. 9.466 Kit ..................... 75270, 74283 .................................... Kit, Pack, Tray. Kit, BCR/ABL DNA probe ................. 42.650 Kit ..................... 88365 ................................................ Kit, Pack, Tray. Kit, slit catheter (for compartment

pressure monitor). 73.750 Kit ..................... 20950 ................................................ Kit, Pack, Tray.

Kit, vasotomy .................................... ........................ Kit ..................... 55200, 55250 .................. .................. Kit, Pack, Tray. Lacrimal duct stent-tube set ............. 74.000 Item .................. 68815 ................................................ Acces sory, Procedure. Lead citrate ....................................... 0.510 gm .................... 88348 ............................................ .... Lab. Manifold (for angiography) ................ 6.682 Item .................. 93501, 93508, 93510, 93526 ........... Accessory, procedure.Marker, gold, for radiosurgery-radiotherapy. 29.667 Item .................. 77761

– 63 .......................................... Accessory, Procedure.

Mask, CPR (RespAide) ..................... 16.950 Item .................. 92950 ................................................ Acces sory, Procedure. Methoxsalen, sterile solution

(UVADEX), 10ml vial. 49.500 ml ...................... 36522 ................................................ Pharmacy, Rx.

Microsponge, cellulose (10 pack

uou). 3.620 Item .................. 22 codes ........................................... Wound Care, Dressings.

Mount, carbon spectro-pure (for

SEM). 0.500 Item .................. 88349 ................................................ Lab.

Nasal tip, olive .................................. 0.340 Item .................. 92512 ............................................ .... Accessory, Procedure. Nebulizer medication cup ................. 0.140 Item .................. 95070 ................................................ Acces sory, Procedure. Needle, arterial, percutaneous .......... 3.150 Item .................. 93501, 93505, 93508, 93510, 93526 Hypodermic, IV. Needle, bone biopsy ......................... 65.000 Item .................. 20225 ................................................ H ypodermic, IV. Needle, flexi, hyperthermia ............... 12.000 Item .................. 77600

– 20 .......................................... Hypodermic, IV. Needle, micropigmentation (tattoo) ... 12.000 Item .................. 11920

– 21 .......................................... Hypodermic, IV. Needle, OSHA compliant

(SafetyGlide). 0.454 Item .................. 37 codes ........................................... Hypodermic, IV.

Needle, retrobulbar (Atkinson) .......... 1.825 Item .................. 67120, 67141 .................................... Hypodermic, IV. Omnipaque 350mg (125ml uou) ....... 29.530 Item .................. 93508, 93510, 93526 ....................... Pharmacy, Rx. Omnipaque 350mg (50ml uou) ......... 12.498 Item .................. 42550, 70370 .................................... Pharmacy, Rx. Osmometer sample tip and cleaner 0.534 Item .................. 88348 ................................................ Lab. Osmometer std, 50 mOsm-kg, 2ml

amp. 17.000 ml ...................... 88348 ................................................ Lab.

Osmometer std, 850 mOsm-kg, 2ml

amp. 17.000 ml ...................... 88348 ................................................ Lab.

Pack, drapes, ortho, large ................ 40.646 Pack ................. 102 codes ......................................... Kit, Pa ck, Tray. Pack, drapes, ortho, small ................ 1.128 Pack ................. 37 codes ........................................... Kit, Pa ck, Tray. Pack, ophthalmology visit (w-dilation) 1.997 Pack ................. 65272

– 73, 65280

– 85, 65290,
65810

– 015, 65855

– 60, 66130,
66625

– 35, 67031, 68130. Kit, Pack, Tray.

Pack, protective, ortho, large ............ 9.182 Pack ................. 99 codes ........................................... Kit, Pa ck, Tray. Pack, protective, ortho, small ........... 4.441 Pack ................. 38 codes ........................................... Kit, Pac k, Tray. Paper, weighing (glassine) ............... 0.021 Item .................. 88348 ................................................ Lab. Phenol, liquified, USP ....................... 0.135 ml ...................... 15788

– 93 .......................................... Pharmacy, Rx. Photo-Flo soln ................................... 0.021 ml ...................... 88348 ........................................... ..... Office Supply, Grocery. Pipette bulb ....................................... 0.271 Item .................. 88348

– 49 .......................................... Lab. Pipette 9inch ..................................... 0.054 Item .................. 88348

– 89 .......................................... Lab. Plasma antibody adsorption column

(Prosorba). 1,150.000 Item .................. 36515 ................................................ Accessory, Procedure.

Plasma LDL adsorption column

(Liposorber). 1,300.000 Item .................. 36516 ................................................ Accessory, Procedure.

Plasma leukocyte filter ...................... 49.719 Item .................. 36515 ................................................ Accessory, Procedure. Plasma separator (Liposorber) ......... 100.000 Item .................. 36516 ................................................ Access ory, Procedure. Plate, surgical, mini-compression, 4

hole. 226.000 Item .................. 21208 ................................................ Accessory, Procedure.

Plate, surgical, mini-i, 16mm ............ 147.000 Item .................. 21210 ................................................ Acc essory, Procedure. Plate, surgical, reconstruction, left, 5

x 16 hole. 719.000 Item .................. 21125

– 27, 21215 .............................. Accessory, Procedure.

Plate, surgical, reconstruction, template, 5 x 16 hole. 50.000 Item .................. 21125

– 27, 21215 .............................. Accessory, Procedure.

Plate, surgical, rigid comminuted

fracture. 389,000 item ................... 21461, 21462 .................................... Accessory, Procedure.

Plate, surgical, rigid comminuted

fracture, template. 29.000 Item .................. 21461, 21462 .................................... Accessory, Procedure.

Pressure bag ..................................... ........................ Item .................. 93501, 93508

– 10, 93526 ................. Hypodermic, IV.Prosthesis, voice button (Blom-Singer). 48.000 Item .................. 31611 ................................................ Accessory, Procedure.

Scalpel, safety, surgical, with blade

(#10

– 20). 2.143 Item .................. 54150, 54160, 54162 ....................... Cutters, Closures, Cautery.

Screw, surgical, auto-drive, 2.0mm x

4mm. 37.000 Item .................. 2120 .................................................. Accessory, Procedure.


## 47500 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 3.

— P ROPOSED 

### P RACTICE 

### E XPENSE 

### S UPPLY 

### I TEM 

### A DDITIONS FOR 

### 2004

— Continued

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

Screw, surgical, Carroll-Girard, 9cm

x 3.75in. 92.000 Item .................. 21401 ................................................ Accessory, Procedure.

Screw, surgical, lag, 2.4mm x 26mm 66.000 Item .................. 21461

– 62 .......................................... Accessory, Procedure. Screw, surgical, locking, 2.4mm x

16mm. 74.000 Item .................. 21127, 21208, 21215 ....................... Accessory, Procedure.

Screw, surgical, self-tapping, 1.5

– 2.0

mm. 27.000 Item .................. 21100, 21452 .................................... Accessory, Procedure.

Screw, surgical, standard, 2.4mm x

14mm. 42.000 Item .................. 21125 ................................................ Accessory, Procedure.

Screw, surgical, standard, 2.7mm x

12mm. 47.000 Item .................. 21125

– 27, 21208, 21215, 21461

– 62 Accessory, Procedure.

Sea salt ............................................. 0.004 gm ..................... 15810

– 11 .......................................... Office Supply, Grocery. Sensor, manometry ........................... 25.000 Item .................. 91010

– 12, 91122 .............................. Accessory, Procedure. Sheath, peel away ............................ 68.990 Item .................. 47530 ................................................ Accessory, Procedure. Skin refrigerant-anesthetic spray

(Frigiderm). 5.000 oz ...................... 15780

– 86, 15788

– 93 ........................ Pharmacy, Rx.

Sodium acetate ................................. 0.064 gm ..................... 88348 .............................................. .. Lab. Sodium barbital ................................. 0.315 gm .................... 88348 .............................................. .. Lab. Specimen block storage box ............ 0.625 Item .................. 88348 ................................................ Lab. Splint, finger (metal-foam) ................ 1.655 Item .................. 26700

– 05, 26720

– 25, 26740

– 42,
26750

– 55, 26770

– 75. Wound Care, Dressings.

Sucrose, reagent ............................... 0.037 gm .................... 88348 ............................................... . Lab. Suture device for vessel closure

(Perclose A

– T). 225.000 Item .................. 35470

– 75 .......................................... Accessory, Procedure.

Suture, monocryl, 3

– 0 to 6

– 0, p, ps 9.887 Item .................. 15050, 15200, 15220, 15240, 15260 Cutters, Closures, Cautery. Suture, nylon, 8

– 0 to 9

– 0 ................. 15.320 Item .................. 65270

– 72, 65275, 65420

– 26, 66130, 66250, 68115

– 30, 68320, 68330, 68340, 68360. Cutters, Closures, Cautery.

Suture, plain, gut, 2

– 0 to 6

– 0 ........... 4.262 Item .................. 41872 ................................................ Cutters, Closures, Cautery. Suture, polyester, 0 to 3

– 0

(Mersilene). 3.895 Item .................. 40840

– 45 .......................................... Cutters, Closures, Cautery.

Suture, vicryl, 7

– 0 ............................. 21.773 Item .................. 67120 ................................................ Cutters, Closure s, Cautery. Syringe 12ml, coronary control ......... 7.000 Item .................. 93508

– 10, 93526 .............................. Hypodermic, IV. Syringe filter ...................................... 2.040 Item .................. 88348 ........................................... ..... Hypodermic, IV. Tape, foam, elastic, 2in (Microfoam) 0.003 Inch ................... 21120

– 23, 21315, 21355

– 56,
31820

– 25. Wound Care, Dressings.

Toluidine Blue O (for microscopy) .... 0.580 gm .................... 88348 ................................................ Lab. Towel clamp, plastic ......................... 0.556 Item .................. 93501

– 10, 93526 .............................. Accessory, Procedure. Tracheostomy collar-neckband ......... 3.235 Item .................. 31580

– 84, 31588, 31610 ................. Wound Care, Dressings. Tracheostomy dressing ..................... 3.240 Item .................. 31580

– 84, 31588, 31610 ................. Wound Care, Dressings. Tracheostomy tube ........................... 20.934 Item .................. 31370

– 82, 31580

– 84, 31588, 31610,
31613

– 14, 31750, 41140, 41145. Accessory, Procedure.

Transducer, pressure monitoring (for

angiography). 9.520 Item .................. 93501, 93508, 93510, 93526 ........... Accessory, Procedure.

Tray, bronchogram ............................ ........................ Tray .................. 31708 ............................... ................. Kit, Pack, Tray. Tray, central line dressing change ... 2.430 Tray .................. 36514

– 16 .......................................... Kit, Pack, Tray. Tray, circumcision ............................. 25.173 Tray .................. 54150, 54160

– 62 .............................. Kit, Pack, Tray. Tray, surgical skin prep, sterile ......... 6.765 Tray .................. 134 codes ......................................... Kit, Pac k, Tray. Trichloroacetic acid 90% (sat soln) .. 0.855 ml ...................... 46900 ................................................ Pharmacy , Rx. Tubing set (Liposorber) ..................... 50.000 Item .................. 36516 ................................................ Hy podermic, IV. Tubing set, blood warmer ................. 7.396 Item .................. 36514

– 16 .......................................... Hypodermic, IV. Tubing set, plasma exchange ........... 173.333 Item .................. 36514 ................................................ Hypoder mic, IV. Tubing set, plasma transfer .............. 1.680 Item .................. 36515 ................................................ Hypode rmic, IV. Tubing set, Y-type blood recipient .... 5.750 Item .................. 36515 ................................................ Hypodermi c, IV. Tubing, pressure injection line

(angiography). 3.170 Item .................. 93508, 93510, 93526 ....................... Accessory, Procedure.

Tubing, sterile, connecting (fluid administration). 1.950 Item .................. 93510, 93526 .................................... Accessory, Procedure.

Tubing, sterile, non-vented (fluid administration). ........................ Item .................. 93501, 93508, 93510, 93526 ........... Accessory, Procedure.

Tubing, suction, non-latex (2ft) with

Frazier tip (1). 7.557 Item .................. 99 codes ........................................... Accessory, Procedure.

Underpad 2ft x 2ft (lab bench) .......... 0.377 Item .................. 88348

– 49 .......................................... Lab. Vial, specimen-sample, 4ml .............. 0.550 Item .................. 88348

– 49 .......................................... Lab. Wax sheet ......................................... 0.285 Item .................. 88348 ............................................. ... Lab.

* CPT codes and descriptions only are copyright. 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.


## 47501 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

We have identified certain supply items for which we were unable to verify the pricing information (see Table 4, Supply Items Needing Specialty Input for Pricing). Therefore, we are requesting commenters, particularly specialty organizations, to provide pricing information on items in this table along with documentation to support the recommended price. In addition, we are seeking information on the specific contents of the listed kits, so that we do not duplicate any supply
items.



### T ABLE 

### 4.

— S UPPLY 

### I TEMS 

### N EEDING 

### S PECIALTY 

### I NPUT FOR 

### P RICING

Code 2005 Description Unit Unit price Primary specialties associated with item *CPT code(s) associated with item Status of item

SL008 ........... Antibodies

— detection ....... Slide ............ 30.90 Lab, pathology .................. 88365 ....................... See Note A. Blood pressure recording

form, average. Item ............. 0.31 Cardiology ........................ 93784, 93786, 93788 See Note A.

Catheter, hyperthermia,

closed-end. Item ............. ........................ Radiation oncology ........... 77600

– 20 ................. See Note A.

Catheter, hyperthermia,

open-end. Item ............. ........................ Radiation oncology ........... 77600 ....................... See Note A.

Edrophonium .................... ml ................ 4.67 Gastroenterology .............. 91011 ....................... See Note AHysteroscope, ablation device. Item ............. 1,146.00 Ob-gyn .............................. 58563 ....................... See Note A

Kit, BCR/ABL DNA probe Kit ................ 42.65 Pathology .......................... 88365 ....................... See Note A. SA013 .......... Kit, detection ..................... Slide ............ 8.50 Pathology, neurology ........ 88355, 88356 ........... See N ote A.SA024 .......... Kit, photopheresis procedure. Kit ................ 809.00 Dermatology, ob-gyn ........ 36522 ....................... See Note A.

Kit, vasotomy .................... Kit ................ ........................ Urology ............................. 55200, 55250 ... ........ See Note A.Methoxsalen, sterile solution (UVADEX) 10 ml
vial. ml ................ 49.50 Dermatology, radiation oncology. 36522 ....................... See Note A.

Pressure bag .................... Item ............. ........................ Cardiology ........................ 93501, 93508, 93510, 93526. See Note A.

SL114 ........... Primary antibodies ............ Slide ............ 3.52 Pathology, neurology ........ 88355, 88356, 88358 See Note A. Tray, bronchogram ........... Tray ............. ........................ Pulmonary disease ........... 31708 ....................... Se e Note A. Tubing, sterile, non-vented

(fluid administration). Item ............. ........................ Cardiology ........................ 93501, 93508, 93510, 93526. See Note A.

*CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS ap ply. **Note A.** Additional information required. Need detailed description (including kit contents), source, and current pricing information.



### v. Addition of Supply Item to CPT 88365, Tissue In Situ Hybridization

We received a request from a pathology society to add a DNA probe to the CPEP database for CPT 88365, tissue in situ hybridization. The society specified that 1.5 DNA probes are typically used in this service and the cost of one probe is $42.65. Documentation supporting this price was also provided. We are proposing to add, on an interim basis, this supply to the practice expense database with the understanding that the inclusion of the item will be subject to forthcoming RUC
review.
vi. Ophthalmology Equipment

In the CPEP equipment data for many of the ophthalmology procedures, there is a duplication of time assigned to the screening lane and exam lane. In a majority of these identified procedures, the same timeframe was assigned to both the screening and exam lanes. While some of the procedures had not been refined by the PEAC, others were refined early on in the PEAC process before the PEAC agreed to assign only one equipment lane to each procedure because a patient can be in only one room at a time. In cases where both the screening and exam lanes are included, we are proposing to adjust the lane assignment by defaulting to the exam lane and, thus, we will delete the screening lane from these procedures. For all of the above services where a lane change was made, time values were assigned to the exam lane in accordance with our established standard procedure. We are asking commenters, in particular, organizations representing ophthalmology, to review these proposed changes and submit specific comments on the appropriateness of the exam lane default.
vii. Other Practice Expense Issues
Parathyroid Imaging, CPT 78070

We received comments from the RUC and the specialty society representing nuclear medicine that the practice expenses for CPT 78070, parathyroid imaging, which is valued in the nonphysician work pool, are too low. Because this procedure involves multiple imaging sessions, the organizations have requested that a different crosswalk of charge-based RVUs be used to more appropriately value the practice expenses involved with CPT 78070. We agree and are proposing to crosswalk the charge-based RVUs from CPT 78306, whole body imaging, to this procedure.

B. Geographic Practice Cost Indices (GPCIs)

[If you choose to comment on issues in this section, please include the caption

‘‘ GPCI ’’ at the beginning of your comments.]

1. Background

The Social Security Act (the Act) requires that payments vary among physician fee schedule areas according to the extent that resource costs vary as measured by the Geographic Practice Cost Indices (GPCIs). In general, the fee schedule areas that existed under the prior reasonable charge system were retained under the physician fee schedule from calendar years 1992 to 1996. We implemented a comprehensive revision in the physician fee schedule payment areas (localities) in 1997, reducing the number of localities from 210 to 89. A detailed discussion of physician fee schedule areas can be found in the July 2, 1996 proposed rule (61 FR 34615) and the November 22, 1996 final rule (61 FR 59494).


## 47502 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

We are required by section 1848(e)(1)(A) of the Act to develop separate GPCIs to measure resource cost differences among localities compared to the national average for each of the three fee schedule components. While requiring that the practice expense and malpractice GPCIs reflect the full relative cost differences, section 1848(e)(1)(A)(iii) of the Act requires that the physician work GPCIs reflect only one-quarter of the relative cost differences compared to the national

average.

Section 1848(e)(1)(C) of the Act requires us to review and, if necessary, to adjust the GPCIs at least every 3 years. This section of the Act also requires us to phase-in the adjustmentover 2 years and implement only onehalf of any adjustment if more than 1 year has elapsed since the last GPCI revision. The GPCIs were first implemented in 1992. The first review and revision was implemented in 1995, the second review was implemented in 1998, and the third review was implemented in 2001. This constitutes the fourth review of the work and practice expense GPCIs.

The malpractice GPCIs were reviewed and revised as part of the November 7, 2003 (68 FR 63196) physician fee schedule final rule. At the time of the publication of the November 2003 final rule, the U.S. Census data upon which the work and practice expense GPCIs are based were not yet available.

Section 412 of MMA amends section 1848(e)(1) of the Act and establishes a floor of 1.0 for the work GPCI for any locality where the GPCI would otherwise fall below 1.0. This 1.0 work GPCI floor will be used for purposes of payment for services furnished on or after January 1, 2004 and before January 1, 2007. In addition, section 602 of MMA further amended section 1848(e)(1) of the Act for purposes of payment for services furnished in Alaska under the physician fee schedule on or after January 1, 2004 and before January 1, 2006, and sets the work, practice expense, and malpractice expense GPCIs at 1.67 if any GPCI would otherwise be less than 1.67.

Based on these MMA provisions, we revised the addenda published in the November 7, 2003 final rule (68 FR 63196) that reflected both the transitional 2004 and 2005 malpractice GPCIs, as well as the work and practice expense GPCIs that were not updated (Addendum D and Addendum E, respectively) in an interim final rule with comment period entitled,

‘‘ Changes to Medicare Payment for Drugs and Physician Fee Schedule Payments for Calendar Year 2004, ’’ published January 7, 2004 (69 FR 1084). Due to the MMA provisions, no locality in these revised addenda has a work GPCI of less than 1.00. Additionally, the work, practice expense, and malpractice GPCIs for Alaska are set at 1.67.

We are proposing to revise the work and practice expense GPCIs beginning in 2005 based on updated U.S. Census data and Department of Housing and Urban Development fair market rent data.
2. Development of the Geographic Practice Cost Indices

The GPCIs were developed by a joint effort of the Urban Institute and the Center for Health Economics Research under contract to us. Indices were developed that measured the relative physician resource cost differences among areas compared to the national average in a ‘‘ market basket ’’ of goods. The market basket consists of the resources involved with operating a private medical practice. The resource inputs are

—

• Physician work or net income (used to construct the physician work GPCI);

• Employee wages, office rents, medical equipment, supplies, and other miscellaneous expenses used to comprise the practice expense GPCI; and

• Professional liability insurance premiums (used to construct the malpractice GPCI).

The resource inputs and their respective weights for the resource costs associated with the work, practice expense, and malpractice expense associated with providing a physician service, were obtained from the 2003 AMA Physician Socioeconomic Characteristics publication (2003 Patient Care Physician Survey data) which measures physicians ’ earnings and overall practice expenses for 2000.

The weights for the 2004 GPCIs, as well as the proposed 2005 through 2007 GPCI revisions, are from the 2003 AMA survey and were used in the Medicare Economic Index (MEI) revision discussed in the November 2003 physician fee schedule final rule (68 FR 63245). Table 5 below shows the weights of the resource inputs, as defined by the MEI, those used for the original GPCIs, as well as the weights for the first, second, and third GPCI revisions. The MEI weights associated with the first and second GPCI updates (1995

– 2000 GPCIs) were not revised. In addition, the MEI weights for the proposed fourth GPCI revision are also shown.



### T ABLE 

### 5.

— H ISTORICAL 

### V IEW OF 

### MEI W EIGHTS

Input component Percentage of practice cost indices

1992

– 1994

GPCIs 1995

– 2000 GPCIs 2001

– 2003 GPCIs 2004

– 2006 GPCI

Physician Work ................................................................................................................ 5 4.2 54.2 54.5 52.5 Practice Expense ............................................................................................................. 40 .2 41.0 42.3 43.7 Employee Wages ............................................................................................................. 15.7 16.3 16.8 18.7 Rent ........................................................................................................................... ...... 11.1 10.3 11.6 12.2 Miscellaneous .................................................................................................................. 13.4 14.4 13.9 12.8 Malpractice .................................................................................................................... ... 5.6 4.8 3.2 3.9 Total .......................................................................................................................... 100.0 100.0 100.0 100.0



### a. Work Geographic Practice Cost Indices

As in previous GPCI updates, the median hourly earnings component is based on a 20 percent sample of U.S. Census data from workers in seven professional occupations. The actual reported earnings of physicians were not used to establish the GPCIs because Medicare payments (which are based on the GPCIs) are in part determinants of the earnings. Including physician wages in the physician work GPCI could, in effect, make the index dependent upon Medicare payments. Based upon analysis performed by Health Economics Research, we believe that in the majority of instances, the earnings of physicians will vary among areas to the same degree that the earnings of other professionals vary.


## 47503 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

Data from the 2000 decennial U.S. Census by county of seven professional occupations (architecture and engineering; computer, mathematical, and natural sciences; social scientist, social workers, lawyers; education, library, training; registered nurses; pharmacists; writers, artists, editors) were utilized in the development of the proposed work GPCIs.



### T ABLE 

### 6.

— S PECIFIC 

### O CCUPATION 

### C ATEGORIES 

### U SED IN 

### D EVELOPMENT

OF 

### P HYSICIAN 

### W ORK 

### GPCI

Categories Census 2000 occupation code

Architecture and Engineering 130

– 156 Computer, Mathematical, and

Natural Sciences ................. 100

– 124
160

– 176Social Scientists, Social Workers, Lawyers ........................ 180

– 215Education, Training, and Library .................................... 220

– 255 Registered Nurses .................. 313 Pharmacists ............................ 305 Writers, Artists, and Editors .... 260

– 296



### The Census Bureau has very specific criteria that tabulations must meet in order to be released to the public. To maximize the accuracy and availability of the data collection, the nonphysician professional wage data were aggregated into three geographic area categories:

1. By Individual Counties

— The tabulations were requested for each county in a Consolidated Metropolitan Statistical Area (CMSA).

2. By Metropolitan Statistical Area (MSA)

— The tabulations were requested by MSA for all counties that fall within
an MSA.

3. By Rest of State

— The tabulations were requested by rest of State for counties that are not in a CMSA or
MSA.

The nonphysician professional wage data were subsequently assigned to each respective county within the MSA or Rest of State aggregations (or, in the case of CMSAs, the data were already at the county level), and a median wage by county was calculated for each occupational category. These median wages were then weighted by the total RVUs associated with a given county to ultimately arrive at locality-specific work GPCIs. This geographic aggregation of Census data is the same methodology that was utilized in previous updates to the GPCIs.

The work GPCIs reflect one-fourth of the relative cost differences, as required by statute, with the exception of those areas where MMA requires that the GPCI be set at no lower than 1.00 and that the Alaska GPCIs be set at 1.67.
b. Practice Expense GPCIs

As in the past, we are proposing that the practice expense GPCI would be comprised of several factors that represent the major expenses incurred in operating a physician practice. The factors and the data sources we propose to use are detailed below. The impact of each individual factor on the calculation of the practice expense GPCI is based on the relative weight for that factor consistent with the calculation of the
MEI.

Employee Wage Indices

— The employee wage index is based on special tabulations of 2000 census data, which are generated from the Long Form Questionnaire. These special tabulations provided by the Census Bureau are designed to capture the median wage by county of the professional labor force. The Employee Wage Index uses the median wages of four labor categories that are most commonly present in a physician ’ s private practice (administrative support, registered nurses, licensed practical nurses, and health technicians). Median wages for these occupations were provided by the U.S. Census Bureau using the same set of geographic aggregation rules discussed previously in the physician work GPCI section.



### T ABLE 

### 7.

— S PECIFIC 

### O CCUPATIONS 

### U SED IN 

### C REATING 

### E MPLOYEE 

### W AGE 

### I NDEX 

### U PDATE

Categories Census 2000 occupation code

Administrative Support .... 500

– 593 Registered Nurses ........... 313 Licensed Practical Nurses 350 Health Technicians .......... 330, 332, 341,
351

– 354, 365



### Office Rent Indices

—Since no national data are readily available for physician office rents, some proxy must be used for this portion of the practice expense index. To construct the practice expense GPCIs, we need data that are widely and consistently available across all fee schedule areas. Although we searched for alternative commercial rental data that were both widely and consistently available across all fee schedule areas, we were unable to identify any reliable sources of commercial rental data.

As with the current practice expense GPCIs, the Department of Housing and Urban Development (HUD) Fair Market Rental (FMR) data for the residential rents were again used as the proxy for physician office rents. The proposed 2005 through 2007 practice expense GPCIs reflect the final fiscal year 2004 HUD FMR data. See Addendum E for a more detailed illustration of the actual office rent indices.

We believe that the FMR data remain the best available source for constructing the office rent index. The FMR data are available for all areas, are updated annually, and retain consistency from area-to-area and from year-to-year. Additionally, physicians frequently locate their offices in areas that are residential, rather than commercial, in nature. Residential rates may, in fact, be a better measure of the differences among areas in the physician office market than a general commercial rental index. In developing FMRs for metropolitan areas, HUD assumes that all counties within an MSA have the same rent. However, we believe that the rents in the New York City MSA vary too widely and propose that the FMR for this metropolitan area should be adjusted to account for this variation. For the New York City MSA, we used median gross rent from the 2000 Census to adjust the individual rents within counties in this MSA.

A reduction in an area ’ s rent index does not necessarily mean that rents have gone down in that area since the last GPCI update. Since the GPCIs measure area costs compared to the national average, a decrease in an area ’ s rent index means that that area ’ s rental costs are lower relative to the national average rental costs. Addendum E illustrates the changes in the rental index based upon the new FMR data.

Medical Equipment, Supplies, and other Miscellaneous Expenses

— The GPCIs assume that items such as medical equipment and supplies have a national market and that input prices do not vary among geographic areas. We were again unable to find any data sources that demonstrated price differences by geographic areas. As mentioned in previous updates, some price differences might exist, but these differences are more likely to be based on volume discounts rather than on geographic areas. The medical equipment, supplies, and miscellaneous expense portion of the practice expense geographic index will continue to be 1.000 for all areas in the proposed GPCIs, except for Alaska which will have an overall practice expense GPCI set at 1.67 for 2004 and 2005.
c. Malpractice Expense GPCIs

The malpractice GPCIs were reviewed and revised as part of the November 7, 2003 (68 FR 63196) physician fee schedule final rule. Please refer to that


## 47504 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

final rule for a detailed discussion of the update to the malpractice GPCIs.

4. Calculation and Effect of the Proposed 2005 Through 2007 Work and Practice Expense GPCIs

All three of the indices for a specific fee schedule locality are based on the indices for the individual counties within the respective fee schedule localities. As has been done in the past, fee schedule RVUs would again be used to weight the county indices (to reflect volumes of services within counties) when mapping to fee schedule areas and in constructing the national average indices. However, we propose to use more recent data, 2002 versus 1998 RVUs, in the county, locality, and national mapping in the proposed GPCIs. The payment effect associated with the use of these revised RVUs would generally be negligible, in most cases resulting in changes at the third decimal point, if at all.

Fee schedule payments are the product of the RVUs, the GPCIs, and the conversion factor. Updating the GPCIs changes the relative position of fee schedule areas compared to the national average. Since the changes represented by the proposed GPCIs could result in total payments either greater than or less than what would have been paid if the GPCIs were not updated, it would be necessary to apply scaling factors to the proposed GPCIs to ensure budget neutrality (prior to applying the provisions of MMA that change the work GPCIs to a minimum of 1.0 and increase the Alaska GPCIs to 1.67 because these provisions are exempted from budget neutrality). We determined that the proposed work and practice expense GPCIs would have resulted in slightly higher total national payments. Since the law requires that each individual component of the fee schedule

— work, practice expense, and malpractice expense

— is separately adjusted by its respective GPCI, we propose to scale each of the GPCIs separately. To ensure budget neutrality prior to applying the MMA provisions, it would be necessary to

—

• Decrease the proposed work GPCI by 0.9965;

• Decrease the proposed practice expense GPCI by 0.9930; and

• Increase the malpractice GPCIs that were published in the November 7, 2003 final rule by 1.0021.

As all geographic payment areas would receive the same percentage adjustments, the adjustments do not change the new relative positions among areas indicated by the proposed GPCIs. After the appropriate scaling factors are applied, the MMA provision setting a 1.0 floor would be applied to all work GPCIs falling below 1.0. Additionally, the GPCIs for Alaska would all be set to 1.67 in accordance with MMA.

The locality specific effect of these proposed revisions to the work and practice expense GPCIs, as well as the revisions to the malpractice GPCIs published in the November 7, 2003 final rule, and the MMA provisions enacted December 8, 2003, are shown in Addendum F through Addendum H. Addendum F reflects the current GPCIs that were effective on January 1, 2004. Addendum F can be utilized as a baseline for purposes of comparison to the proposed GPCIs. Addendum H illustrates the proposed fully implemented 2006 GPCIs. Addendum G illustrates the proposed transitional 2005 GPCIs, which are one-half of the effect of the proposed fully implemented GPCI revisions as required by section 1848(e)(1)(C) of the Act.

Because the three GPCIs have different weights, the overall effect of the proposed changes cannot be achieved by summing the individual effects of the revisions on the work, practice expense, and malpractice expense GPCIs. The overall effect of all three revised GPCI components on an area can be estimated by a comparison of the area ’ s geographic adjustment factors (GAFs). The GAF for a specific payment area is the weighted composite of the three separate components. The GAF illustrates an estimate of the general effect on total payments across a specific fee schedule locality. The effects on individual physicians would vary depending on each physician ’ s mix and volume of services.

To illustrate a comparison of the overall effect of the current and proposed GPCIs, Addendum J contains a comparison of the current 2004 GAFs to the proposed fully-implemented 2006 GAFs. Addendum I contains a comparison of the proposed transitional GAFs (2005) to the current 2004 GAFs. Both Addenda I and J are sorted in descending order of change. As Addendum J shows, no fee schedule area would experience a total decrease in its respective GAF by more than 3.5 percent, or increase by more than 7 percent, if the proposed GPCI revisions are fully implemented in 2006. The majority of payment areas would change by considerably less than these amounts. Nearly 75 percent of payment areas would change by less than 2 percent with the majority of these payment areas changing by less than 1 percent. Consequently, as illustrated by Addendum I, no fee schedule area would experience a total decrease in its respective GAF of more than 1.6 percent, or an increase of more than 3.5 percent, in the transition year (2005).

The GPCIs measure relative cost differences among payment areas compared to the national average. The national average cost is represented by a value of about 1.000. A proposed GPCI revision showing a decrease from the current value does not necessarily mean that absolute costs in a payment area have decreased, only that the average costs of a payment area have decreased as compared to the national average

costs.
5. Payment Localities

In the August 15, 2003 proposed rule, we requested comments on the composition of the current 89 Medicare physician payment localities to which the GPCIs are applied. In the November 7, 2003 final rule, we indicated that we received comments from various parties requesting that specific counties be removed from their current locality. We further indicated that we are continuing to examine alternatives for reconfiguring the current locality structure.

While we have considered alternatives, we have not yet been able to come up with a policy and criteria that would satisfactorily apply to all situations. Any policy that we would propose would have to apply to all States and payment localities. For example, if we were to establish a policy that if adjacent county geographic indices exceeded a threshold amount, the lower county could be moved to the higher county or a separate locality could be created, that approach would cause redistributions within a State.

Locality changes are budget-neutral with respect to the aggregate amount of Medicare money in a State. That is, reconfigurations of localities within a State do not result in any more Medicare money for the State in the aggregate, but only redistributions of money within a State. Since there will be both winners and losers in any locality reconfiguration, the State medical associations should be the impetus behind these changes. Since 1996, we have moved to Statewide areas in several States after receiving resolutions from State medical societies including support from physicians in losing areas, and after going through Notice and Comment rulemaking. The support of State medical associations has been the basis for previous changes to Statewide areas, and continues to be equally important in our consideration of other future locality changes.


## 47505 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

C. Malpractice Relative Value Units (RVUs) [If you choose to comment on issues in this section, please include the caption

‘‘ Malpractice RVUs ’’ at the beginning of your comments.]
1. History of Relative Value Unit System

Section 1848(c)(2)(C) of the Act requires that each service paid under the physician fee schedule be comprised of three components: work, practice expense, and malpractice.

From 1992 to 1999, malpractice RVUs were charge-based, using weighted specialty-specific malpractice expense percentages and 1991 average allowed charges. Malpractice RVUs for new codes after 1991 were extrapolated from similar existing codes or as a percentage of the corresponding work RVU. Section 4505(f) of the BBA required us to implement resource-based malpractice RVUs for services furnished beginning in 2000. With the implementation of resource-based malpractice RVUs in 2000 and the full implementation of resource-based practice expense RVUs in 2002, all physician fee schedule RVUs were resource-based, eliminating the last vestiges of charged-based payment. 2. Proposed Methodology for the Revision of Resource-based Malpractice
RVUs

The methodology used in calculating the proposed resource-based malpractice RVUs is the same methodology that was used in the initial development of resource-based RVUs, the only difference being the use of more current data. The proposed resource-based malpractice expense RVUs are based upon:

• Actual 2001 and 2002 malpractice premium data;

• Projected 2003 premium data; and

• 2002 Medicare payment data on allowed services and charges.

As was done in the initial development of resource-based malpractice expense RVUs in the November 2, 1999 final rule, we are proposing to revise resource-based malpractice expense RVUs using specialty-specific malpractice premium data because they represent the actual malpractice expense to the physician. In addition, malpractice premium data are widely available. We propose to use actual 2001 and 2002 malpractice premium data and projected 2003 malpractice premium data for three

reasons:

• These are the most current data available.

• These data capture the highly publicized and most recent trends in the specialty-specific costs of professional liability insurance.

• These are the same malpractice premium data that were utilized in the development of revised malpractice GPCIs in the November 7, 2003 final rule.

We were unable to obtain a nationally representative sample of 2003 malpractice premium data for two reasons: (1) The premium data that we collected from the private insurance companies had to ‘‘ match ’’ the market share data that were provided by the respective State Departments of Insurance. Because none of the State Departments of Insurance had 2003 market share information at the time of this data collection, 2003 premium data were not usable; and (2) the majority of private insurers were not amicable to releasing premium data to us. In the majority of instances, the private insurance companies would release their premium data only to the State Departments of Insurance.

Discussions with the industry lead us to conclude that the primary determinants of malpractice liability costs remain physician specialty, level of surgical involvement, and the physician ’ s malpractice history. Malpractice premium data were collected for the top 20 Medicare physician specialties measured by total payments. Premiums were for a $1 million/$3 million mature claims-made policy (a policy covering claims made, rather than services provided during the policy term). We attempted to collect premium data from all 50 States, Washington, DC, and Puerto Rico. Data were collected from commercial and physician-owned insurers and from joint underwriting associations (JUAs).A JUA is a State governmentadministered risk pooling insurance arrangement in areas where commercial insurers have left the market. Adjustments were made to reflect mandatory patient compensation funds (PCFs) (funds to pay for any claim beyond the statutory amount, thereby limiting an individual physician ’ s liability in cases of a large suit) surcharges in States where PCF participation is mandatory. The premium data collected represent at least 50 percent of physician malpractice premiums paid in each
State.

For 2001, we were able to collect premium data from 48 States (for purposes of this discussion, State counts include Washington, DC and Puerto Rico). We were unable to obtain premium data from Kentucky, New Hampshire, New Mexico, and Washington DC. To calculate a proxy for the malpractice premium data for these four areas in 2001, we began with the most current malpractice premium data collected for these areas, 1996 through 1998 (the last premium data collection that was undertaken). An average premium price was calculated (using 1996 through 1998 data) for all States except Kentucky, New Hampshire, New Mexico, and Washington, DC. Similarly, an average premium price was calculated for the 1999 through 2001 period for all States except Kentucky, New Hampshire, New Mexico, and Washington, DC. The percentage change in these premium prices was calculated as the percent difference between the 1999 to 2001 calculated average premium price and the 1996 to 1998 calculated average premium price. This percentage change was then applied to the weighted average 1996 to 1998 malpractice premium price for these four areas to arrive at a comparable 1999 to 2001 average premium price.

For 2002, we were able to obtain malpractice premium data from 33 States. Many State Departments of Insurance had not yet obtained premium data from the primary insurers within their State at the time of this data collection. For those States for which we were unable to obtain malpractice premium data, we calculated a national average rate of growth for 2002 and applied this national rate of growth to the weighted average premium for 2001 to obtain an average premium for 2002 for each county for which we were unable to obtain malpractice premium data for 2002.

We projected premium values for 2003 based on the average of historical year-to-year changes for each locality (when locality level data were available) or by State (when only Statewide premium data projections were available). First, we calculated the percentage changes in the premiums from the 1999 through 2000, 2000 through 2001, and 2001 through 2002 periods for each payment locality. Next, we calculated the geometric mean of these three percentages and applied the mean to the 2002 premium to obtain the forecasted 2003 malpractice premium. We used the geometric mean to calculate the forecasted 2003 premium data because the geometric mean is commonly used to derive the mean of a series of values that represent rates of change. Because the geometric mean is based on the logarithmic scale, it is less impacted by outlying data.

Malpractice insurers generally use five-digit codes developed by the Insurance Services Office (ISO), an advisory body serving property and casualty insurers, to classify physician


## 47506 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

specialties into different risk classes for premium rating purposes. ISO codes classify physicians not only by specialty, but in many cases also by whether or not the specialty performs surgical procedures. A given specialty could thus have two ISO codes, one for use in rating a member of that specialty who performs surgical procedures and another for rating a member who does not perform surgery. Medicare uses its own system of specialty classification for payment and data purposes. It was therefore necessary to map Medicare specialties to ISO codes and insurer risk classes. Different insurers, while using ISO codes, have their own risk class categories. To ensure consistency, we used the risk classes of St. Paul Companies, one of the oldest and largest malpractice insurers. Table 8 crosswalks Medicare specialties to ISO codes and to the St. Paul risk classes used.



### T ABLE 

### 8.

— C ROSSWALK OF 

### M EDICARE 

### S PECIALTIES TO 

### IOS C ODES AND TO THE 

### S T 

### . P AUL 

### R ISK 

### C LASSES 

### U SED

Medicare code Medicare description ISO code Risk class St. Paul ’ s description Surgery Other Surgery Other

1 ...................... General practice ........................................ 80117 80420 4 1 Family/Gen. Practitioners

— No Obstetrical. 2 ...................... General surgery ......................................... 80143 80143 5 5 Surgery, General. 3 ...................... Allergy/Immunology ................................... 80254 80254 1A 1A Allergy. 4 ...................... Otolaryngology .......................................... 80159 80265 3 1 Otarhinolaryngology. 5 ...................... Anesthesiology .......................................... 80151 80151 5A 5A Anesthesiology. 6 ...................... Cardiology ................................................. 80281 80255 2 1 Cardiovascular Disease. 7 ...................... Dermatology .............................................. 80472 80256 5 1A Dermatology. 8 ...................... Family practice .......................................... 80117 80420 4 1 Family/Gen. Practitioners

— No Obstetrical. 10 .................... Gastroenterology ....................................... 80104 80241 3 1 Gastroenterology.
11 .................... Internal medicine ....................................... 80284 80257 2 1 Internal medicine. 13 .................... Neurology .................................................. 80288 80261 2 2 Neurology. 14 .................... Neurosurgery ............................................. 80152 80152 8 8 Surgery, Neurology. 16 .................... Obstetrics/Gynecology .............................. 80167 80244 4 1 Gynecology. 18 .................... Ophthalmology .......................................... 80114 80263 2 1 Ophthalmology. 20 .................... Orthopedic surgery .................................... 80501 80501 5 5 Surgery, Orthopedic

— excluding Spinal Surgery. 20 .................... Orthopedic surgery .................................... 80154 80154 6 6 Surgery, Orthopedic

— including Spinal Surgery. 22 .................... Pathology ................................................... 80292 80266 2 1A Pathology. 24 .................... Plastic and reconstructive surgery ............ 80156 80156 5 5 Surgery, Plastic. 25 .................... Physical medicine and rehab .................... 80235 80235 1 1 Physical medicine and rehab. 26 .................... Psychiatry* ................................................. 80492,
80431 80249 2 1A Psychiatry.

28 .................... Colorectal surgery ..................................... 80115 80115 3 3 Surgery, Colon and Rectal. 29 .................... Pulmonary Disease ................................... 80269 80269 1 1 Pulmonary Disease. 30 .................... Diagnostic radiology ** .............................. 80280 80253 2 2 Radiology. 33 .................... Thoracic surgery ........................................ 80144 80144 6 6 Surgery, Thoracic. 34 .................... Urology ...................................................... 80145 80145 2 2 Surgery, Urological.
36 .................... Nuclear medicine ....................................... 80262 80262 1 1 Nuclear medicine. 37 .................... Pediatric medicine ..................................... 80293 80267 2 1 Pediatrics. 38 .................... Geriatric medicine*** ................................. 80276 80243 2 1 Geriatrics. 39 .................... Nephrology*** ............................................ 80287 80260 2 1 Nephrology. 40 .................... Hand surgery ............................................. 80169 80169 5 5 Surgery, Hand. 44 .................... Infectious disease ...................................... 80279 80246 2 1 Infectious disease. 46 .................... Endocrinology*** ........................................ 80272 80238 2 1 Endocrinology. 65 .................... Physical therapist (independent) ............... 80235 80235 1 1 Physical medicine and rehab. 66 .................... Rheumatology ........................................... 80252 80252 1 1 Rheumatology. 67 .................... Occupational therapist (independent) ....... 80235 80235 1 1 Occupational Medicine. 77 .................... Vascular surgery ....................................... 80146 80146 6 6 Surgery, Vascular. 78 .................... Cardiac surgery ......................................... 80141 80141 6 6 Surgery, Cardiac. 82 .................... Hematology ............................................... 80278 80245 2 1 Hematology. 83 .................... Hematology/oncology ................................ 80473 80473 1 1 Oncology. 84 .................... Preventive medicine .................................. 80231 80231 1 1 General Preventive Medicine. 92 .................... Radiation Oncology  ............................. 80425 80425 2 2 Radiation Therapy. 93 .................... Emergency medicine ................................. 80157 80102 5 4 Emergency Medicine. 98 .................... Gynecologist/oncologist ............................. 80167 80244 4 1 Gynecology.

** Note:** For specialties with multiple risk classifications depending on the level of surgical involvement, the highest level of surgery for each specialty was selected for the ‘‘ surgery ’’ ISO and risk class; and the lowest level of surgery was selected for the ‘‘ nonsurgery ’’ ISO and risk class.

**Note:** If a specialty has only one risk classification, the same classification was used for both surgery and nonsurgery. * The ISO codes for surgery for Psychiatry represents Psychiatry

— shock therapy. ** St. Paul ’ s is the only one of the five companies that has a ‘‘ major invasive ’’ procedures ISO Code for Radiology; therefore, the ‘‘ minor invasive procedures ’’ ISO Code is being used as the highest level of surgery.

*** St. Paul ’ s is the only one of the five companies that has a ‘‘ major surgery ’’ ISO Code for Geriatrics, Nephrology, and Endocrinology; therefore, the minor surgery ’’ ISO Code is being used as the highest level of surgery.

**** Medical Protective ’ s Description was used, as St. Paul ’ s does not provide specific medical malpractice insurance for Radiation Therapy.


## 47507 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

Some physician specialties, nonphysician practitioners, and other entities (for example, independent diagnostic testing facilities) paid under the physician fee schedule could not be assigned an ISO code. We crosswalked these specialties to similar physician specialties assigned an ISO code and a risk class. The unassigned specialties and the specialty to which they were assigned are shown in Table 9.



### T ABLE 

### 9.

— C ROSSWALK OF 

### S PECIALTIES TO 

### S IMILAR 

### P HYSICIAN 

### S PECIALTIES 

### A SSIGNED AN 

### ISO C ODE AND A 

### R ISK 

### C LASS

Medicare code Unassigned Medicare specialty Crosswalk specialty

12 ............................................... Osteopathic Manipulative Therapy .............................................. ................... Family Practice. 32 ............................................... Anesthesiologist Assistant .................................................... .......................... Anesthesiology. 35 ............................................... Chiropractic .................................................................. ................................... Physical medicine and rehab. 41 ............................................... Optometry ..................................................................... ................................... Ophthalmology. 43 ............................................... Certified Registered Nurse Assistant .......................................... .................... All Physicians. 47 ............................................... Physiological Laboratory (independent) ........................................ .................. All Physicians. 48 ............................................... Podiatry ...................................................................... ..................................... All Physicians. 50 ............................................... Nurse Practitioner ............................................................ ............................... All Physicians. 62 ............................................... Psychologist .................................................................. .................................. Psychiatry. 68 ............................................... Clinical Psychologist ......................................................... .............................. Psychiatry. 69 ............................................... Clinical Laboratory ........................................................... ............................... All Physicians. 70 ............................................... Multi-Specialty Clinic or Group Practice ...................................... ................... All Physicians. 74 ............................................... Radiation Therapy Center ...................................................... ......................... Radiation Oncology. 76 ............................................... Peripheral Vascular Disease ................................................... ........................ Vascular Surgery.
79 ............................................... Addiction Medicine ............................................................ .............................. Psychiatry. 80 ............................................... Licensed Clinical Social Worker ............................................... ...................... Psychiatry. 81 ............................................... Critical Care (Intensivists) .................................................. ............................. All Physicians. 85 ............................................... Maxillofacial Surgery ......................................................... .............................. Plastic Surgery. 86 ............................................... Neuropsychiatry ............................................................... ............................... Psychiatry. 89 ............................................... Certified Clinical Nurse Specialist ........................................... ........................ All Physicians. 90 ............................................... Medical Oncology .............................................................. .............................. Internal Medicine. 91 ............................................... Surgical Oncology ............................................................. .............................. General Surgery. 94 ............................................... Interventional Radiology ...................................................... ............................ Radiology. 96 ............................................... Optician ...................................................................... ..................................... Ophthalmology. 97 ............................................... Physician Assistant ........................................................... .............................. All Physicians.



### In the development of the proposed resource-based malpractice RVU methodology, we considered two malpractice premium-based alternatives for resource-based malpractice RVUs, the dominant specialty approach and the specialty-weighted approach.
Dominant Specialty Approach

The dominant specialty approach bases the malpractice RVUs upon the risk factor of only the dominant specialty performing a given service as long as the dominant specialty accounted for at least 51 percent of the total utilization for a given service. When 51 percent of the total utilization does not comprise the dominant specialty, this approach uses a modified specialty-weighted approach. In this modified specialty-weighted approach, two or more specialties are collectively defined as the dominant specialty. Starting with the specialty with the largest percentage of allowed services, the modified specialty-weighted approach successively adds the next highest specialty in terms of percentage of allowed services until a 50 percent threshold is achieved. The next step is to sum the risk factors of those specialties (weighted by utilization) in order to achieve at least 50 percent of the total utilization of a given service and then use the factors in the calculation of the final malpractice
RVU.

The dominant specialty approach produces modest increases for some specialties and modest decreases for other specialties. The largest increase for any given specialty, over the specialty-weighted approach, is less than 1.5 percent of total RVUs, while the largest decrease for any given specialty is less than 0.5 percent of total
RVUs.
Specialty-Weighted Approach

The approach that we adopted in the November 1999 final rule and are proposing to use in this proposed rule, bases the final malpractice RVUs upon a weighted average of the risk factors of all specialties performing a given service. The specialty-weighted approach ensures that all specialties performing a given service are accounted for in the calculation of the final malpractice RVU. Our proposed methodology is as follows: (1) Compute a national average premium for each specialty. Insurance rating area malpractice premiums for each specialty were mapped to the county level. The specialty premium for each county is then multiplied by the total county RVUs (as defined by Medicare claims data), which had been divided by the malpractice GPCI applicable to each county to standardize the relative values for geographic variations. If the malpractice RVUs were not normalized for geographic variation, the locality cost differences (as reflected by the GPCIs) would be counted twice. The product of the malpractice premiums and standardized RVUs is then summed across specialties for each county. This calculation is then divided by the total RVUs for all counties, for each specialty, to yield a national average premium for each specialty.

Table 10 shows the national average premiums for the years 1999 through 2003 for the 20 specialties for which we collected premium data. As stated previously, we used an average of the 3 most current years, 2001 to projected 2003 malpractice premiums, in our calculation of the proposed malpractice
RVUs.


## 47508 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 10.

— N ATIONAL 

### A VERAGE 

### P REMIUMS FOR THE 

### Y EARS 

### 1999 T HROUGH 

### 2003 FOR THE 

### 20 S PECIALTIES FOR 

### W HICH 

### W E 

### C OLLECTED 

### P REMIUM 

### D ATA

ISO Specialty 2001 average 2002 average 2003 average 1996

– 1998 average 2001

– 2003 average 1 Annual trend 2 (percent) Specialty MGPCI 3 Normalized 2001

– 2003 premium 4 Risk factor 5

80269 ......... Pulmonary disease ............... 12,574 13,456 14,541 9,508 13,524 7.30 1.027 13,168 2.14 80280 ......... Diagnostic radiology ............. 15,807 16,783 17,997 12,372 16,862 6.39 0.997 16,913 2.75 80284 ......... Internal medicine .................. 14,395 15,714 16,985 11,836 15,698 5.81 1.028 15,270 2.48 80274 ......... Gastroenterology .................. 14,347 15,398 16,643 11,745 15,463 5.65 1.017 15,204 2.47 80143 ......... General surgery .................... 33,163 36,004 39,059 27,825 36,075 5.33 0.957 37,696 6.13 80423 ......... General practice ................... 13,325 14,479 15,731 11,234 14,512 5.25 0.943 15,389 2.50 80288 ......... Neurology ............................. 16,206 17,330 18,629 13,726 17,388 4.84 1.032 16,849 2.74 80114 ......... Ophthalmology ..................... 13,064 14,103 15,317 11,209 14,161 4.79 0.997 14,204 2.31 80152 ......... Neurosurgery ........................ 64,724 70,125 76,060 57,701 70,303 4.03 0.952 73,848 12.00 80281 ......... Cardiology ............................ 14,798 15,836 17,085 13,204 15,906 3.79 1.021 15,579 2.53 80145 ......... Urology ................................. 18,701 20,253 21,931 16,958 20,295 3.66 0.999 20,315 3.30 80159 ......... Otolaryngology ..................... 21,720 23,127 24,794 19,990 23,214 3.04 0.997 23,284 3.78 80154 ......... Orthopedic w/spinal .............. 40,384 43,758 47,321 38,584 43,821 2.58 0.955 45,886 7.46 80144 ......... Thoracic surgery ................... 39,538 43,200 47,249 38,812 43,329 2.23 1.020 42,479 6.91 80282 ......... Dermatology ......................... 11,046 11,549 12,375 10,650 11,657 1.82 1.020 11,428 1.86 80260 ......... Nephrology 6 ......................... 8,408 9,290 10,142 n/a 9,280 n/a 0.999 9,289 1.51 80146 ......... Vascular surgery .................. 39,391 42,660 46,211 n/a 42,754 n/a 1.014 42,164 6.85 80141 ......... Cardiac surgery .................... 37,802 40,498 43,722 n/a 40,674 n/a 0.921 44,163 7.18 80425 ......... Radiation oncology ............... 13,800 14,755 15,976 n/a 14,844 n/a 0.995 14,918 2.43 80102 ......... Emergency medicine ............ 20,671 22,672 24,733 n/a 22,692 n/a 0.974 23,298 3.79

1 A simple average of figures for 2001, 2002, and 2003.

2 Percent annualized average growth rate between 1996

– 1998 and 2001

– 2003.

3 An average of locality malpractice GPCIs using specialty-specific malpractice RVUs as weights.

4 2001

– 2003 premium divided by specialty MGPCI.

5 (Normalized 2001

– 2003 Premium, .9289) × 1.51.

6 Nephrology is set to 1.51 to be consistent with the risk factor taken from the rating manuals. n/a signifies that the premium d ata were not available.



### (2) Calculate a risk factor for each specialty . Differences among specialties in malpractice premiums are a direct reflection of the malpractice risk associated with the services performed by a given specialty. The relative differences in national average premiums between various specialties can be expressed as a specialty risk factor. These risk factors are an index calculated by dividing the national average premium for each specialty by the national average premium for the specialty with the lowest average premium, nephrology. Table 11 shows the risk factors, surgical and nonsurgical, by specialty.



### T ABLE 

### 11.

— R ISK 

### F ACTORS 

### , S URGICAL AND 

### N ONSURGICAL



### , BY 

### S PECIALTY

Medicare code Medicare description Nonsurgical risk factor Surgical risk factor

01 .................................. General practice ........................................................................... ................................ 1.79 4.26 02 .................................. General surgery ............................................................................ ............................... 6.13 6.13 03 .................................. Allergy/Immunology ......................................................................... ............................. 1.00 1.00 04 .................................. Otolaryngology ............................................................................. ................................ 1.45 3.78 05 .................................. Anesthesiology ............................................................................. ................................ 2.84 2.84 06 .................................. Cardiology ................................................................................. ................................... 1.45 2.53 07 .................................. Dermatology ................................................................................ ................................. 1.00 3.90 08 .................................. Family practice ............................................................................ ................................. 1.79 4.26 10 .................................. Gastroenterology ........................................................................... ............................... 2.05 3.49 11 .................................. Internal medicine .......................................................................... ................................ 2.05 2.48 12 .................................. Osteopathic Manipulative Therapy ........................................................... ................... 1.79 4.26 13 .................................. Neurology .................................................................................. ................................... 2.52 2.74 14 .................................. Neurosurgery ............................................................................... ................................. 12.00 12.00 16 .................................. Obstetrics/Gynecology ...................................................................... ........................... 2.15 5.63 18 .................................. Ophthalmology .............................................................................. ............................... 1.24 2.31 20 .................................. Orthopedic surgery w/o Spinal .............................................................. ....................... 8.06 8.06 20 .................................. Orthopedic surgery with Spinal ............................................................. ....................... 7.46 7.46 22 .................................. Pathology .................................................................................. ................................... 1.72 2.09 24 .................................. Plastic Surgery ............................................................................ ................................. 6.92 6.92 25 .................................. Physical Med & Rehab ....................................................................... ......................... 1.26 1.26 26 .................................. Psychiatry ................................................................................. .................................... 1.11 3.08 28 .................................. Colorectal surgery ......................................................................... ............................... 4.08 4.08 29 .................................. Pulmonary disease .......................................................................... ............................. 2.14 2.14 30 .................................. Diagnostic radiology ....................................................................... .............................. 2.07 2.75 32 .................................. Anesthesiologist Assistant ................................................................. .......................... 2.84 2.84 33 .................................. Thoracic surgery ........................................................................... ............................... 6.91 6.91 34 .................................. Urology .................................................................................... ..................................... 3.30 3.30 35 .................................. Chiropractic ............................................................................... ................................... 1.26 1.26 36 .................................. Nuclear medicine ........................................................................... .............................. 1.66 1.66 37 .................................. Pediatric medicine ......................................................................... ............................... 1.76 2.42 38 .................................. Geriatric medicine ......................................................................... ............................... 1.35 2.17 39 .................................. Nephrology ................................................................................. .................................. 1.51 1.96


## 47509 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 11.

— R ISK 

### F ACTORS 

### , S URGICAL AND 

### N ONSURGICAL



### , BY 

### S PECIALTY



### — Continued

Medicare code Medicare description Nonsurgical risk factor Surgical risk factor

40 .................................. Hand surgery ............................................................................... ................................. 4.71 4.71 41 .................................. Optometry .................................................................................. ................................... 1.24 2.31 43 .................................. Certified Registered Nurse Assistant ....................................................... .................... 3.04 3.71 44 .................................. Infectious disease ......................................................................... ............................... 1.55 2.09 46 .................................. Endocrinology .............................................................................. ................................. 2.03 2.09 47 .................................. Physiological Laboratory (independent) ..................................................... .................. 3.04 3.71 48 .................................. Podiatry ................................................................................... ..................................... 3.04 3.71 50 .................................. Nurse Practitioner ......................................................................... ............................... 3.04 3.71 62 .................................. Psychologist ............................................................................... .................................. 1.11 3.08 65 .................................. Physical therapist (independent) ........................................................... ....................... 1.26 1.26 66 .................................. Rheumatology ............................................................................... ............................... 2.11 2.11 67 .................................. Occupational therapist ..................................................................... ............................ 1.11 1.11 68 .................................. Clinical Psychologist ...................................................................... .............................. 1.11 3.08 69 .................................. Clinical Laboratory ........................................................................ ............................... 3.04 3.71 70 .................................. Multi-Specialty Clinic or Group Practice ................................................... ................... 3.04 3.71 74 .................................. Radiation Therapy Center ................................................................... ......................... 2.43 2.43 76 .................................. Peripheral Vascular Disease ................................................................ ........................ 6.85 6.85 77 .................................. Vascular surgery ........................................................................... ............................... 6.85 6.85 78 .................................. Cardiac surgery ............................................................................ ................................ 7.18 7.18 79 .................................. Addiction Medicine ......................................................................... .............................. 1.11 3.08 80 .................................. Licensed Clinical Social Worker ............................................................ ...................... 1.11 3.08 81 .................................. Critical Care (Intensivists) ............................................................... ............................. 3.04 3.71 82 .................................. Hematology ................................................................................. ................................. 1.77 2.26 83 .................................. Hematology/oncology ........................................................................ ........................... 2.05 2.11 84 .................................. Preventive medicine ........................................................................ ............................. 1.26 1.26 85 .................................. Maxillofacial Surgery ...................................................................... .............................. 6.92 6.92 86 .................................. Neuropsychiatry ............................................................................ ............................... 1.11 3.08 89 .................................. Certified Clinical Nurse Specialist ........................................................ ........................ 3.04 3.71 90 .................................. Medical Oncology ........................................................................... .............................. 2.05 2.48 91 .................................. Surgical Oncology .......................................................................... .............................. 6.13 6.13 92 .................................. *Radiation oncology/therapy ................................................................ ........................ 2.43 2.43 93 .................................. Emergency medicine ......................................................................... ........................... 3.79 4.55 94 .................................. Interventional Radiology ................................................................... ............................ 2.07 2.75 96 .................................. Optician ................................................................................... ..................................... 1.24 2.31 97 .................................. Physician Assistant ........................................................................ .............................. 3.04 3.71 98 .................................. Gynecologist/oncologist .................................................................... ........................... 2.15 5.63

**Note:** If a specialty has only one risk classification, the same classification was used for both surgery and nonsurgery. **Note:** For specialties with multiple risk classifications depending on the level of surgical involvement, the highest level of surgery was selected for surgery risk factor and the lowest level of surgery was selected for nonsurgery risk factor.



### (3) Calculate malpractice RVUs for each code. Resource-based malpractice RVUs were calculated for each procedure. The first step was to identify the percentage of services performed by each specialty for each respective procedure code. This percentage was then multiplied by each respective specialty ’ s risk factor as calculated in Step 2. The products for all specialties for the procedure were then summed, yielding a specialty-weighted malpractice RVU reflecting the weighted malpractice costs across all specialties for that procedure. This number was then multiplied by the procedure ’ s workRVUs to account for differences in riskof-service. Since we were unable to find an acceptable source of data to be used in determining risk-of-service, work RVUs were used. We would welcome any suggestions for alternative datasources to be used in determining riskof-service.

As mentioned above, certain specialties may have more than one ISO rating class and risk factor. The surgical risk factor for a specialty was used for surgical services and the nonsurgical risk factor for evaluation and management services. Also, for obstetrics/gynecology, the lower gynecology risk factor was used for all codes except those obviously surgical services, in which case the higher, surgical risk factor was used.

Certain codes have no physician work RVUs. The overwhelming majority of these codes are the technical components (TCs) of diagnostic tests, such as x-rays and cardiac catheterization, which have a distinctly separate technical component (the taking of an x-ray by a technician) and professional component (the interpretation of the x-ray by a physician). Examples of other codes with no work RVUs are audiology tests and injections. These services are usually furnished by nonphysicians, in this example, audiologists and nurses, respectively. In many cases, the nonphysician or entity furnishing the TC is distinct and separate from the physician ordering and interpreting the test. We believe it is appropriate for the malpractice RVUs assigned to TCs to be based on the malpractice costs of the nonphysician or entity, not the professional liability of the physician.

Our proposed methodology, however, would result in zero malpractice RVUs for codes with no physician work, since we propose the use of physician work RVUs to adjust for risk-of-service. We believe that zero malpractice RVUs would be inappropriate because nonphysician health practitioners and entities such as independent diagnostic testing facilities (IDTFs) also have malpractice liability and carry malpractice insurance. Therefore, we are proposing to retain the current charge-based malpractice RVUs for all services with zero work RVUs. We are open to comments and suggestions for constructing resource-based malpractice RVUs for codes with no physician work.


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(4) Rescale for budget neutrality. The law requires that changes to fee schedule RVUs be budget neutral. The current resource-based malpractice RVUs and the proposed resource-based malpractice RVUs were constructed using entirely different malpractice premium data. Thus, the last step is to adjust for budget neutrality by rescaling the proposed malpractice RVUs so that the total proposed resource-based malpractice RVUs equal the total current resource-based malpractice RVUs. The proposed resource-based malpractice RVUs for each procedure were multiplied by the frequency count for that procedure to determine the total resource-based malpractice RVUs for each procedure. This was summed for all procedures to determine the total fee schedule proposed resource-based malpractice RVUs. This was compared to the total current resource-based malpractice RVUs, using the same calculation and cases. The total current and proposed malpractice RVUs were equal, and therefore budget neutral. Thus, no adjustments were needed to ensure that expenditures remained constant for the malpractice RVU portion of the physician fee schedule payment.

The proposed resource-based malpractice RVUs are shown in Addendum B. These values have been adjusted for budget neutrality on the basis of the most recent available data. The values do not reflect the final budget-neutrality adjustment, which we will make in the final rule based upon the more current Medicare claims data. We do not believe, however, that the values will change significantly as a result of the final budget-neutrality adjustment.

Because of the differences in the sizes of the three fee schedule components, implementation of the proposed resource-based malpractice RVUs will have a smaller payment effect than theprevious implementation of resourcebased practice expense RVUs. On average, work represents about 52.5 percent of the total payment for a procedure, practice expense about 43.6 percent of the total payment, and malpractice expense about 3.9 percent of the total payment. Thus, a 20 percent change in practice expense or work RVUs would yield a change in payment of about 8 to 11 percent. In contrast, a corresponding 20 percent change in malpractice values would yield a change in payment of only about 0.6 percent. Estimates of the effects onpayment by specialty and selected highvolume procedures can be found in the impact section of this rule. We are requesting comments on ourproposed methodology and resourcebased malpractice RVUs.
D. Coding Issues
1. Change in Global Period for CPT Code 77427, Radiation Treatment Management, Five Treatments [If you choose to comment on issues in this section, please include the caption

‘‘ CODING-GLOBAL PERIOD ’’ at the beginning of your comments.]

This code was included in the November 2, 1999 physician fee schedule final rule and was effective for services beginning January 1, 2000. In that rule, and subsequent rules, we have applied a global indicator of ‘‘ xxx ’’ to this code, meaning that the global concept does not apply. It has been brought to our attention that this global indicator is incorrect. The global indicator should be 090 since the RUC valuation of this service reflected a global period of 90 days and we accepted this valuation. Therefore, we would correct the global indicator for this service to reflect a global period of 90 days (090).
2. Requests for Adding Services to the List of Medicare Telehealth Services [If you choose to comment on issues in this section, please include the caption

‘‘ CODING

— TELEHEALTH ’’ at the beginning of your comments.]
a. Background

Section 1834(m) of the Act defines telehealth services as professional consultations, office and other outpatient visits, and office psychiatry services identified as of July 1, 2000 by CPT codes 99241 through 99275, 99201 through 99215, 90804 through 90809, and 90862. 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 CY 2003 final rule, we established a process for adding or deleting services to the list of Medicare telehealth services. This process provides the public an opportunity on an ongoing basis to submit requests for adding a service. For more information on submitting a request for addition to the list of Medicare telehealth services, visit our Web site at www.cms.hhs.gov/ physicians/telehealth.
b. Submitted Requests for Addition to the List of Telehealth Services

Requests for adding services to the list of Medicare telehealth services must be submitted and received no later than December 31st of each calendar year to be considered for the next proposed rule. For example, requests submitted in CY 2003 are considered for the CY 2005 proposed rule.

We received the following public requests for addition in CY 2003: Inpatient hospital care, emergency department visits, hospital observation services, inpatient psychotherapy, monthly management of patients with end-stage renal disease (ESRD), speech and audiologist services, case management, and care plan oversight.

Requests for additions submitted in CY 2003 are discussed below.

Inpatient hospital care, emergency department visits, hospital observation services, and inpatient psychotherapy

The American Telemedicine Association (ATA) and an individual practitioner submitted a request to add initial and subsequent inpatient hospital care as represented by CPT codes 99221 through 99223 and 99231 through 99233; hospital observation services (CPT codes 99217, 99218 through 99220); and individual psychotherapy furnished in an inpatient, partial hospitalization, or residential care facility setting (as defined by CPT codes 90816 through 90822). The requestors argue that the addition of hospital observation services, inpatient hospital care, and inpatient psychotherapy will reduce transfers from remote facilities to tertiary care facilities, decrease length of stay, improve diagnostic accuracy, plan of care strategies and patient outcomes, and also stabilize local health care systems. The requestors emphasize that adding individual psychotherapy in the inpatient and partial hospitalization setting is crucial for providing access to mental health services for the rural population. Additionally, the requestors believe that no current Medicare telehealth service can be billed when a patient is in observation status or is admitted as an inpatient. They also noted that the current psychiatry services paid for as telehealth services are not appropriate for mental health patients in the hospital, partial hospital, or residential facility settings.

The University of Kansas Medical Center requested that we add emergency department visits as defined by CPT codes 99281 through 99285 as telehealth services. The requestor stated that, for many rural hospitals, the attending physician in emergency cases is a local primary care or family physician who may not have sufficient experience with the complexities of emergent care. The requestor believes that adding emergency department visits will provide quicker access to an expert trauma or emergency physician and that the time saved could be life-saving for the patient.


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CMS Review

As discussed in the June 28, 2002 Federal Register (67 FR 43862), we assign requests to one of two categories for review. Category 1 is comprised of services, which are similar in nature to an office or other outpatient visit, consultation, or office psychiatry. We review category 1 services to ensure that the roles of, and interaction among, the patient, physician, or practitioner at the distant site and telepresenter (if necessary) are similar to the current telehealth services.

Category 2 services would include services that are not similar to an office or other outpatient visit, consultation, or office psychiatry. Because of the potential acuity of the patient in the hospital setting, we consider inpatient hospital care, emergency department visits, hospital observation services, and inpatient psychotherapy to fall into the second category of requests. As discussed on our website, for category 2 services, requestors must provide evidence indicating that the use of a telecommunications system produces similar diagnostic findings ortherapeutic interventions as would faceto-face delivery of the same service.

For inpatient hospital care, hospital observation services, and inpatient psychotherapy, the requestors did not submit evidence indicating that the use of a telecommunications system does not affect the diagnosis or treatment plan as compared to the face-to-face delivery of the service. The requestors instead submitted various studies and articles regarding: the psychiatric diagnostic interview examination; school-based pediatric acute care to children; child and adolescent psychotherapy in clinics and schools; the use of telehealth technology to simplify case management and prior authorization; consultation on neurology cases; and nursing care to reduce hospitalization for heart failure.

These data are not directly relevant to the services that the requesters wanted to have added. They do not address whether the use of a telecommunications system produces similar diagnoses or therapeutic interventions by physicians or practitioners, as would the face-to-face delivery of inpatient hospital care, hospital observation services, and inpatient psychotherapy. With respect to emergency department visits, the requestor submitted a comparison study between emergency department telemedicine and face-to-face emergency department visits. However, this study did not take into account complex emergent care. Study participants were pre-selected based on cases with limited clinical intervention, for example, animal bites with no skin laceration or puncture wounds, insect bites without evidence of wheezing or airway compromise, sore throat, first degree burns

— less than 5 percent, and nonurgent medical problems requiring a referral.

In the absence of sufficient, welldesigned comparison studies showing that the use of a telecommunications system produces similar diagnoses or therapeutic interventions as would the face-to-face delivery of the requested services, we are proposing not to add these services to the list of telehealth
services.

We believe that the current list of Medicare telehealth services is appropriate for hospital inpatients, emergency room cases, and patients designated as observation status. If guidance or advice is needed in these settings, a consultation could be requested from an appropriate source.

End Stage Renal Disease

— Monthly Management of Patients on Dialysis

The ATA and an individual practitioner submitted a request that we add the monthly management of patients on dialysis, as represented by HCPCS codes G0308 through G0319, to the list of Medicare telehealth services. Under these codes, Medicare pays an increased monthly capitated payment amount for additional visits during the month (up to four). The requestors noted the shortage of nephrologists andthe difficulty they have in visiting faceto-face with all patients on dialysis. Additionally, the requestors stated that many States, including Alaska, Hawaii, Montana, and Wisconsin, have remote community-based dialysis centers with underserved populations located a considerable distance from a nephrologist. To address this issue, consultations and patient care conferences are currently being provided using a telecommunications system to manage patients on dialysis located in communities that do not have a nephrologist, including communities in Texas, where dialysis consultations and assessments using telecommunications are paid under the
State ’ s Medicaid program. Given the claims of a shortage of nephrologists and the new face-to-face visit requirements for physicians managing patients on dialysis, the requestors believe that permitting the management of dialysis patients through telehealth services is crucial. CMS Review The MCP G codes represent a range of services provided during a month, including a complete assessment of the patient and subsequent visits to monitor the patient ’ s condition. We believe the types of services provided as part of the subsequent visits included in the codes are similar to the office and other outpatient visits currently on the list of Medicare telehealth services. Therefore, we believe these services would meet the criteria set forth in Category 1 of the process for adding services described above. However, we do not believe the complete assessment aspect of the MCP G codes is similar to existing telehealth services. For example, one aspect of a complete assessment would involve examination of the vascular access site. This is a specific clinical examination that is not similar to other services on the list.

Therefore, we consider the request for addition of the complete assessment to the list of telehealth services to be a Category 2 request, requiring comparative analyses. In submitting their requests for addition to the list of Medicare telehealth services, the requestors included summaries of many studies related to renal dialysis patient monitoring. However, we do not believe the requestor provided comparative analyses illustrating that the use of a telecommunications system is an adequate substitute for the clinical examination of the vascular access site. We do not believe that the use of a telecommunications system is an adequate method for conducting a complete assessment of the ESRD beneficiary. We believe that a clinical examination of the vascular access site can be adequately performed only with a face-to-face, ‘‘ hands on ’’ examination of the patient.

However, we do believe the subsequent visits meet the criteria for approving a Category 1 request. That is, we believe the roles and interactions between the patient and the physician (or practitioner) are similar to those of office and other outpatient visits currently on the telehealth list. This presents a unique scenario, wherein a portion of the services represented by the MCP G codes are eligible to add to the list, but one service (the complete assessment) is not. To address thisissue, we propose to add the ESRDrelated services with 2 or 3 visits per month and ESRD-related services with 4 or more visits per month as described by G0308, G0309, G0311, G0312, G0314, G0315, G0317, G0318 to the list of Medicare telehealth services. However, the complete assessment of the ESRD


## 47512 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

beneficiary would not be permitted through the use of a telecommunications system. A comprehensive visit including a clinical examination of the vascular access site must be furnished face-to-face ‘‘ hands

on ’’ by a physician, clinical nurse specialist, nurse practitioner, or physician ’ s assistant. An interactive telecommunications system may be used for providing additional visits required under the 2-to-3 visit MCP and the 4-or-more visit MCP.

As noted previously, the MCP G codes are unique in that they reflect the ongoing care provided to ESRD patients by the physician or practitioner, on a monthly basis. These codes also reflect a range of services, from a monthly comprehensive assessment to monitoring the patient ’ s overall condition and addressing individual issues and concerns as they arise during the month. We believe these codes are distinguishable from other codes by the scope of services and the ongoing nature of the services provided. Therefore, we believe that it would be appropriate to permit the use of a telecommunications system for providing some of the visits required under the ESRD MCP and to add these codes to the list of Medicare telehealth services.

The MCP physician, for example, the physician or practitioner who provided the complete assessment, and other practitioners within the same group practice or employed by the sameemployer/entity, may furnish ESRDrelated visits through a telecommunications system. However, the physician or practitioner who performs the complete assessment and establishes the plan of care should bill for the MCP in any given month.

Clinical Criteria

— The complete assessment visit must be conducted face-to-face. For subsequent visits, the physician or practitioner at the distant site is required, at a minimum, to use an interactive audio and video telecommunications system that allows the physician or practitioner to provide medical management services for a maintenance dialysis beneficiary. For example, an ESRD visit conducted via telecommunications system must permit the physician or practitioner at the distant site to perform an assessment of whether the dialysis is working effectively and whether the patient is tolerating the procedure well (physiologically and psychologically). During this assessment, the physician or practitioner at the distant site must be able to determine whether alteration in any aspect of the beneficiary ’ s prescription is indicated, due to such changes as the estimate of the patient ’ s dry weight.

Clarification on originating sites

— The statute currently defines a telehealth originating site as a physician ’ s or practitioner ’ s office, hospital, critical access hospital, rural health clinic, or Federally-qualified health center. ESRD facilities are not originating sites (dialysis facilities are not defined in the statute as originating sites). Subsequent visits (other than the comprehensiveassessment) in any of the statutorilycovered settings could be provided via telecommunications equipment, including a physician ’ s satellite office within a dialysis center. Adding dialysis facilities to the list of Medicare telehealth originating sites would require a legislative change.

Speech and Audiologist Services

The American Speech-Language Hearing Association (ASHA) requested that we add 36 audiology services (CPT code range 92541 through 92596) and 30 speech language pathology (SLP) services (CPT code range 31575 through 97703) to the list of Medicare telehealth services. The ASHA believes the cognitive nature of these services makes them well-suited for telehealth and noted several telehealth programs that have been successful at providing SLP and audiology services. For example, existing telehealth networks were cited as successfully providing diagnosis, treatment, and management recommendations for patients with speech language and hearing disorders.

CMS Review

Speech language pathologists and audiologists are not permitted under current law to provide and receive payment for Medicare telehealth services at the distant site. The statute permits only a physician, as defined by section 1861(r) of the Act or a practitioner as described in section 1842(b)(18)(C) of the Act (clinical nurse specialist, nurse practitioner, physician assistant, nurse midwife, clinical psychologist, and clinical social worker), to furnish Medicare telehealth services. We are exploring this issue as part of a report to Congress (required by section 223(d) of BIPA) on additional sites and settings, geographic areas, and practitioners that may be reimbursed for the provision of telehealth services. At this time, we are not adding speech and audiology services to the list of Medicare telehealth services. Case Management and Care Plan Oversight (Team Conferences and Physician Supervision)

Two requests were submitted asking that we add medical team conferences as identified by CPT codes 99361 and 99362 and physician supervision (CPT codes 99374 and 99375) as telehealth services. Requestors stated that for these services, the use of a telecommunications system provides interdisciplinary medical teams serving remote underserved populations better access to the clinical expertise and decision making of specialty physicians. The requestors note that the current list of Medicare telehealth services, for example, consultations or office visits, cannot be used for case management and care plan oversight services because the patient is not typically present.

CMS Review

Medical team conferences and monthly physician supervision are already covered Medicare services and do not require a face-to-face encounter with the beneficiary. Under the Medicare program, the use of a telecommunications system in furnishing a telehealth service is a substitution for the face-to-face requirements of a service. Since medical team conferences and monthly physician supervision do not require a face-to-face encounter with the patient, we cannot add these services to the list of Medicare telehealth services.

Review Summary

For the reasons stated above, we propose to add ESRD-related services as described by G0308, G0309, G0311, G0312, G0314, G0315, G0317 and G0318 to the list of Medicare telehealth
services.

Moreover, we would add the term

‘‘ ESRD-related visits ’’ to the definition of Medicare telehealth services at CFR 410.78 and 414.65 as appropriate.

We do not propose to add any additional services discussed above to the list of Medicare telehealth services for CY 2005.
3. National Pricing of G0238 and G0239 Respiratory Therapy Service Codes [If you choose to comment on issues in this section, please include the caption

‘‘ CODING

— RESPIRATORY THERAPY ’’ at the beginning of your comments.]

In the 2001 final rule, we created three G codes for respiratory therapy
services: G0237 Therapeutic procedures to increase strength orendurance of respiratory muscles, faceto-face, one-on-one, each 15 minutes (includes monitoring), G0238 Therapeutic procedures to improve


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respiratory function, other than onesdescribed by G0237, one-on-one, faceto-face, per 15 minutes (includes monitoring) and G0239 Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring).

We assigned RVUs to one of the codes (G0237), and indicated that the other two codes (G0238 and G0239) would be carrier-priced. Since the services represented by these codes are frequently being performed in comprehensive outpatient rehabilitation facilities, and paid under the physician fee schedule through fiscal intermediaries, there has been some uncertainty surrounding the payment for the carrier-priced services. We believe assigning RVUs to G0238 and G0239 would alleviate some of this uncertainty. Since these services are typically performed by respiratory therapists, no physician work was assigned to G0237, and we are not proposing work RVUs for either G0238
or G0239.

Therefore, we are proposing to value these services using the nonphysician workpool.

We propose practice expense RVUS for G0238 equal to those for G0237. While these codes represent two different types of activities (G0237 involves therapeutic procedures specifically targeted at improving the strength and endurance of respiratory muscles such as pursed-lip breathing, diaphragmatic breathing, and paced breathing, and G0238 involves other activities such as teaching patients strategies for performing tasks with less respiratory effort and the performance of graded activity programs to increase endurance and strength of upper and lower extremities), we believe that the practice expense involved is substantially the same for both services and thus, propose to crosswalk the practice expense RVUs for G0237 to
G0238.

G0239 represents situations in which two or more individuals are receiving services simultaneously (such as those described above in G0237 or G0238) during the same time period. Although the practitioner must be in constant attendance, he or she need not be providing one-on-one patient contact. For G0239, we believe a typical group session to be 30 minutes in length and to consist of 3 patients. Therefore, for the practice expense RVUs for G0239, we will use the practice expense RVUs of G0237 reduced by one-third to account for the fact that the service is being provided to more than one patient simultaneously and each patient in a group can be billed for the services of
G0239.

We also propose a malpractice RVU of 0.02, the malpractice RVU assigned to G0237, for these two G codes.
4. Bone Marrow Aspiration and Biopsy Through the Same Incision on the Same Date of Service [If you choose to comment on issues in this section, please include the caption

‘‘ CODING

— BONE MARROW ASPIRATION ’’ at the beginning of your comments.]

In the physician fee schedule final rule published on June 28, 2002 (67 FR 43864), we proposed creation of a new G-code that reflects a bone marrow biopsy and aspiration procedure performed on the same date, at the same encounter, through the same incision. While some commenters were supportive of this proposal, othercommenters felt that creation of a Gcode was unnecessary and that any concerns with respect to payment could be addressed through application of the multiple procedure payment rules. In a final rule published on December 31, 2002 (67 FR 79992), we agreed that the code should go through the CPT process and did not make our proposal final.

To date, CPT has not addressed the issue. Therefore, we are proposing to create a G-code for this service in 2005. We believe that there is minimal incremental work associated with performing the second procedure through the same incision during a single encounter and are proposing an add-on G-code to reflect the additional physician work and practice expense. As we had stated in our previous proposal, if the two procedures, aspiration and biopsy, are performed at different sites (for example, contralateral iliac crests, sternum/iliac crest or two separate incisions on the same iliac crest), the

– 59 modifier, which denotes a distinct procedural service, would be appropriate to use and Medicare ’ s multiple procedure rules would apply. In this instance, the CPT codes for aspiration and biopsy would each be used.
G0XX1: Bone Marrow Aspiration Performed With Bone Marrow Biopsy Through Same Incision on Same Date of Service, Add-On

The code would be used when a bone marrow aspiration and a bone marrow biopsy are performed on the same day through a single incision. The physician would use the CPT code for bone marrow biopsy (38221) and G0XX1 for the second procedure ( bone marrow aspiration ). Based on our estimation that the time associated with this G-code is approximately 5 minutes and based on a comparison to CPT code 38220 which has 34 minutes of intraservice time and a work RVU of 1.08 work, we are proposing 0.16 work RVUs for this proposed G-code. The proposed malpractice RVUs are 0.04 which are the current malpractice RVUS assigned to CPT code 38220. We are proposing the following practice expense inputs:

— Clinical staff time: Registered nurse

— 5 minutes Lab technician

— 2 minutes

— Equipment: Exam table

We are also proposing a ZZZ global period for this add-on code since this code is related to another service and is included in the global period of the other service.
5. Q Code for the Set-Up of Portable XRay Equipment

The Q-code for the set-up of portable x-ray equipment, Q0092, is currently paid under the physician fee schedule and is assigned an RVU of 0.33. In 2004, this produces a national payment of $12.32. This set-up code encompasses only a portion of the resources required to provide a portable x-ray service to patients. In 2003, portable x-ray suppliers received total Medicare payments of approximately $208 million. More than half of these payments (approximately $116 million) were for portable x-ray transportation (codes R0070 and R0075). The portable x-ray set-up code (Q0092) generated approximately $19 million in payments. The remainder of the Medicare payments for portable x-ray services (approximately $73 million) were for the actual x-ray services themselves.

Between 2002 and 2004, the Medicare carriers increased the average amount paid for portable x-ray transportation across the country from about $89 to $112, an increase of about 25 percent (transportation is carrier-priced). Nonetheless, the Conference Report accompanying the Consolidated Appropriations Bill, HR 2673 (Pub. L.

108

– 199, enacted January 23, 2004), urged the Secretary to review and update the RVUs for Q0092 utilizing existing data.

In 2002, the National Association of Portable X-ray Providers had requested that we use their cost data to develop practice expense RVUs for the physician fee schedule services they provide. We asked the Lewin Group to evaluate the data using the same standards of review applied to other specialty survey data. The Lewin Group found that the data as presented were not adequately detailed


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to calculate a practice expense per hour based on the current practice expense methodology. Therefore, we did not use the data. However, in response to ongoing requests from the portable x-ray industry that we reexamine payments for this code, we have reevaluated this code.

This code is currently priced in the nonphysician work pool. Removing this code from the nonphysician work pool has an overall negative impact on payments to portable x-ray suppliers (as a result of decreases to radiology codes that remain in the nonphysician work pool) and has a negative impact on many of the codes remaining in the nonphysician workpool. An alternativeto national pricing of portable x-ray setup would be to require Medicare carriers to develop local pricing as they do currently for portable x-ray transportation. In 2002, we received acomment from a supplier of portable xrays stating that the practice costs associated with set-up of portable x-ray equipment are not included in the Socioeconomic Monitoring System (SMS) and that there are sufficient differences among geographic regions in the performance of this procedure that warrant reclassifying this service as carrier-priced. We are interested in public comments on whether we shouldpursue national pricing for portable xray set-up outside of the nonphysician work pool or local carrier pricing for 2005 or whether we should continue to price the service in the nonphysician workpool.
6. Venous Mapping for Hemodialysis

We are proposing to create a new Gcode (G0XX3: Venous mapping for hemodialysis access placement (Service to be performed by operating surgeon for preoperative venous mapping prior to creation of a hemodialysis access conduit using an autogenous graft). Autogenous grafts have longer patency rates, a lower incidence of infection and greater durability than prosthetic grafts. Use of autogenous grafts can also result in a decrease in hospitalizations and morbidity related to vascular access complications. Creation of this G-code will enable us to distinguish between CPT code 93971 ( Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study ) and G0XX3. This new code will allow us to track use of venous mapping for quality improvement purposes.

This G code would only be billed by the operating surgeon in conjunction with the following CPT codes: 36819, 36821, 36825, and 36832. Because CPT code 93971 and the new G-code would be used to describe a similar service, we would propose that we not permit payment for CPT code 93971 when this G-code is billed, unless code 93971 were being performed for a separately identifiable clinical indication in a different anatomic region.

The physician work, practice expense and professional liability expense for this new G code would be the same as those for CPT code 93971. Thus, we propose to crosswalk the RVUs for the new G-code from those of CPT code 93971. We would also assign this new G-code a global period of ‘‘ XXX ’’ , which means that the global concept does not apply.

III. Provisions of the Medicare Modernization Act of 2003

A. Section 611—Initial Preventive Physical Examination

[If you choose to comment on issues in this section, please include the caption

‘‘ Section 611 ’’ at the beginning of your comments.]
1. Coverage of Initial Preventive Physical Examinations

Section 611 of the MMA provides for coverage under Part B of an initial preventive physical examination for new beneficiaries, effective for services furnished on or after January 1, 2005, subject to certain eligibility and other limitations.

Previously, Medicare law had not allowed for payment 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 have interpreted section 1862(a)(1)(A) of the Act to exclude coverage for preventive physical examinations. This section provides that items and 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.

To conform the regulations to the MMA, we are specifying an exception to the list of examples of routine physical examinations excluded from coverage in § 411.15(a)(1) and § 411.15(k)(11) for initial preventive physical examinations that meet the eligibility limitation and the conditions for coverage that we are specifying under § 410.16

— Initial Preventive Physical Examinations.

Coverage of initial preventive physical examinations is provided under Medicare Part B only. The MMA permits payment for one initial preventive physical examination within the first 6 months after the effective date of the beneficiary ’ s first Part B coverage period, but only if that coverage period begins on or after January 1, 2005.

We are proposing to add § 410.16(b), Condition for Coverage of Initial Preventive Physical Examinations, and § 410.16(c), Limitation on Coverage of Initial Preventive Physical Examinations, to provide for coverage of the various initial preventive physical examination services specified in the

statute.

We are proposing to define several terms, as described specifically in § 410.16, that would be used in implementing the statutory provisions, including definitions of the following

terms

—

(1) Eligible beneficiary; (2) An initial preventive physical examination;

(3) Medical history; (4) Physician; (5) Qualified nonphysician practitioner.

(6) Social history; (7) Review of the individual ’ s functional ability and level of safety;

Section 611 of the MMA defines an

‘‘ initial preventive physical
examination ’’ to mean physicians ’ and certain qualified nonphysician practitioners ’ services consisting of

— (1) A physical examination (including measurement of height, weight, blood pressure, and an electrocardiogram, but excluding clinical laboratory tests) with the goal of health promotion and disease detection; and

(2) Education, counseling, and referral with respect to screening and other covered preventive benefits separately authorized under Medicare Part B.

Specifically, section 611(b) of the MMA provides that the education, counseling, and referral of the individual by the physician or other qualified nonphysician practitioner should be with respect to the following statutory screening and other preventive services authorized under Medicare Part
B: (1) Pneumococcal, influenza, and hepatitis B vaccine and their administration.

(2) Screening mammography. (3) Screening pap smear and screening pelvic exam services.

(4) Prostate cancer screening services. (5) Colorectal cancer screening tests.(6) Diabetes outpatient selfmanagement training services;


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(7) Bone mass measurements. (8) Screening for glaucoma. (9) Medical nutrition therapy services for individuals with diabetes or renal disease.

(10) Cardiovascular screening blood

tests.

(11) Diabetes screening tests. Based on the language of the statute, our review of the medical literature, current clinical practice guidelines, and United States Preventive Services Task Force recommendations, we are proposing to interpret the term, ‘‘ initial preventive physical examination, ’’ for purposes of this new benefit to include all of the following:

(1) Review of the individual ’ s comprehensive medical and social history, as those terms are defined in paragraph (a) of proposed § 410.16.

(2) Review of the individual ’ s potential (risk factors) for depression (including past experiences with depression or other mood disorders) based on the use of an appropriate screening instrument which the physician or other qualified nonphysician practitioner may select from various available standardized screening tests for this purpose, unless the appropriate screening instrument is defined through the national coverage determination (NCD) process.

(3) Review of the individual ’ s functional ability and level of safety, as described in paragraph (a) of proposed § 410.16, (that is, at a minimum, a review of the following areas: hearing impairment, activities of daily living, falls risk, and home safety), based on the use of an appropriate screening instrument, which the physician or other qualified nonphysician practitioner may select from various available standardized screening tests for this purpose, unless the appropriate screening instrument is further defined through the NCD process.

(4) An examination to include measurement of the individual ’ s height, weight, blood pressure, a visual acuity screen, and other factors as deemed appropriate by the physician or qualified nonphysician practitioner, based on the individual ’ s comprehensive medical and social history and current clinical standards.

(5) Performance and interpretation of an electrocardiogram.

(6) Education, counseling, and referral, as appropriate, based on the results of the previous five elements of the initial preventive physical
examination.

(7) Education, counseling, and referral, including a written plan provided to the individual for obtaining the appropriate screening and other preventive services, which are separately covered under Medicare Part B benefits; that is, pneumococcal, influenza, and hepatitis B vaccines and their administration, screening mammography, screening pap smear and screening pelvic exams, prostate cancer screening tests, diabetes outpatient self-management training services, bone mass measurements, screening for glaucoma, medical nutrition therapy services, cardiovascular screening blood tests, and diabetes screening tests.

We are requesting public comments on the definition of the term ‘‘ initial preventive physical examination. ’’ For example, we have chosen not to define the term, ‘‘ appropriate screening instrument, ’’ for screening individuals for depression, functional ability, and level of safety, as specified in the proposed rule, because we anticipate that the examining physician or qualified nonphysician practitioner will want to use the test of his or her choice, based on current clinical practice guidelines. We believe that any standardized screening test for depression, functional ability, and level of safety recognized by the American Academy of Family Physicians, theAmerican College of PhysiciansAmerican Society of Internal Medicine, the American College of Preventive Medicine, the American Geriatrics Society, the American Psychiatric Association, or the United States Preventive Services Task Force, or other recognized medical professional group, would be acceptable for purposes of meeting the ‘‘ appropriate screening instrument ’’ provision. We ask that commenters making specific recommendations on this or any related issue provide documentation from the medical literature, current clinical practice guidelines, or the United States Preventive Services Task Force recommendations.

We recognize that the NCD process could be used to define more specifically the type or types of appropriate screening instruments for depression, functional ability, or level of safety and propose to include in § 410.16(a) in elements (2) and (3) of the definition of an initial preventive physical examination a reference that would allow us to define these screening instruments more specifically through the national coverage determination ( ‘‘ NCD ’’ ) process. The NCD process would include an opportunity for public comment on the medical and scientific issues related to the coverage of the new tests that may be brought to our attention in the future. Use of an NCD to establish a change in the scope of benefits is authorized by section 1871(a)(2) of the Act.
2. Payment for Initial Preventive Physical Examination

There is no current CPT code that contains the specific elements included in the initial preventive examination. Therefore, we are proposing to establish the following new HCPCS code, G0XX2, Initial preventive physical examination, to be used for billing for the initial preventive examination. As required by the statute, this code includes an electrocardiogram, but does not include the other previously mentioned preventive services that are currently separately covered and paid under the Medicare Part B screening benefits. When these other preventive services are performed, they should be identified using the existing appropriate codes.
a. Basis for Payment

Payment for this new HCPCS code will be based on the following:

1. Work RVUs

— We are proposing a work value of 1.51 RVUs for G0XX2. This value is based on our determination that this new service has equivalent resources and work intensity to those contained in CPT E/M code
99203, new patient, office or other outpatient visit, and CPT code 93000 electrocardiogram, complete. CPT code 99203 has a work RVU of 1.34 and requires a detailed history, detailed examination, and medical decision making of low complexity, which we believe to be representative of the elements contained in the initial preventive health examination. CPT code 93000, which is for a routine ECG with the interpretation and report, has a work RVU of 0.17.

2. Malpractice RVUs

— For the malpractice component of G0XX2, we are proposing malpractice RVUs of 0.13 in the nonfacility setting based on the malpractice RVUs currently assigned to CPT code 99203 (0.10) and CPT code 93000 (0.03). In the facility setting, we are proposing malpractice RVUs of 0.11 based on the current malpractice RVUs assigned to CPT code 99203 (0.10) and 93010 (an EKG interpretation with a value of 0.01).

3. Practice Expense RVUs

— For the practice expense component of G0XX2, we are proposing practice expense RVUs of 1.65 in the nonfacility setting based on the practice RVUs assigned to CPT code 99203 (1.14) and CPT code 93000 (0.51). In the facility setting, we are proposing practice expense RVUs of 0.54 based on the practice RVUs assigned to CPT code 99203 (0.48) and 93010 (0.06).


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b. Evaluation and Management (E/M)
Service

Since some of the components for a medically necessary E/M visit are reflected in this new HCPCS code, we are also proposing, when it is appropriate, to allow a medically necessary E/M service no greater than a level 2 to be reported at the same visit as the initial preventive physical examination. That portion of the visit must be medically necessary to treat the patient ’ s illness or injury or to improve the function of a malformed body member and should be reported with modifier

– 25. The physician or qualified nonphysician practitioner could also bill for the screening and other preventive services currently covered and paid by Medicare Part B under separate provisions of section 1861 of the Act, if provided during this initial preventive physical examination.

c. Coinsurance and Part B Deductible

MMA did not make any provision for the waiver of the Medicare coinsurance and Part B deductible for the initial preventive physical examination. Payment for this service would be applied to the required deductible, which is $110 for CY 2005, if the deductible has not been met, and the usual coinsurance provisions would apply.

B. Section 613

— Diabetes Screening
Tests [If you choose to comment on issues in this section, please include the caption

‘‘ Section 613 ’’ at the beginning of your comments.]

Section 613 of the MMA adds section 1861(yy) to the Act and mandates coverage of diabetes screening tests.

The term ‘‘ diabetes screening tests ’’ is defined in section 613 as testing furnished to an individual at risk for diabetes including a fasting plasma glucose test and such other tests, and modifications to tests, as the Secretary determines appropriate, in consultation with appropriate organizations. In compliance with this directive, we consulted with the American Diabetes Association, the American Association of Clinical Endocrinologists, and the National Institute for Diabetes and Digestive and Kidney Diseases.

1. Coverage

We are proposing in § 410.18 that Medicare cover

—

• A fasting plasma glucose test; and

• Post-glucose challenge tests; either an oral glucose tolerance test with a glucose challenge of 75 grams of glucosefor nonpregnant adults, or a 2-hour postglucose challenge test alone. We would not include a random serum or plasma glucose for persons with symptoms of uncontrolled diabetes such as excessive thirst or frequent urination in this benefit because it is already covered as a diagnostic service. This language is not intended to exclude other post-glucose challenge tests that may be developed in the future, including panels that may be created to include new diabetes and lipid screening tests. We also would include language that would allow Medicare to cover other diabetes screening tests, subject to a NCD process. We are requesting comments regarding the specific tests, definitions, and eligibility criteria. The comments that we receive will also be used to create the list of billing codes for covered tests and diagnosis codes that would be published in instructions for Medicare

contractors.

The statutory provision describes an

‘‘ individual at risk for diabetes ’’ as having any of the following risk factors:

1. Hypertension. 2. Dyslipidemia. 3. Obesity, defined as a body mass index greater than or equal to 30 kg/m2.

4. Previous identification of an elevated impaired fasting glucose.

5. Previous identification of impaired glucose tolerance.

6. A risk factor consisting of at least two of the following characteristics:

(a) Overweight, defined as a body mass index greater than 25 kg/m2, but less than 30.

(b) A family history of diabetes. (c) A history of gestational diabetes mellitus or delivery of a baby weighing greater than 9 pounds.

(d) 65 years of age or older. The statutory language directs the Secretary to establish standards regarding the frequency of diabetes screening tests that will be covered and limits the frequency to no more than twice within the 12-month period following the date of the most recent diabetes screening test of that individual.

We are proposing that Medicare beneficiaries diagnosed with ‘‘ prediabetes ’’ be eligible for the maximum frequency allowed by the statute, that is, 2 screening tests per 12 month period. We propose to define ‘‘ pre-diabetes ’’ as a previous fasting glucose level of 100

– 125 mg/dL, or a 2-hour post-glucose challenge of 140

– 199 mg/dL. This definition of ‘‘ pre-diabetes ’’ was developed with the assistance of the American Association of Clinical Endocrinologists and complements the definition of diabetes that we published November 7, 2003 (68 FR 63195). We are specifically asking for comments regarding our new definition of ‘‘ prediabetes. ’’ We are also requesting suggestions for the definition of ‘‘ a family history of diabetes. ’’

For individuals not meeting the ‘‘ prediabetes ’’ criteria, we are proposing that one diabetes screening test be covered per individual per year.

2. Payment

We are proposing to pay for the screening diabetes tests at the same amounts paid for these tests when performed to diagnose an individual with signs and symptoms of diabetes. We would pay for these tests under the clinical laboratory fee schedule. We propose to pay for these tests under CPT code 82947 Glucose; quantitative, blood (except reagent strip) and CPT code 82951 Glucose; tolerance test (GTT), three specimens (includes glucose). To indicate that the purpose of the test is for diabetes screening, we would require that the laboratory include a screening diagnosis code in the diagnosis section of the claim. We propose V77.1 Special screening for diabetes mellitus as the applicable ICD

– 9

— CM code for this purpose. Because laboratories are required and accustomed to submitting diagnosis codes when requesting payment for testing, we believe including a screening diagnosis code is appropriate for this benefit.

C. Section 612

— Cardiovascular Screening Blood Tests [If you choose to comment on issues in this section, please include the caption

‘‘ Section 612 ’’ at the beginning of your comments.] Section 612 of the MMA provides for Medicare coverage of cardiovascular screening blood tests for the early detection of cardiovascular disease or abnormalities associated with an elevated risk for that disease effective on or after January 1, 2005.

1. Coverage

The Act requires coverage of tests for cholesterol and other lipid or trigylcerides levels for this purpose. It also authorizes the Secretary to approve coverage of other screening tests for other indications associated with cardiovascular disease or an elevated risk for that disease, including indications measured by noninvasive testing, if the United States Preventive Services Task Force (USPSTF) recommended a blood test for that indication.

We invited comments about the types of tests from the American College of Physicians/ American Society of Internal Medicine, the American College of Cardiology, American Academy of


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Family Physicians, American Heart Association, College of American Pathologists, American Society for Clinical Laboratory Science, American Society for Clinical Pathologists, American Association for Clinical Chemistry, and the American Clinical Laboratory Association. Comments were received from the American Heart Association, American Academy of Family Physicians, the American Association for Clinical Chemistry, American Society for Clinical Laboratory Science, the National Kidney Foundation, and the Vascular Disease Foundation, regarding the coverage of a number of cardiovascular screening tests in addition to the required blood lipid tests; for example, high sensitivity C-Reactive Protein (CRP), homocysteine, or Beta Naturetic Protein (BNP), electrocardiograms, Doppler and noninvasive vascular tests, and a skin reflectance test.

We also reviewed the following 2001 recommendations of the USPSTF regarding screening for lipid disorders that are associated with cardiovascular disease:

a. Clinicians should routinely screen men aged 35 years and older and women aged 45 years and older for lipid disorders and treat abnormal lipids in people who are at increased risk.

b. Clinicians should routinely screen younger adults (men aged 20 to 35 and women aged 20 to 45) for lipid disorders if they have other risk factors for coronary heart disease.

c. No recommendation was made for or against routine screening for lipid disorders in younger adults (men aged 20 to 35 or women aged 20 to 45) in the absence of known risk factors for coronary heart disease.

d. Screening for lipid disorders should include measurement of total cholesterol (TC) and high-density lipoprotein cholesterol (HDL

– C).

e. Evidence is insufficient to recommend for or against trigylcerides measurement as a part of routine screening for lipid disorders.

Based on the statutory language and our review of the scientific literature, expert opinion, and the USPSTF recommendations, we are proposing coverage of the following three screening blood tests for conditions associated with cardiovascular disease:

(1) A total cholesterol test. (2) A cholesterol test for high density lipoproteins.

(3) A triglycerides test. These tests should be performed as part of a panel and should be done after a 12-hour fast. We are also proposing coverage of each of these tests once every 5 years. The statute provides that the Secretary shall establish frequency standards for the coverage of cardiovascular screening blood tests, provided the frequency is no more often than once every 2 years. However, the scientific literature shows that cholesterol levels are fairly stable and do not fluctuate drastically for those older than age 65. The USPSTF clinical considerations indicate that, while screening may be appropriate in older people, repeated screening is less important because lipid levels are less likely to increase after age 65. Under the USPSTF recommendations, routine measurement of total cholesterol and HDL cholesterol every 5 years is recommended by the National Cholesterol Education program Adult Treatment Panel II (ATP II), sponsored by the National Institutes of Health, and endorsed by the American Heart Association. In addition, the most recent Report of the Adult Treatment Panel (ATP III) includes similar recommendations. In all adults aged 20 years or older, a fasting lipoprotein profile (total cholesterol, LDL cholesterol, high density lipoprotein (HDL) cholesterol, and triglyceride) should be obtained once every 5 years. Since the LDL cholesterol can be calculated, the remaining tests, which are part of the lipid panel, are the tests we are proposing for coverage under this new benefit at a 5-year screening interval. We do not believe the evidence justifies or the statute allows for coverage of other cardiovascular screening blood tests at this time.

To facilitate our consideration of future coverage of other new types of cardiovascular screening blood tests, we have decided to add a provision to this proposed regulation that, in addition to the specific cardiovascular screening blood tests proposed for coverage in this proposed rule, would provide that other types of these tests may be covered under this new screening benefit, if we determine that this is appropriate through a National Coverage Determination (NCD). This provision would allow us to conduct a more timely assessment of other new types of cardiovascular screening blood tests that may have been approved for marketing by the Food and Drug Administration and recommended by the USPSTF than is possible under the standard rulemaking process. We intend to use the NCD process, which includes an opportunity for public comments, for evaluating the medical and scientific issues relating to the coverage of additional tests that may be brought to our attention in the future. Use of an NCD to establish a change in the scope of benefits is authorized by section 1871(a)(2) of the Act. These proposed coverage requirements are set forth in
new section § 410.17.
2. Payment

Section 612 of the MMA provides for Medicare coverage of cardiovascular screening blood tests for the early detection of cardiovascular disease or abnormalities associated with an elevated risk for cardiovascular disease. The coverage is effective on or after January 1, 2005. We are proposing to pay for the screening cardiovascular disease tests at the same amounts paid for these tests when they are performed to diagnose an individual with signs and symptoms of cardiovascular disease. Medicare would pay for the tests under the clinical laboratory fee schedule. We propose to use the following CPT codes:

• 82465 Cholesterol, serum or whole blood, total.

• 83718 Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol).

• 84478 Triglycerides.

• 80061 Lipid Panel. To indicate that the purpose of the test is for cardiovascular screening, we propose that the laboratory include in the diagnosis section of the claim the diagnosis code that provides the highest degree of accuracy and completeness in describing the diagnosis. We propose that the applicable ICD

– 9

– CM codes for cardiovascular screening blood tests be selected from the following:

• V81.0 Special screening for ischemic heart disease.

• V81.1 Special screening for Hypertension.

• V81.2 Special screening for other and unspecified cardiovascular conditions.

Because laboratories are required and accustomed to submitting diagnosis codes when requesting payment for testing, we believe including a screening diagnosis code for this purpose will not be unduly burdensome to them.

D. Section 413

— Physician Scarcity Areas and Health Professional Shortage Areas Incentive Payments
[If you choose to comment on issues in this section, please include the caption

‘‘ Section 413 ’’ at the beginning of your comments.]
1. Background

Section 4043 of the Omnibus Budget Reconciliation Act (OBRA) of 1987 added section 1833(m) to the Act to provide incentive payments to physicians who furnish services to


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Medicare beneficiaries in Health Professional Shortage Areas (HPSAs). Under section 1833(m) of the Act, a 5 percent payment was added, beginning January 1, 1989, to the amounts otherwise payable under the physician fee schedule to doctors who furnish covered services to Medicare patients in designated HPSAs. Section 6102 of OBRA 1989 further amended section 1833 of the Act to raise the amount of this incentive payment from 5 percent to 10 percent for services furnished after December 31, 1990. The OBRA 1989 amendment also increased eligible service areas to include both rural and urban HPSAs. The Congress established the HPSA incentive payments as incentives to attract new physicians to medically underserved communities and to encourage physicians in those areas to remain there.

Eligibility for receiving the 10 percent incentive payment is based on whether the specific location at which the service is furnished is within an area that is designated (under section 332(a)(1)(A) of the Public Health Service Act (PHS)) as a HPSA. The Health Resources and Services Administration of the Department of Health and Human Services (HRSA) is responsible for designating shortage areas. HRSA designates several types of HPSAs. Some HPSAs are areas with shortages of primary care physicians, dentists, or psychiatrists. These shortage designations are referred to as geographic-based HPSAs. Also, there are HPSA designations based on underserved populations within an area,which are referred to as populationbased HPSAs.

Section 1833(m) of the Act provides incentive payments for physicians who furnish services in areas designated as HPSAs under section 332(a)(1)(A) of the PHS Act. These include all three types of geographic-based HPSAs (primary medical care, dental, and mental health). Consequently, physicians, including psychiatrists, furnishing services in a primary medical care HPSA are eligible to receive bonus payments. Medicare HPSA bonus payments apply to all physicians who perform covered services within a primary medical care HPSA, regardless of specialty. In addition, psychiatrists furnishing services in mental health HPSAs are eligible to receive incentive payments. We do not recognize dental HPSAs for the Medicare HPSA payment program because Medicare does not cover general dental services for its beneficiaries.

Since the inception of the Medicare HPSA incentive payment program, physicians have been responsible for indicating their eligibility for the incentive payment on the Medicare billing form. To facilitate the verification of eligibility, physicians have been notified by their Medicare carriers when changes (withdrawals, revisions, or replacements) occur in HPSA designations. Using this information from carriers, physicians have been required to verify their eligibility and correctly code their Medicare claims using modifiers (QB for rural HPSAs and QU for urban HPSAs) to receive incentive payments.
2. New Legislation
a. Physician Scarcity Areas

Section 413(a) of the MMA, provides a new 5 percent incentive payment to physicians furnishing services in physician scarcity areas. The MMA adds a new section 1833(u) of the Act which provides for paying primary care physicians furnishing services in a primary care scarcity county and specialty physicians furnishing services in a specialist care scarcity county, an additional amount equal to 5 percent of the amount paid for these services. Eligible physicians furnishing services in an area qualified as a physician scarcity area (PSA) and HPSA would be entitled to receive both incentive payments, that is, a 15 percent bonus payment. Eligibility for receiving both incentive payments is time limited (January 1, 2005 to January 1, 2008) because the 5 percent PSA bonus is scheduled to sunset on December 31,

2007.

The Congress created the new 5 percent incentive payment program to make it easier to recruit and retain both primary and specialist care physicians for furnishing services to Medicare beneficiaries in PSAs.

The two measures of physician scarcity are defined by the statute as follows:

1. The primary care scarcity areas are determined by the ratio of primary care physicians to Medicare beneficiaries.

2. The specialist care scarcity areas are determined by the ratio of specialty care physicians to Medicare beneficiaries.

i. Primary Care

Consistent with section 1833(u) of the Act, we would identify eligible primary care scarcity counties by ranking each county by its ratio of primary care physicians to Medicare beneficiaries. From the list of primary care scarcity counties, only those counties with the lowest primary care ratios that represent 20 percent of the total number of Medicare beneficiaries residing in the counties will be considered eligible for the 5 percent incentive payment. For calculating the ratios, section 1833(u)(6) of the Act, as added by the MMA, defines a primary care physician as a general practitioner, family practice practitioner, general internist, obstetrician, or gynecologist. All other physicians will be considered specialists for purposes of the 5 percent incentive payment. Section 1833(u) of the Act, as added by the MMA, specifically defines ‘‘ physician ’’ as one described in section 1861(r)(1) of the Act. This statutory provision does not include dentists, podiatrists, optometrists, and chiropractors.
ii. Specialist Care

To identify eligible specialist care scarcity areas, we would rank each county by its ratio of specialty physicians to Medicare beneficiaries. From the list of specialist care scarcity counties, only those counties with the lowest ratios that represent 20 percent of the total number of Medicare beneficiaries residing in the counties will be considered eligible for the 5 percent incentive payment.

iii. The Goldsmith Modification

For purposes of counties identified as having a shortage of primary care or specialty care physicians, section 1833(u)(5) of the Act also requires that, to the extent feasible, we treat a rural census tract of a metropolitan statistical area (as determined under the most recent modification of the Goldsmith Modification) as an equivalent area. The Goldsmith modification evolved from an outreach grant program sponsored by the Office of Rural Health Policy of HRSA. This program was created to establish an operational definition of rural populations lacking easy access to health services in Large Area Metropolitan Counties (LAMCs). Dr. Harold F. Goldsmith and his associates created a methodology for identifying rural census tracts located within a large metropolitan county of at least 1,225 square miles. Using a combination of data on population density and commuting patterns, census tracts were identified as being so isolated by distance or physical features that they are more rural than urban in character.
iv. Rural-Urban Commuting Area

The original Goldsmith Modification was developed using data from the 1980 census. In order to more accurately reflect current demographic and geographic characteristics of the nation, the Office of Rural Health Policy, in partnership with the Department of Agriculture ’ s Economic Research


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Service and the University of Washington, developed the Rural-Urban Commuting Area codes (RUCAs). Rather than being limited to LAMCs, RUCAs use urbanization, population density, and daily commuting data to categorize every census tract in the country. RUCAs are the updated version of the Goldsmith Modification and are used to identify rural census tracts in all metropolitan counties.

Once all the full county PSAs are determined, we would identify, consistent with section 1833(u)(4)(C)of the Act, eligible PSAs by their 5-digit zip code area for the purpose of automatically providing the 5 percent incentive payment to eligible physicians. The zip code of the place of service is the only data element reported on the Medicare claim form that would allow automation. For zip codes that cross county boundaries, the statute specifically requires the use of the dominant county of the postal zip code (as determined by the U.S. Postal Service) if the Secretary uses the 5-digit postal zip code to identify areas eligible to receive the 5 percent payment. The statute also requires us to publish a list of eligible areas as part of the proposed and final physician fee schedule rules for the years for which PSAs are identified or revised and to post a list of PSAs on the CMS Website. Lastly, the statute provides no administrative or judicial review under sections 1869 or 1878 of the Act or otherwise, regarding the identification of a county or area, the assignment of a specialty of any physician, the assignment of a physician to a county, or the assignment of a postal ZIP Code to a county or other

area. b. Improvement to Medicare HPSA Incentive Payment Program

In addition to the creation of the 5 percent PSA incentive payment, section 413 of MMA amended section 1833(m) of the Act to mandate that we automate payment of the 10 percent HPSA incentive payment to eligible physicians for full county HPSAs without a requirement for the physician to identify the HPSA involved. When automation is not feasible, consistent with section 1833(m) of the Act as amended by section 413(b) of MMA, we plan to post a list of HPSAs on our website. When automation is not feasible, the billing of modifiers would still be required.

The statute provides for no administrative or judicial review of the identification of a county or area, the assignment of the individual physician ’ s specialty, the assignment of a physician to a county or the assignment of a zip code to a county or area.
3. Provisions Related to Physician Scarcity Areas and HPSA Incentive Payment Program a. Determination of Physician Scarcity
Areas

As the statute prescribes, PSAs for primary care would be determined by the ratio of primary care physicians to the Medicare beneficiaries residing in that county or area. A primary care physician is defined by statute as a general practitioner, family practice practitioner, general internist, obstetrician, or gynecologist. The physician definition for determining primary care PSAs will be based on
HRSA ’ s physician designations for primary medical care HPSAs, which include all of the above physicians. In other words, the PSA definition for primary care will be identical to
HRSA ’ s, except for pediatricians. Furthermore, the statute provides that the primary care ratio include only primary care doctors in the active practice of medicine. Physicians whose practice is exclusively for the Federal Government or who provide only administrative services would not be included in the physician tally. PSAs for specialty care would be determined by the ratio of physicians who are not primary care physicians to the Medicare beneficiaries residing in that county or area. The specialist care PSA ratio would include all physicians other than primary care physicians as defined in the statute. To the extent feasible, we also plan to include rural census tracts of metropolitan statistical areas (as determined under the most recent modification of the Goldsmith Modification), as identified at the zip code level, with sufficiently low physician-to-Medicare population ratios as equivalent to qualified full county scarcity areas. The calculation of physician scarcity ratios is being made by the North Carolina Rural Research and Policy Analysis Center using the most current Medicare beneficiary and physician data available. At this time, the North Carolina Rural Research and Policy Analysis Center can only determine physician scarcity for Goldsmith areas at the zip code level due to the fact that Medicare beneficiary data is currently unavailable at the census tract level.

As previously discussed, section 1833(u) of the Act requires the automation of incentive payments for all PSAs, which we can only achieve by assigning zip codes to eligible areas. We propose the identification of qualified PSAs by zip code for automatic payment as follows:

• For zip codes that fall within a full county PSA, the bonus would be paid automatically.

• For full county PSAs, the dominant county of the 5-digit zip code, as determined by the U.S. Postal Service, would be used when the zip code area is not entirely located within the county. In some cases, a service may be provided in a county that is considered to be a PSA, but the zip code is not considered to be dominant for that area, which would not permit automation of the bonus payment. In order to receive the bonus for those areas, physicians would need to include a new physician scarcity modifier on the claim. We plan to establish and implement the new modifier through the Medicare Claims Processing Manual.

• For partial county PSAs (Goldsmith Modification), all zip code areas that are entirely located within the qualified Goldsmith area and all zip code areas that are partially located within a qualified Goldsmith area as long as the majority (51 percent) of the population located within the zip code area resides in the qualified Goldsmith area would be able to receive automatic payment.

Due to the complex nature of processing available physician and Medicare beneficiary data into a usable format to identify counties and areas with the lowest ratios, we cannot make available a list of PSAs within this proposed rule. We are working closely with HRSA and its contractors to publish these lists in the physician fee schedule final rule.
b. Incentive Payments for Physician Scarcity Areas

Similar to the Medicare HPSA bonus payment program, eligibility for receiving the 5 percent bonus payment would be based on whether the specific location at which the service is furnished is within an area that is designated as a PSA. Furthermore, the statute requires us to restrict eligibility for receiving the incentive payments for physicians ’ services furnished within primary care PSAs to general practitioners, family practice practitioners, general internists, obstetricians, or gynecologists. Also prescribed by statute, dentists, podiatrists, optometrists, and chiropractors are not eligible to receive incentive payments for PSAs. Section 1833(u) of the Act specifically defines a physician as one described in section 1861(r)(1) of the Act, which does not include dentists, podiatrists, optometrists, and chiropractors.


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To conform our regulations to the statute, we are proposing to add § 414.66 to provide a 5 percent incentive payment to eligible physicians furnishing covered services in eligible PSAs. We propose to add § 414.66(a)(1) to specify that primary care physicians furnishing services in primary care PSAs are entitled to an additional 5 percent incentive payment above the amount paid under the physician fee schedule for their professional services furnished on or after January 1, 2005, and before January 1, 2008. The new incentive payment would apply to the professional services performed by physicians, including evaluation and management, surgery, consultation, and home, office and institutional visits. The technical component of physicians ’ services is not eligible because this component is not included in the definition of physicians ’ services at section 1861(q) of the Act as applied by the MMA. We are also proposing to add § 414.66(b) to specify that physicians, other than primary care physicians, dentists, podiatrists, optometrists, and chiropractors, furnishing services in specialist care PSAs are entitled to an additional 5 percent payment above the amount paid under the physician fee schedule for their professional services furnished on or after January 1, 2005, and before January 1, 2008.
c. Improvement to Medicare HPSA Incentive Payment Program

As of January 1, 2005, most physicians eligible for the 10 percent HPSA incentive payment would no longer be required to determine whether their service areas are eligible for incentive payments and to modify their claims to receive those payments. The MMA requires us to automate bonus payments for physicians ’ services furnished in full county HPSAs.

Automation of full county HPSA incentive payments involves the same issues of automation as PSA incentive payments: the zip code of the place of service is the only data element reported on the claim form that would allow automation. Similarly, zip codes need to be cross-walked to full county HPSAs. The statute allows use of the same method of automation of incentive payments for full county HPSAs as for full county PSAs. We are proposing the identification of HPSAs by zip code for automatic payment as follows:

• For zip codes that fall entirely within a full or partial county HPSA, the bonus would be paid automatically.

• When the zip code area is not entirely located within the full county HPSA, only the dominant county of the 5-digit zip code as determined by the U.S. Postal Service would be used for automatically paying the HPSA incentive payment.

• For all other zip code areas that are not entirely, but are to some extent, located within a designated HPSA (full county or partial), we would require physicians furnishing services in these areas to bill for the incentive payments by using the appropriate modifier on their Medicare claims. We propose to post on our website, prior to January 1, 2005, a list of zip codes that fully fall within a designated HPSA and a list of zip codes that partially fall within a designated HPSA, so that physicians can determine whether they would need to bill using a modifier.

Determination of zip codes eligible for automatic HPSA bonus payment would be made on an annual basis, and there would not be any mid-year updates. We would effectuate mid-year revisions made to designations by HRSA the following year for automatic bonus payment purposes.
d. Medicare HPSA Incentive Payments

The Medicare HPSA Incentive Payment program, which the Congress established under OBRA 1987, was implemented through the Medicare Claims Processing Manual. This proposed rule would create § 414.67 to conform the regulations to the law, as amended by OBRA 1987 and 1989.

We propose in § 414.67 to provide a 10 percent incentive payment to eligible physicians furnishing covered services in eligible HPSAs. Section 414.67(a) would specify that physicians, regardless of specialty, furnishing services in a primary medical care HPSA are entitled to a 10 percent incentive payment above the amount paid for their professional services under the physician fee schedule. We would also create § 414.67(c) to specify that psychiatrists furnishing services in a mental health HPSA are entitled to a 10 percent incentive payment above the amount paid for their professional services under the physician fee schedule. Psychiatrists furnishing services in mental health HPSAs that do not overlap with primary care HPSAs are the only physicians eligible to receive the 10 percent incentive payment in those areas. In other words, these stand-alone mental health HPSAs are eligible areas for psychiatrists only to receive incentive payments.

E. Section 303

— Payment Reform for Covered Outpatient Drugs and Biologicals
[If you choose to comment on issues in this section, please include the caption ‘‘ Section 303 ’’ at the beginning of your comments.]
1. Average Sales Price (ASP) Payment Methodology
a. Background

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. Medicare Part B covered drugs generally fall into the following three categories:

• Drugs furnished incident to a physician ’ s service.

• Durable medical equipment (DME) drugs.

• Drugs specifically covered by statute (for example, immunosuppressive drugs).

Section 303(c) of the MMA revises the payment methodology for Part B covered drugs that are not paid on a cost or prospective payment basis. In particular, section 303(c) of the MMA amends Title XVIII of the Act by adding section 1847A. Beginning in 2005, section 1847A of the Act establishes a new ASP drug payment system. In 2005, almost all Medicare Part B drugs not paid on a cost or prospective payment basis will be paid under this system.

The new ASP drug payment system is based on data submitted to us quarterly by manufacturers. For calendar quarters beginning on or after January 1, 2004, the statute requires manufacturers to report their ASP data to us for almost all Medicare Part B drugs not paid on a cost or prospective payment basis. Manufacturers ’ submissions are due to us not later than 30 days after the last day of each calendar quarter.

For further information on the submission of manufacturers ’ ASP data, see the interim final rule titled

‘‘ Manufacturer Submission of Manufacturer ’ s Average Sales Price (ASP) Data for Medicare Part B Drugs and Biologicals ’ published in the Federal Register on April 6, 2004 (69 FR 17935). It is accessible on the CMS Web
site at http://www.cms.hhs.gov/ providers/drugs/default.asp.

The methodology for developing Medicare drug payment allowances based on the manufacturer ’ s submitted ASP data is described in this proposed rule and reflected in proposed revisions to the regulations at § 405.517 and new Subpart K in part 414.
b. Provisions of the Proposed Rule
i. The ASP Methodology

Beginning in 2005, section 1847A of the Act establishes an ASP payment system for certain drugs and biologicals


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not paid on a cost or prospective payment basis furnished on or after January 1, 2005. The most notable exceptions are described below in sections III.E.1.c through III.E.1.e.

ii. Calculation of ASP

As described in section 1847A(b)(3)(A) of the Act for multiple source drugs and section 1847A(b)(4)(A) for single source drugs, the ASP for all drug products included within the same billing and payment code [or HCPCS code] is the volume-weighted average of the manufacturer ’ s average sales prices reported to us across all the NDCs assigned to the HCPCS code. Specifically, section 1847A(b)(3)(A) of the Act and section 1847A(b)(4)(A) of the Act require that this amount be determined by

—

• Computing the sum of the products (for each National Drug Code assigned to those drug products) of the manufacturer ’ s average sales price and the total number of units sold; and

• Dividing that sum by the sum of the total number of units sold for all NDCs assigned to those drug products.

Note that in the following discussions, the term ‘‘ manufacturer ’ s ASP ’’ refers to the ASP data submitted to us by manufacturers at the NDC level and the term ‘‘ ASP ’’ used in isolation refers to the weighted average sales price for all drug products included within the HCPCS [billing and payment] code.

Section 1847A(b)(5) of the Act requires that the ASP be determined without regard to any special packaging, labeling, or identifiers on the dosage form or product or package.
iii. Medicare Payment Allowances for Multiple Source Drugs

Section 1847A(b)(1)(A) of the Act requires that the Medicare payment allowance for a multiple source drug included within the same HCPCS code be equal to 106 percent of the ASP for the HCPCS code. This payment allowance is subject to applicable deductible and coinsurance. The payment limit is also subject to the two limitations described below in section III.E.1.b.v of this preamble concerning widely available market prices and average manufacturer prices in the Medicaid drug rebate program. As described in section 1847A(e) of the Act, the payment limit may also be adjusted in response to a public health emergency under section 319 of the Public Health Service Act in which there is a documented inability to access drugs and a concomitant increase in the price of the drug which is not reflected in the manufacturer ’ s average sales price.
iv. Medicare Payment Allowances for Single Source Drugs

Section 1847A(b)(1)(B) of the Act requires that the Medicare payment allowance for a single source drug HCPCS code be equal to the lesser of 106 percent of the average sales price for the HCPCS code or 106 percent of the wholesale acquisition cost of the HCPCS code. This payment allowance is subject to applicable deductible and coinsurance. The payment limit is also subject to the two limitations described below in section III.E.1.b.v concerning widely available market prices and average manufacturer prices in the Medicaid drug rebate program. As described in section 1847A(e) of the Act, the payment limit may also be adjusted in response to a public health emergency under section 319 of the Public Health Service Act.

It has been brought to our attention that some physicians have concerns about their ability to purchase drugs at the Medicare payment amount of 106 percent of the ASP as these physicians believe that they are small purchasers of the Medicare Part B drugs subject to this proposed rule and do not have access to the average discounts. It is our understanding that many physicians are members of purchasing groups, which do obtain discounts on drugs. We encourage physicians to consider participating in such groups in order to achieve advantageous prices. We are interested in comments regarding the extent to which physicians can become members of such buying groups and the possible effects of doing so.

v. Limitations on ASP

Section 1847A(d)(1) of the Act states that ‘‘ The Inspector General of the Department of Health and Human Services shall conduct studies, which may include surveys, to determine the widely available market prices 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 average sales price under this section for drugs and biologicals with

—

• The widely available market price for such drugs and biologicals (if any); and

• The average manufacturer price (as determined under section 1927(k)(1)) for such drugs and biologicals. ’’ Section 1847A(d)(3) of the Act states that ‘‘ The Secretary may disregard the average sales price for a drug or biological that exceeds the widely available market price or the average manufacturer price for such drug or biological by the applicable threshold percentage (as defined in subparagraph (B)). ’’ Section 1847A(d)(3)(B) states that

‘‘ the term ‘ applicable threshold percentage ’ means

—

• In 2005, in the case of an average sales price for a drug or biological that exceeds widely available market price or the average manufacturer price, 5 percent; and

• In 2006 and subsequent years, the percentage applied under this subparagraph subject to such adjustment as the Secretary may specify for the widely available market price or the average manufacturer price, or both. ’’

Section 1847A(d)(3)(C) of the Act states that ‘‘ If the Inspector General finds that the average sales price for a drug or biological exceeds such widely available market price or average manufacturer price for such drug or biological by the applicable threshold percentage, the Inspector General shall inform the Secretary (at such times as the Secretary may specify to carry out this subparagraph) and the Secretary shall, effective as of the next quarter, substitute for the amount of payment otherwise determined under this section for such drug or biological the lesser of

—

• The widely available market price for the drug or biological (if any); or

• 103 percent of the average manufacturer price (as determined under section 1927(k)(1)) for the drug or biological. ’’
vi. Payment Methodology in Cases Where the Average Sales Price During the First Quarter of Sales Is Unavailable

Section 1847A(c)(4) of the Act states that ‘‘ In the case of a drug or biological during an initial period (not to exceed a full calendar quarter) in which data on the prices for sales for the drug or biological is not sufficiently available from the manufacturer to compute an average sales price for the drug or biological, the Secretary may determine the amount payable under this section for the drug or biological based on

—

• The wholesale acquisition cost; or

• The methodologies in effect under this part on November 1, 2003, to determine payment amounts for drugs or biologicals. ’’


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c. Payment for Influenza, Pneumococcal, and Hepatitis B
Vaccines

Section 1841(o)(1)(A)(iv) of the Act requires that influenza, pneumococcal, and hepatitis B vaccines described in subparagraph (A) or (B) of section 1861(s)(10) of the Act be paid based on 95 percent of the average wholesale price (AWP) of the drug. These AWP payments, which will be updated quarterly, have not been revised by the ASP provisions.
d. Payment for Drugs Furnished During 2005 in Connection With the Furnishing of Renal Dialysis Services if Separately Billed by Renal Dialysis Facilities.

Section 1881(b)(13)(A)(ii) of the Act indicates that payment for a drug furnished during 2005 in connection with the furnishing of renal dialysis services, if separately billed by renal dialysis facilities, will be based on the acquisition cost of the drug as determined by the Inspector General (IG) report to the Secretary required by section 623(c) of the MMA or, insofar as the IG has not determined the acquisition cost with respect to a drug, the Secretary shall determine the payment amount for the drug. In the report, ‘‘ Medicare Reimbursement for Existing End-Stage Renal Disease Drugs, ’’ the IG found that, on average, in 2003 the four largest chains had drug acquisition costs that were 6 percent lower than the ASP of 10 of the top drugs, including erythropoietin. A sample of the remaining independent facilities had acquisition costs that were 4 percent above the ASP. Based on this information, the overall weighted average drug acquisition cost for renal dialysis facilities is 3 percent lower than the ASP. Therefore, payment for a drug or biological furnished during 2005 in connection with renal dialysis services and separately billed by renal dialysis facilities will be based on the ASP of the drug minus 3 percent. This will be updated quarterly based on the ASP reported to us by drug manufacturers.

e. Payment for Infusion Drugs Furnished Through an Item of DME

In 2005, section 1841(o)(1)(D)(i) of the Act requires an infusion drug furnished through an item of DME covered under section 1861(n) of the Act be paid 95 percent of the average wholesale price for that drug in effect on October 1,

2003. 2. Provisions for Appropriate Reporting and Billing for Physicians ’ Services Associated With the Administration of Covered Outpatient Drugs

Section 1848(c)(2)(J) of the Act (as added by section 303(a) of the MMA) requires the Secretary to promptly evaluate existing drug administration codes for physicians ’ services to ensure accurate reporting and billing for those services, taking into account levels of complexity of the administration and resource consumption. According to section 1848(c)(2)(B)(iv) of the Act (also as amended by section 303(a) of the MMA), any changes in expenditures in 2005 or 2006 resulting from this review are exempt from the budget neutrality requirement of section 1848(c)(2)(B)(ii) of the Act. The statute further indicates that the Secretary shall use existing processes for the consideration of coding changes and, to the extent changes are made, shall use those processes to establish relative values for those services. The Secretary is also required to consult with physician specialties affected by the provisions that change Medicare payments for drugs and drug administration.

In the January 7, 2004 interim final rule with comment (69 FR 1094), we indicated that the Physicians Regulatory Issues Team (PRIT) will review Medicare payment policy for drug administration and that we plan to consult with the AMA ’ s CPT Editorial Panel and physician specialties affected by changes in payment for drugs and drug administration. We requested that the CPT Editorial Panel review all codes related to the administration of drugs and consider whether any revisions or additional codes are needed. At its February 2004 meeting, the CPT Editorial Panel established a workgroup, with representatives from affected specialties, to make recommendations on drug administration coding to the full Panel. In addition, the workgroup will be reviewing issues related to drug administration that were identified in the public comments on the January 7, 2004 Physician Fee Schedule rule. These comments raised the following two major issues:

1. Can the current coding distinction between chemotherapy and nonchemotherapy infusions allow for recognition of the resources needed to administer drugs with high toxicity or potential for serious side effects for diagnoses other than cancer? If not, are code revisions or new codes needed?

2. Does the current coding for chemotherapy administration capture all the support services provided by oncology practices for chemotherapy patients? If not, are code revisions or new codes such as a cancer management code needed?

There were also a number of specific comments on individual codes raised by some specialties such as urology and ophthalmology. On June 21, 2004, the workgroup held a public meeting to receive input and comments about drug administration code changes under consideration. The workgroup is expected to report to the full CPT Editorial Panel on all these issues at its August 2004 meeting. Once we review the CPT Editorial Panel ’ s work on this issue, we will consider whether it is necessary for us to make coding changes effective January 1, 2005 through the use of G codes, since the 2005 CPT book will already have been published. While the CPT Editorial Panel ’ s work on this issue is important to us, we finally determine coding policy for Medicare; we also would welcome public comments on these issues. We would also welcome comments concerning any alternative methods of allocating practice expenses to the drug administration codes. ( See section II.A.2. of this proposed rule for a discussion of allocation of practice expenses.) If coding changes are to be made for next year, we would announce them in the physician fee schedule final rule effective January 1, 2005.

We also plan to analyze any shift or change in utilization patterns once the payment changes for drugs and drug administration required by MMA go into effect. While we do not believe the changes will result in access problems, we plan to continue studying this issue. We also note that the MMA requires the Medicare Payment Advisory Commission (MedPAC) to study items and services furnished by oncologists and drug administration services furnished by other specialties.
3. Blood Clotting Factor

— Section 303(e)(1)

— Items and Services Relating to Furnishing of Blood Clotting Factors

For clotting factors furnished on or after January 1, 2005, we propose to establish a separate payment of $0.05 per unit to hemophilia treatment centers and homecare companies for the items and services associated with the furnishing of blood clotting factor.

Section 303(e)(1) of the MMA requires the Secretary, after review of the January 2003 report to the Congress by the Comptroller General of the United States, to establish a separate payment to hemophilia treatment centers and homecare companies for the items and services associated with the furnishing of blood clotting factor. In the proposed rule, Payment Reform for Part B Drugs


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(68 FR 50440), published in the Federal Register on August 20, 2003, we indicated that we are proposing to create a payment of $0.05 per unit of clotting factor provided to Medicare beneficiaries by hemophilia treatment centers and homecare companies to appropriately pay for the administrative costs associated with furnishing the clotting factor. We did not propose the creation of separate payment for furnishing the clotting factor for individuals or entities other than hemophilia treatment centers and homecare companies.

We received comments from hemophilia organizations and specialty pharmacy providers of blood clotting factor. Most comments questioned our position to create a separate payment of $0.05 per unit, stating that this amount would jeopardize the ability of these facilities to adequately supply the clotting factor. Commenters were concerned that the $0.05 amount was too low and would cause many entities to discontinue providing the clotting factors and severely impact beneficiaries ’ access to clotting factor.

Based on a review of the General Accounting Office (GAO) report and data received from various clotting factor providers, we believe a separate payment amount of $0.05 per unit would cover the administrative costs associated with supplying the clotting factor. As outlined in the MMA, any separate payment amount established may include the mixing and delivery of factors, including special inventory management and storage requirements, as well as ancillary supplies and patienttraining necessary for the selfadministration of these factors. The MMA states that, in determining the separate payment, the total amount of payments and these separate payments shall not exceed the total amount of payments that would have been made for the factors if the amendments in section 303 of the MMA had not been enacted. As indicated in the GAO report, ‘‘ [w]hen Medicare ’ s payment for clotting factor more closely reflects acquisition costs, we recommend that the Administrator establish a separate payment for providers based on the costs of delivering clotting factor to Medicare beneficiaries. Effective January 1, 2005, payment for blood clotting factors will more closely reflect acquisition costs as payment will be based on the average sales price as reported by drug manufacturers plus 6 percent. ’’

Therefore, in the absence of additional data, we believe that a separate payment amount of $0.05 per unit for the cost of delivering clotting factor is an appropriate amount beginning CY 2005 and we are proposing revisions to § 410.63 to reflect this amount. However, we are also seeking updated data and comments on the GAO report, as well as information on the fixed and variable costs of furnishing clotting factor. We recognize that there may be alternatives to a fee, which varies entirely based on the number of units of clotting factor furnished. We will closely examine all data and information submitted in order to make a final determination with respect to the appropriateness of the $0.05 per unit amount. That information will enable us to effectively determine the appropriateness of the $0.05 per unit

amount. 4. Supplying Fee

Section 1842(o)(6) of the Act, as added by section 303(e)(2) of the MMA, requires the Secretary to pay a supplying fee (less applicable deductible and coinsurance) to pharmacies for certain Medicare Part B drugs and biologicals, as determined appropriate by the Secretary. The types of Medicare Part B drugs and biologicals eligible for a supplying fee are immunosuppressive drugs described in section 1861(s)(2)(J) of the Act, oral anticancer chemotherapeutic drugs described in section 1861(s)(2)(Q) of the Act, and oral anti-emetic drugs used as part of an anticancer chemotherapeutic regimen described in section 1861(s)(2)(T) of the Act. As discussed in the interim final rule published on January 7, 2004 (69 FR 1084), we considered this fee to be bundled into the current payment for these drugs for 2004 where payment is based on the Average Wholesale Price (AWP).

We propose to establish a separately billable supplying fee, effective January 1, 2005, when Medicare implements a different payment system for these drugs. We believe that a separately billable supplying fee of $10 per prescription is an appropriate level, beginning CY 2005. We received data suggesting various amounts for the supplying fee. Retail chain pharmacies suggested a supplying fee of $12 to $15 per prescription. These pharmacies stated that on average it cost between $10 to $12 to dispense a prescription to a Medicare beneficiary. However, when supplying immunosuppressive and oral anti-cancer drugs to Medicare beneficiaries, they argued that costs increase due to factors such as coordination of benefits activities. The specialty pharmacies that exclusively or largely furnish immunosuppressive drugs submitted data indicating that they believe a supplying fee of $44 (weighted average) to $56 (unweighted average) was appropriate. Pharmacies have pointed to the additional Medicare billing requirements as additional costs they had to incur, in the form of extra staff and time required to fulfill the billing requirements. We believe that a supplying fee of $10 per prescription is appropriate, especially when combined with the savings the pharmacy will experience with the clarification and elimination of the billing and shipping requirements, as described below.

We point out that if we were to establish a supplying fee of $44, then we expect that Medicare would be spending more money in 2005 on the supplying fees and immunosuppressive drugs than Medicare would have paid for immunosuppressive drugs in 2005 under the former system at 95 percent of AWP, when the supplying fee was bundled into payment for the drug.

Our goal is to assure that each beneficiary who needs covered oral drugs has access to those medications. We seek comments about the appropriateness of our proposed supplying fee amount as well as the components of a supplying fee that would assure beneficiary access to oral drugs. We believe that a supplying fee is intended to cover a pharmacy ’ s activities to get oral drugs to beneficiaries. We seek data and information on the additional services these pharmacies provide to Medicare beneficiaries, the extent to which oral drugs can be furnished without these additional services and the extent to which such services are covered under Medicare. We seek comment about whether the supplying fee should be somewhat higher during the initial month following a Medicare beneficiary ’ s transplant to the extent that additional resources are required for example, due to more frequent changes in prescriptions for immunosuppressive drugs.
5. Billing Requirements

We propose to clarify or eliminate the following billing requirements in an effort to reduce a pharmacy ’ s costs of supplying covered immunosuppressive and oral drugs to Medicare beneficiaries:

• Original signed order . We wish to clarify Medicare ’ s policy regarding the necessity of an original signed order prior to the filling of a prescription. According to the Medicare Program Integrity Manual (section 5.1 of Chapter 5), which addresses the ordering requirement for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), including drugs, most DMEPOS items can be dispensed


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based on a verbal order from a physician. A written order must be obtained before submitting a claim, but that written order may be faxed, photocopied, electronic, or pen and ink. The order for the drug must specify the name of the drug, the concentration (if applicable), the dosage, and the frequency of administration. We hope that clarification of this requirement would reduce a pharmacy ’ s costs of supplying covered immunosuppressive and oral drugs to Medicare beneficiaries to the extent that pharmacies are currently applying an original signed prescription requirement.

• Assignment of Benefits Form

. Currently, pharmacies must obtain a completed Assignment of Benefits form in order to receive payment from Medicare. Other payors do not impose this requirement. This requirement increases a pharmacy ’ s cost of supplying covered drugs to Medicare beneficiaries. Section 1842(o)(3) of the Act requires that payment for drugs under Part B of Medicare can only be made on an assignment related basis. However, § 424.55(a) implies that if a beneficiary does not sign an assignment of benefits form, then Medicare will not make payment to the supplier. It has been pointed out that this requirement increases costs to suppliers that are not reimbursed by Medicare. We believe that it is not necessary for an assignment of benefit form to be filled out for drugs covered under Part B since payment for them can only be made on an assignment-related basis. We propose to eliminate use of the Assignment of Benefits form for Part B covered oral drugs as a means of reducing a pharmacy ’ s costs of supplying such drugs to Medicare beneficiaries. (Additional discussion on assignment of Medicare claims is in section IV.G of this preamble.)

• DMERC Information Form (DIF)

. The DIF is a form created by the DMERC Medical Directors that contains information regarding the dates of the beneficiary ’ s transplant and other diagnosis information. Pharmacies must have a completed DIF in order to receive payment. This requirement increases a pharmacy ’ s cost of supplying covered drugs to Medicare beneficiaries. The DIF is a one-time requirement that was established to facilitate implementation of the immunosuppressive drug benefit when Medicare covered the drugs for different periods of time to distinguish between transplant and non-transplant uses for immunosuppressive drugs. Since section 1861(s)(2)(J) of the Act no longer imposes limits on the period of time for coverage of immunosuppressive drugs, we believe that the information on transplant diagnosis can be captured through other means (for example, diagnosis codes on the Part B claim form). In light of this statutory revision, we have had discussions with the DMERCs about their elimination of the use of this form when billing DMERC drugs. The DMERCs plan to eliminate the use of this form effective October 1, 2004. We believe that a pharmacy ’ s costs of supplying Part B covered oral drugs to Medicare beneficiaries would be reduced with this change.
6. Shipping Time Frame

It has been suggested that Medicare guidelines for refill prescriptions allowed too short of a window between shipping the next month ’ s prescription and the end of the current month. It has been argued that, as a result, a pharmacy

‘‘ effectively ’’ had to ship the product to a beneficiary using an overnight delivery service.

As indicated in section III.N of this preamble, on January 2, 2004, we revised the guidelines (effective February 2, 2004) regarding the time frame for subsequent deliveries of refills of DMEPOS products to occur no sooner than ‘‘ approximately 5 days prior to the end of the usage for the current product ’’ (see section 4.26.1 of Chapter

4

— Benefit Integrity of the Medicare Program Integrity Manual). This change allows shipping of refills on

‘‘ approximately ’’ the 25th day of the month in the case of a month ’ s supply. We emphasize the word

‘‘ approximately ’ ; while we believe that normal ground service shipping would allow delivery in 5 days, if there were circumstances where ground service could not occur in 5 days, the guideline would still be met if the shipment occurs in 6 or 7 days. ( ‘‘ Days ’’ refers to business days or shipping days applicable to the shipper, that is, a 6- day week in the case of the U.S. Postal Service.) We believe that this change eliminates the need for suppliers to use overnight shipping methods and allows shipping of drugs by less expensive ground service.

F. Section 952

— Revisions to Reassignment Provisions

— Section 952 of the MMA [If you choose to comment on issues in this section, please include the caption

‘‘ Section 952 ’’ at the beginning of your comments.]

Section 1842(b)(6) of the Act requires that payment may only be made to the physician or other person who furnished a service, or to the beneficiary for whom services were furnished, unless certain specified exceptions are met. Prior to the enactment of section 952 of the MMA, Medicare did not permit the reassignment of payments for services provided by an independent contractor physician or nonphysician practitioner unless the services were performed on the premises of the facility or health care delivery system that submitted the bill. Therefore, if the services were furnished offsite, reassignment was prohibited (see section 1842(b)(6)(A)(ii) of the Act).

Section 1842(b)(6)(A)(ii) of the Act, as amended by section 952 of the MMA, allows a physician or nonphysician practitioner to reassign payment for Medicare-covered services, regardless of the site of service, as long as there is a contractual arrangement between the physician and nonphysician practitioner and the entity through which the entity submits the bill for those services. Thus, the services may be provided on or off the premises of the entity receiving the reassigned payments. The MMA Conference Agreement states that entities that retain independent contractors may enroll in the Medicare program. We note that the expanded exception created by section 952 applies to those situations when an entity seeks to obtain the medical services of a physician or nonphysician practitioner.

Section 952 states that reassignment is permissible if the contractual arrangement between the entity that submits the bill for the service and the physician or nonphysician practitioner who performs the service ‘‘ meets such program integrity and other safeguards as the Secretary may determine to be appropriate. ’’ The Conference Agreement supports appropriate program integrity efforts for entities with independent contractors that bill the Medicare program, including joint and several liability (that is, both the entity accepting reassignment and the physician or nonphysician practitioner providing a service are both liable for any Medicare overpayments). The Conference Agreement also recommends that physician or nonphysician practitioners have unrestricted access to the billings submitted on their behalf by entities with which they contract. We incorporated these recommended safeguards in a change to the Medicare Manual, implementing section 952 of the MMA that was published on February 27, 2004. We are proposing to
revise § 424.71 and § 424.80 to reflect these safeguards, as well as the expanded exception established by
section 952.

Given the myriad relationships and financial arrangements potentially permitted by section 952, the purpose of


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joint and several liability is to encourage both parties to the contractual arrangement to exercise oversight of billings submitted to the Medicare program by holding them each fully accountable. Since physician or nonphysician practitioners will be subject to liability for claims that are submitted to the Medicare program by entities to which they have reassigned payments, it follows that a physician or nonphysician practitioners should have access to the billings submitted on their behalf.

We note that section 952 of the MMA revises only the statutory reassignment exceptions relevant to services provided in facilities and clinics (section 1842(b)(6)(A)(ii) of the Act). Arrangements involving reassignment must not violate any other applicable Medicare laws or regulations governing billing or claims submission, including, but not limited to, those regarding

‘‘ incident to ’’ services, payment for purchased diagnostic tests, and payment for purchased test interpretations.

In addition, physician group practices should be mindful that compliance with the in-office ancillary services exception to the physician self-referral prohibition requires that a physician who is engaged by a group practice on an independent contractor basis must provide services to the group practice ’ s patients in the

group ’ s facilities. As noted in the Phase I physician self-referral final rule (66 FR 887), ‘‘ [w]e consider an independent contractor physician to be ‘‘ in the group practice ’’ if (1) he or she has a contractual arrangement to provide services to the group ’ s patients in the group practice ’ s facilities, (2) the contract contains compensation terms that are the same as those that apply to group members under section 1877(h)(4)(iv) of the Act or the contract fits in the personal services exception, and (3) the contract complies with the reassignment rules * * * . ’’ See also 66 FR 886. This test is codified at § 411.351 in the definition of ‘‘ physician in the group practice. ’’

We are aware that the changes in the reassignment rules based on section 952 of the MMA may create new fraud and abuse vulnerabilities, which may not become apparent until the program has experience with the new contractual arrangements addressed in section 952 of the MMA. Parties should be mindful that contractual arrangements involving reassignment may not be used to camouflage inappropriate fee-splitting arrangements or payments for referrals. We are soliciting public comment on potential program vulnerabilities and on possible additional program integrity safeguards to guard against such vulnerabilities. We intend to monitor reassignment arrangements for potential program abuse.

G. Section 642

— Extension of Coverage of IVIG for the Treatment of Primary Immune Deficiency Diseases in the
Home
[If you choose to comment on issues in this section, please include the caption

‘‘ Section 642 ’’ at the beginning of your comments.]

Beginning for dates of service on or after January 1, 2004, Medicare pays for intravenous immune globulin administered in the home. This benefit is for the drug and not for the items or services related to the administration of the drug when administered in the home, if deemed medically appropriate. Manual instructions implementing this MMA provision have been issued and can be found at http:// www.cms.hhs.gov/manuals/pm

_ trans/ R6BP.pdf and http://www.cms.hhs.gov/ manuals/pm

_ trans/R74CP.pdf. We are also proposing to revise § 410.10 to address this statutory change.

H. Section 623

— Payment for Renal Dialysis Services
[If you choose to comment on issues in this section, please include the caption

‘‘ Section 623 ’’ at the beginning of your comments.]
1. Background

We are proposing changes affecting payments to ESRD facilities that result from enactment of the MMA and would be effective January 1, 2005. Section 1881(b) of the Act, as amended by section 623 of the MMA, directed the Secretary to revise the current composite rate payment system. The statute has several major provisions that require the development of revised composite payment rates, as follows:

• An update of 1.6 percent.

• An add-on to the composite rate for the difference between current payments for separately billable drugs and biologicals and payments based on the revised drug pricing methodology using acquisition costs.

• Case-mix adjustments for a limited number of patient characteristics.

• Application of a budget neutrality adjustment. The statute also allows the Secretary to adjust the payment rates by a geographic index as the Secretary determines to be appropriate which would be phased-in over a multiyear period.

By January 1, 2005, we plan to implement the proposed revisions affecting the composite payment rate which would include the following: • An increase of 1.6 percent to the basic composite payment rate.

• Proposed revisions to the pricing of separately billable drugs and biologicals.

• A drug add-on to the composite rate to reflect the difference between current payments for separately billable drugs and biologicals, and payment based on the revised drug pricing methodology using acquisition costs.

We propose to implement the patient characteristics adjustments and the related budget neutrality adjustments by April 1, 2005. ( See detailed discussion later in this section.)
2. Legislative History

Section 2991 of the Social Security Amendments of 1972 (Pub. L. 92

– 603), established Medicare ’ s End Stage Renal Disease (ESRD) Program. This law extended Medicare coverage to individuals who have permanent kidney failure, require either dialysis or transplantation, and meet certain other eligibility requirements. The End Stage Renal Disease Program Amendments of 1978 (Pub. L. 95

– 292) added section 1881(b)(2)(B) to title XVIII of the Act.

That legislation provided for the establishment of a prospective reimbursement methodology for the payment of dialysis treatments provided by renal dialysis facilities. Further changes to the ESRD payment system were made by section 2145 of Pub. L.

97

– 35, which amended section 1881 of the Act, requiring the development of a prospective reimbursement system for outpatient maintenance dialysis that promotes home dialysis. The payment system required either thereimbursement of home dialysis and infacility dialysis under ‘‘ composite ’’ rates, or the use of some other more efficient method determined to promote home dialysis more effectively.

On February 12, 1982, we published a proposed rule on reimbursement for outpatient maintenance dialysis services (47 FR 6556) and we published the final rule on May 13, 1983 (48 FR 21254). This regulation implemented section 1881 of the Act, as amended by section 2145 of Pub. L. 97

– 35, and provided that each ESRD facility will receive a fixed composite payment rate per dialysis treatment, adjusted for geographic differences in area wage levels. Payment for in-facility and home dialysis treatments was established using a composite payment rate reflecting the costs of both modalities. Separate composite payment rates were established for hospital-based and independent dialysis facilities. The regulation also included a process under which facilities could obtain exceptions


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to their composite payment rates under specified circumstances.

The average composite payment rate per treatment, effective on August 1, 1983, was $123 for independent ESRD facilities and $127 for hospital-based facilities. The composite rate was designed to provide payment for a package of goods and services needed to furnish dialysis treatments that included certain routinely provided drugs, laboratory tests, supplies, and equipment. Unless specifically included in the composite payment rate, other injectable drugs and laboratory tests medically necessary for the care of the dialysis patient are separately billable.

Prior to January 1, 2004, drugs not paid on a cost or prospective payment basis were paid based on the lower of the actual charge or 95 percent of the AWP (section 1842(o)(1) of the Act, as added by section 4556 of the BBA of 1997 (Pub. L. 105

– 33)). Sections 303 through 305 of the MMA make revisions to payment methodology for Part B covered drugs that are not paid on a cost or prospective payment basis. For CY 2004, the MMA provides that drugs not paid on a cost or prospective payment basis will be paid at 85 percent of the AWP determined as of April 1, 2003. However, there are several exceptions to this general rule, including payment of ESRD drugs and biologicals. In CY 2004, drugs and biologicals furnished in connection with the furnishing of renal dialysis services if separately billed by renal dialysis facilities are paid at 95percent of AWP. We note that hospitalbased ESRD facilities are paid reasonable costs for separately billable drugs, except for Erythropoietin/ Epoietin (EPO).

EPO is an anti-anemia drug administered to certain patients with ESRD. Medicare Part B pays for EPO and its administration if it is furnished by an approved ESRD facility as part of an outpatient dialysis service or by a supplier of home dialysis equipment and supplies to ESRD patients in their homes as part of home dialysis services. Most dialysis is furnished to ESRDpatients on an outpatient basis or is selfadministered in the home.

Section 1881(b)(11) of the Act expressly excludes payment for EPO furnished to ESRD patients from the composite rate for dialysis services. The costs of EPO are, therefore, billed separately by an ESRD facility or by a supplier of home dialysis equipment and supplies and are paid in addition to the facility ’ s composite rate. Any EPOrelated costs, such as the cost of its administration or overhead costs associated with its storage, however, are subsumed in the facility ’ s composite

rate.

Section 413.174(f)(3) requires that we prospectively determine the EPO amount pursuant to section 1881(b)(11)(B)(ii) of the Act. Section 4201(c) of the Omnibus Budget Reconciliation Act of 1990 (OBRA 90) (Pub. L. 101

– 508), however, amended section 1881(b)(11) of the Act to establish a new EPO payment methodology. OBRA 90 directed, effective January 1, 1991, that payment for EPO furnished to ESRD patients by Medicare-approved dialysis facilities or suppliers of home dialysis equipment and supplies for home use be made on a per-unit basis. OBRA 90 also established a maximum payment amount of $11 per 1,000 unit doses rounded to the nearest 100 units. Subsequently, section 13556(a)(2) of OBRA 93 was enacted, which further amended section 1881(11)(b)(B)(ii) of the Act to reduce the maximum payment level to $10 per 1,000 units effective January 1, 1994. Although we have the authority to revise the rate, we continue to pay at the rate of $10 per 1,000 units.

Section 9335(a) of Pub. L. 99

– 509 required the Secretary to reduce the initially established composite payment rates by $2.00 per treatment effective October 1, 1986. This reduction was partially reversed as a result of the enactment of section 4201(a)(2) of Pub.
L. 101

– 508, which increased the composite payment rates in effect as of September 30, 1990 by $1.00 per treatment, but effectively froze the methodology for their calculation, including the data and definitions used, as of that date. Section 222 of Pub. L.

106

– 113, provided for a 1.2 percent increase to the payment rates effective January 1, 2000, and also provided for another 1.2 percent increase effective January 1, 2001. Section 422(a)(1) of Pub. L. 106

– 554, raised the amount of the January 1, 2001 payment increase by another 1.2 percent for a total increase of 2.4 percent effective January 1, 2001.

Section 422 of Pub. L. 106

– 554 also directed the Secretary to develop a Prospective Payment System (PPS) that expanded the bundle of routine services reflected in the composite rate to include separately billable laboratory tests and drugs ‘‘ to the maximum extent feasible ’’ . In addition, section 422(a) of Pub. L. 106

– 554 prohibited the granting of new composite rate payment exceptions for services furnished after December 31, 2000. Because a bundled ESRD payment system must be periodically updated, section 422(b) of Pub. L. 106

– 554 also required the development of an ESRD market basket to account for changes in price inflation, with discretionary consideration of other factors known to affect costs. Section 422(c) of Pub. L. 106

– 554 mandated the submission of a report to the Congress on the bundled payment system and ESRD market basket.

On May 12, 2003, the Secretary submitted the required report to the Congress. The report explained the major issues that must be addressed before a bundled ESRD PPS can be implemented, presented an ESRD composite rate market basket, and discussed the results from the first phase of our sponsored research to develop a bundled payment system. The report presented the following three major findings that are relevant to our efforts to revise the composite rate payment system:

• Current data sources are adequate for proceeding to develop a bundled
ESRD PPS.

• Case-mix may be an important variable for risk adjusting payments, based on preliminary analysis.

• Current data provide a sound basis for monitoring patient outcomes in a revised ESRD payment system.
3. Summary of Section 623 of MMA

The following provisions in section 623 of the MMA, effective January 1, 2005, affect the composite payment rate methodology, as well as the pricing methodology for separately billable drugs and biologicals furnished by ESRD facilities:

a. Section 623(a)

— The last sentence of section 1881(b)(7) of the Act, as amended by MMA, provides for an increase in the current composite payment rate of 1.6 percent.

b. Section 623(d)(1)

— Section 1881(b)(13) of the Act, as added by MMA section 623(d)(1), provides for a revision to the current AWP pricing of separately billable drugs and biologicals; payment will be based on acquisition costs as determined by the
OIG ’ s study mandated under section 623(c) of the MMA. Insofar, as the OIG has not determined the acquisition costs, with respect to a drug or biological, the Secretary shall determine the payment amount for such drug or biological.

c. Section 623(d)(1)

— Section 1881(b)(12) of the Act, as added by MMA section 623(d)(1), also requires the establishment of a basic case-mix adjusted composite payment rate that applies certain adjustments to the composite payment rate as follows:

• Adjustments for a limited number of patient characteristics.

• An adjustment that reflects the difference between current payments for


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separately billed drugs and biologicals and the revised pricing based on acquisition costs or other method as determined by the Secretary.

• A geographic adjustment, if the Secretary determines such an adjustment is appropriate with the possibility of a phase-in.

• A budget neutrality adjustment, so that aggregate payments under the basic case-mix adjusted composite payment rates for 2005 equal the aggregate payments that would have been made for the same period if section 1881(b)(12) of the Act did not apply.
4. Provisions of the Proposed Rule
a. Composite Rate Increase

The current composite payment ratesapplicable to urban and rural hospitalbased and independent ESRD facilities were effective January 1, 2002. The current wage-adjusted rates for each urban and rural area were published in Tables III and IV of Program Memorandum A

– 01

– 19 issued February 1, 2001 and are applicable through the end of 2004. Section 623(a)(3) of the MMA requires that the composite rates in effect on December 31, 2004 be increased by 1.6 percent. We are publishing revised wage-adjusted composite rates that reflect the statutorily required 1.6 percent increase. Those rates are set forth in Tables I and II at the end of this section. These tables reflect the updated hospital-based and independent facility composite rate of $132.40 and $128.35, respectively, adjusted by the current wage index. The rates will be effective January 1, 2005. The rates shown in the tables do not include any of the basic case-mix adjustments required under section 623 of the MMA.
b. Revised Pricing Methodology for Separately Billable Drugs and Biologicals Furnished by ESRD Facilities

Section 623(d) of the MMA requiresthe Secretary to establish a basic casemix adjusted PPS for dialysis services that are furnished beginning on January 1, 2005 by providers of services and renal dialysis facilities to individuals in a facility and to individuals at home. This system will include services comprising the composite rate as well as the difference between payment amounts for separately billed drugs and biologicals (including erythropoietin) furnished by ESRD facilities and acquisition costs of such drugs and biologicals as determined by the OIG reports from the studies mandated by section 623(c) of the MMA.

For 2004, the payment amounts for separately billed drugs and biologicals (other than erythropoietin) furnished by ESRD facilities are determined by 95 percent of AWP. For 2005, the payment amounts for separately billed drugs and biologicals (including erythropoietin) furnished by ESRD facilities are described in section III.E of the NRPM. Insofar as the acquisition cost has not been determined by the OIG, then the Secretary shall determine the payment amount of the drug and biological.

For 2005 and subsequent years, the payment amounts for separately billed drugs and biologicals (including erythropoietin) furnished by ESRD facilities will be the acquisition cost or the amount that is derived from the ASP methodology in section 1847A of the Act, as the Secretary may specify.

See section III.E.1.d. of this proposed rule for further explanation of payment for separately billable drugs and biologicals furnished by renal dialysis facilities.
c. Composite Rate Adjustment to Account for Changes in Pricing of Separately Billable Drugs and Biologicals

Section 1881(b)(12) of the Act, as added by section 623(d) of the MMA, contains two provisions that specify how the drug add-on adjustment is to be handled in the revised ESRD payment system. First, subparagraph (B)(ii) of such section requires an adjustment to the composite payment rates to account for the difference between payment amounts for separately billed drugs (including erythropoietin) under the current payment system and acquisition costs as determined by the OIG. Second, subparagraph (E)(i) requires that thedrug add-on adjustment be budgetneutral, that is, that it be designed to result in the same aggregate amount of expenditures as would have been made without the statutory policy change.

We need to determine the composite rate adjustment for drug add-on amount that simultaneously deals with both statutory requirements. That is, the aggregate amount of the composite rate adjustment for drug add-on amount needs to equal the aggregate amount of the drug spread (the difference between drug payments under the old system and acquisition costs).

In order to ensure that we satisfy both constraints, it is necessary to consider the proposed drug pricing in developing the adjustment to the composite rates. As discussed in section III.E.1.d. of this proposed rule, we are proposing to pay for separately billable ESRD drugs using ASP minus 3 percent based on the average relationship of acquisition costs to average sales prices from the drug manufacturers as outlined in the OIG report. We have developed the proposed drug add-on adjustment using the ASP minus 3 percent drug prices. Section 2 below discusses the details of the calculation of the drug add-on adjustment. An alternative approach would be to use the 2003 acquisition prices from the OIG report, calculate the aggregate difference between such prices and payments for drugs under the AWP system, update this difference to 2005 and then apply the budget neutrality adjustment. Because the same budget-neutrality adjustment would be used in both calculations, we believe that the drug add-on adjustment for the drug spread would be the same with both approaches. Therefore, we are proposing to use the ASP minus 3 percent prices as the basis for developing the drug add-on adjustment to the composite rate.
1. Options for Applying the Drug AddOn Adjustment to the Composite Payment Rate

Currently, separately billable ESRDdrugs are paid differently to hospitalbased and independent ESRD facilities. EPO is currently the only drug for which payment is uniform across ESRD facilities; EPO is paid at the current rate of $10 per 1000 units. All other separately billed ESRD drugs provided by independent ESRD facilities are currently paid 95 percent of AWP prices. However, hospital based ESRD facilities are paid their reasonable cost for the other separately billed drugs they provide. Because they are paid on cost, hospital-based facilities have not made the profits from drug payment that independent facilities have enjoyed.

The statutory language describing the add-on adjustment to the composite rate does not specifically differentiate between hospital-based and independent facility composite rate adjustments. However, the drug add-on provision is included with the other provisions related to the basic case-mix adjusted composite rate system; thus, it could be argued that the drug add-on provision was intended to address ESRD industry concerns about the inadequacy of the composite payment rate. We believe these concerns apply equally to hospital-based facilities and independent facilities. Therefore, we are proposing a single adjustment to the composite payment rates for both hospital based and independent facilities.

An alternative option would be to develop a separate adjustment for hospital-based facilities for EPO and one for independent facilities for all of their separately billed drugs. The IG ’ s report provided the acquisition costs we are


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using; it did not provide different acquisition costs for hospital-based and independent facilities. We believe that it would not be appropriate for us to use these data to create two separate adjustments. The following discussion outlines the development of the drug add-on adjustment under both options

— a single factor and separate factors. 2. Computation of Drug Add-On Adjustment to the ESRD Composite Payment Rate

i. Data

To develop the drug add-on adjustment we used historical total aggregate payments for separately billed ESRD drugs for half of 2000 and all of 2001 and 2002. For EPO, these payments were broken down according to type of ESRD facility (hospital-based versus independent). We also used the number of dialysis treatments performed by these two types of facilities over the same period.

ii. ASP Minus 3 Percent

We updated the ASP minus 3 percent prices, for the first quarter of 2004, to represent 2005 prices. We used the projected annual price growth factor for National Health Expenditure prescription drugs of 3.39 percent.



### TABLE 12

Drugs First quarter 2004 average

sales price first minus 3

percent Quarter 2005 average sales price minus 3 percent

Epogen ......................................................................................................................... ............................................ $8.74 $9.04 Calcitriol ..................................................................................................................... .............................................. 0.66 0.68 Doxercalciferol ................................................................................................................ ......................................... 2.55 2.64 Iron

_ dextran ........................................................................................................................ ..................................... 9.22 9.54 Iron

_ sucrose ........................................................................................................................ .................................... 0.34 0.35 Levocarnitine .................................................................................................................. .......................................... 7.15 7.39 Paricalcitol ................................................................................................................... ............................................. 3.86 3.99 Sodium

_ ferric

_ glut ........................................................................................................................... ........................ 4.15 4.29 Alteplase, Recombinant ......................................................................................................... .................................. 27.74 28.68 Vancomycin ..................................................................................................................... ........................................ 3.40 3.52



### iii. Current Medicare Reimbursement

We updated the first quarter 2004 Medicare payment amounts (95 percent of AWP), based on the January 2004 Single Drug Pricer, for drugs other than EPO, to estimate 2005 payment amounts by using an estimated AWP growth of 3 percent. These growth factors are based on historical trends of AWPs. We did not increase the price for Epogen since payment was maintained at $10.00 per thousand units prior to MMA.



### TABLE 13

Drugs Current medicare reimbursement prices for 2005

Epogen ............................. $10.00 Calcitriol ............................ 1.42 Doxercalciferol .................. 5.67
Iron

_ dextran ...................... 18.45 Iron

_ sucrose ..................... 0.68 Levocarnitine .................... 35.23 Paricalcitol ........................ 5.49 Sodium

_ ferric

_ glut ............ 8.42 Alteplase, Recombinant .... 37.80 Vancomycin ...................... 7.24



### iv. Dialysis Treatments

We updated the number of dialysis treatments by actuarial projected growth in the number of ESRD beneficiaries. Since Medicare covers a maximum of three treatments per week, utilization growth is limited, and therefore any increase in the number of treatments should be due to enrollment. In 2005, we project there will be a total of 36.5 million treatments performed (5.1 million treatments will be performed by hospital-based facilities and 31.4 million treatments by independent facilities).

v. Drug Payments

We updated the total aggregate Epogen drug payments for each hospital-based and independent facilities using historical trend factors. For 2003 through 2005, the 2002 payment level was increased each year by trend factors of 2.8 percent for hospital-based facilities and by 9.4 percent for independent facilities.

Using drug growth factors for drugs paid for by Medicare Part B carriers, which were calculated from historical data, we updated the aggregate spending for separately billable drugs, other than EPO, for independent facilities. We used 24.7 percent for 2003, 23.3 percent for 2004, and 21.4 percent for 2005 as factors because historical growth of ESRD drugs is similar to that for drugs paid for by Part B carriers. These factors are projected to approach the level of National Health Expenditure prescription drug growth. For 2005, we estimate that spending will reach $185million for Epogen provided in hospitalbased facilities, and $2,664 million for drugs provided in independent facilities ($1,568 million for Epogen and $1,096 million for other drugs).
vi. Add-On Calculation and Budget Neutrality

For each of the ten drugs, we calculated the percent by which ASP minus 3 percent prices are projected to be less than reimbursement amounts under the current system for 2005. For Epogen, this amount is 10 percent. We applied this 10 percent figure to the total aggregate drug payments for Epogen in hospital-based facilities, resulting in a difference of $18 million. We then calculated a weighted average of the percentages by which ASP minus 3 percent would be below current Medicare reimbursement prices for the top 10 ESRD drugs. We weighted these percentages by using the 2002 Medicare reimbursement values contained in the OIG report for the ten drugs. This procedure resulted in a weighted average of 19 percent. Since these ten drugs represented 98 percent of drugs payments, we applied the weighted average to 100 percent or all of aggregate drug spending projections for independent facilities, producing a projected difference of $516 million.

Combining the 2005 figures of $18 million and $516 million, for a total of $534 million and then distributing this over a total projected 36.5 milliontreatments would result in a single addon to the per treatment composite rate


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of 11.3 percent. By making this adjustment to the composite rate, we estimate that the aggregate payments to ESRD facilities would be budget neutral with respect to drug payments.

Alternatively, we could produce separate drug add-on adjustments for hospital-based and independent facilities using the same methodology. Under this option, we could distribute the $18 million difference in EPO payments to hospital-based facilities based on data projecting 5.1 million treatments resulting in a hospital-based facility drug add-on adjustment of 2.7 percent. We would distribute the $516 million difference in drug payments (including EPO) to independent facilities using projected treatments of 31.4 million, resulting in a drug add-on adjustment of 12.8 percent for independent facilities.

Drug prices used in the computation of the proposed drug add-on adjustment to the ESRD composite payment rate, may be revised based on later data and will be reflected in the final rule. 3. Composite Rate Effect of Proposed Drug Add-On Adjustment

We used a single drug add-on adjustment for both hospital-based and independent ESRD facilities, the proposed adjustment to the composite rate would be 1.113. Separate adjustments would provide a 1.128 adjustment for independent facilities and 1.027 for hospital-based facilities. The following table illustrates the effect on the composite payment rates under the two potential drug add-on options. (Case-mix budget neutrality adjustments are not reflected in this table).



### T ABLE 

### 14

Facility type CY 2005 base rate Separate add-on Single addon

Independent .................................................................................................................... ......................... $128.35 $144.78 $142.85 Hospital Based ................................................................................................................. ........................ 132.41 135.99 147.37



### Under the single add-on, theproportionately higher rate for hospitalbased facilities would be consistent with section 1881(b)(7) which requires that our payment methods differentiate between hospital-based facilities and others. Separate add-on adjustments would result in a significantly higher composite payment rate for independent facilities, than hospital-based facilities, that is, $8.79 higher per treatment.
d. Patient Characteristic Adjustments
1. Statutory Authority

The current ESRD composite payment rates do not adjust for variation in patient characteristics or case mix. Section 1881(b)(12)(A) of the Act, as added by section 623(d)(1) of the MMA, requires that the outpatient dialysis services included in the composite rate be case-mix adjusted. Specifically, the statute states that ‘‘ The Secretary shall establish a basic case-mix adjusted prospective payment system for dialysis services furnished by providers of services and renal dialysis facilities in a year to individuals in a facility and to individuals at home. The case-mix under the system would be for a limited number of patient characteristics. ’’ In the following sections, we describe the development of the methodology for the proposed patient characteristic case-mix adjusters required under the MMA.
2. Background

Case-mix measures utilizing patient characteristics have been used in a number of prospective payment systems. Use of a case-mix measure permits targeting of greater payments tofacilities that treat more costly resourceintensive patients. However, thelegislative mandate to establish a casemix adjustment for services included in the composite rate based on a limited number of patient characteristics presents a unique challenge.

The composite rate represents payment for a fixed bundle of routine services provided to ESRD patients as part of a dialysis treatment. Generally, the items and services needed to provide a dialysis treatment do not vary significantly across patients. Moreover, the bills for composite payment rate services furnished to ESRD patients, which are generally submitted monthly, do not identify the specific items and services provided on a case-by-case basis. In addition, the Medicare cost reports identify only aggregate costs for composite rate services at the facility level. Therefore, any case-mix adjustment based on patient characteristics obtained from the bills for outpatient ESRD services and applied to the composite rate will reflect only variation in composite rate costs at the facility level.

Earlier research by Hirth (1999) and Dor (1992) found that if case-mix adjustments applied only to composite rate items and services the adjustments played a limited role in predicting variation in costs per treatment because case-mix and dialysis treatment patterns are very similar across facilities. However, more recent analyses conducted under our contract with the University of Michigan, Kidney, Epidemiology and Cost Center (KECC) found that patient level case-mix adjustment would be more relevant in a bundled payment system that includes both composite rate and separately billable items and services. KECC ’ s research studies relied on an extensiveset of variables to define patient casemix. These variables included patient characteristics, a large number of specific comorbidities and clinical measures (including primary diagnosis) and other (non-Medicare) insurance coverage, as well as the duration of ESRD. We relied on linear regression analyses used in the studies to assess the relationship of patient characteristics and comorbidity measures to per session cost and Medicare payments to facilities. These studies relied on data from our administrative files.

We are continuing and expanding the research project in support of thedevelopment of a fully bundled casemix adjusted system. We are continuing to explore alternative models and options with more detailed analysis of patient characteristics as part of the legislatively mandated report to the Congress in the fall of 2005.

Despite the difficulty in developing a patient characteristic case-mix adjustment, we were able to develop case-mix adjustment factors for a limited number of patient characteristics, consistent with the legislative mandate. As expected, these adjusters are only modest predictors of variation in average costs for composite services. In developing the proposed patient characteristic adjustments, we used our available administrative data. Because facilities do not list individual composite rate items and services on the dialysis bill, billing data do not identify resources used by each patient. In


## 47530 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

addition, facilities can underreport or not report comorbid conditions. Therefore, these bills are not useful for deriving average facility input costs. Since there are not any current requirements to list comorbid conditions on the dialysis bill, we used a combination of data sources to determine co-morbidities for ESRD patients on maintenance dialysis. These include the Medicare claims history file as well as the CMS Form 2728 (ESRD Medical Evidence Report) which provides information on the cause ofESRD and lists 20 possible comorbidities present at the onset of a patient ’ s ESRD. The Form 2728 is completed only at the initiation of dialysis treatment. It is not updated to reflect more recent medical conditions.

Nonetheless, we found selected variables from the Form 2728 to be valid predictors of cost per treatment for the proposed case-mix adjustment, and the Form 2728 was also useful in developing our proposed case-mix adjustments. As discussed below, the Form 2728 variables were supplemented by additional information we obtained from billing records.
3. Development of the Proposed Adjustments for Patient Characteristics

We are proposing a methodology to establish a basic case-mix adjusted composite rate system using a limited number of patient characteristic variables developed from existing our administrative files. We analyzed a number of patient level variables including age, gender, alcohol and drug dependence, inability to ambulate/ transfer, current smoker, number of years since ESRD onset, weight, height, mean BUN, and mean creatinine clearance, as well as a number of comorbidities.

As a means to estimate how average cost variations among facilities are influenced by selected patient characteristics, extensive analyses were performed to develop a proposed ‘‘ basic case-mix adjusted PPS, for a limited number of patient characteristics, ’’ as specified in the statute. We analyzed the average cost per dialysis session (including both hemodialysis and Method I peritoneal dialysis converted to equivalent 3 times per week hemodialysis sessions) from national data gathered for the years 2000, 2001, and 2002.

A stepwise regression was used to select a limited set of variables that were predictive of average facility cost per treatment. We used data pooled over a three-year period because we found the regression coefficients to reflect a consistent pattern over three years. We used data pooled over a three-year period to minimize the potential for volatility in the regressive coefficients. The analysis controlled for selected variables that influence facility costs, but are not case-mix related. These variables included wage index, the natural log of the number of dialysis sessions provided annually by the facility, type of facility, chain affiliation, and percentage of patients with urea reduction ratio (URR) as a measure of dialysis dose equal to or greater than 65 percent. The proposed model is based not only on the predictive power of these measures, but also upon objectivity (for example, discrete variables: age/gender), clinical plausibility, and practicality (that is, availability) of data collection. The variables used were assessed for their clinical plausibility by clinicians from the University of Michigan and CMS. Physicians assessed a proposed list to determine relationship of the proposed comorbidities to ESRD patients, and clinical practice/patterns.

In addition to exploring a number of potential case-mix variables, we examined two methods, that is, linear and log linear models of the composite rate costs. We selected the log linear model in order to yield patient specific case-mix adjustments which can be multiplied by a dialysis facility ’ s otherwise applicable composite rate payment. In this proposed rule, we provide a detailed example of the calculation of the proposed case-mix adjusted composite rate payments.
4. Proposed Patient Characteristic Adjustments

As discussed in the background section above, the basic case-mix system is constrained by the composite rate and the data available for these adjustments. While we analyzed a number of variables, four patient characteristic variables were found to be modest predictors of cost variation among ESRD facilities. These patient characteristic variables include gender, age, and two comorbidities (AIDs and PVD) (See table 3 for specific ICD 9 codes for these comorbidities). Each of the gender categories was also divided into three age categories so that one adjustment factor could be developed to encompass both gender and age. The proposed patient characteristic adjustments are discussed below.
i. Gender and Age

We are proposing adjustments for both gender and age. We found that gender and age were strong predictors of facility cost variations. In addition, data on gender and age are readily available, and are objective measures. After examining a number of options for age, we are proposing under 65, 65

– 79, and over 80 as the three categories for age. We attempted to develop a case-mix adjuster specific to the under 18 age group. However, the population in that age group that was included in the data used to develop the case-mix adjustments was too small, and was generally concentrated in a very small number of facilities.

While we recognize that pediatric patients are more costly to treat, those patients are generally treated in specialized pediatric facilities. As provided in MMA, those facilities can request adjustments to their composite payment rates through the exceptions process. This process will enable pediatric facilities to obtain payments that specifically recognize the higher cost associated with treating these patients. In developing the age adjustments, data for those patients were grouped into the under 65 age category. We note that adjustments for both gender and age are consistent with the MA risk adjustment models for ESRD patients.
ii. Proposed Comorbidity Adjustments

As discussed above, the effect of the costs of dialysis for a number of conditions were analyzed. These included several comorbidities that did not have a statistically significant relationship to facility costs. In other cases, the lack of data precluded inclusion of a comorbid condition in the proposed patient characteristic adjustments. That is, we are unable to propose any adjustments based on data that cannot be routinely reported, (for example, some data elements that are reported only on the Form 2728). For the reasons discussed above, the Form 2728 is not an appropriate source of information since it is not updated after a patient enters the ESRD program. Two variables not currently available on the Medicare bill are weight and height. Weight and height are used to compute a patient ’ s body mass index (BMI). Our analysis indicates that patients with extremely low or high BMI are costly to treat. Since BMI is directly related to a patient ’ s dialysis prescription, we believe this factor could be an important measure of resource consumption related to the composite payment rate. We also believe that the length of time a patient is dialyzed could directly affect composite rate costs. We are currently exploring the feasibility of developing a mechanism to collect these data on the ESRD bill. In addition, we are soliciting comments on other data elements that could be added to the bill


## 47531 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

that could be relevant predictors of composite rate costs.

We also examined whether having cancer was predictive of higher resource used. We examined all cancers reported within the last 3 to 10 years as reported on our claims history file or the Form 2728. While a patient ’ s history of cancer was associated with higher costs, we found this measure to be too broad to be clinically meaningful. We will continue to evaluate this condition as a potential variable for refinement purposes. As ESRD facilities begin reporting patient comorbidities, we expect that we will be in a better position to identify the specific cancer diagnoses that may be related to increased composite rate

costs.

We also explored whether diabetes as a comorbidity is predictive of high resource use. We found that the predictive power of diabetes was dependent on whether PVD was part of the model. PVD was always statistically significant, when accounted for, while most measures of diabetes were not strongly associated with facility costs. Therefore, we are proposing a case-mix adjustment for PVD diagnoses. We believe this adjustment appropriately addresses the higher costs associated with sicker diabetic patients. We note that about 73 percent of diabetes patients included in our data also had PVD. Another comorbid condition that was found to be a significant predictor of facility cost is AIDs. This diagnosis is currently coded as part of the claims data.

Another Form 2728 variable we examined was the presence of a substance (alcohol and drugs) dependence diagnosis. While the presence of substance abuse was found to be predictive of higher facility level costs, we are not proposing an adjustment for this comorbidity at this time since the substance abuse diagnosis is underreported on the claims. We are soliciting comments on the variables included in the proposed patient characteristic adjustment as well as recommendations for the inclusion of other potential variables that may affect the costs of dialysis.

In summary, we are proposing to use a limited number of patient characteristics that do explain variation in reported costs for composite rate services consistent with the legislative requirement. The proposed adjustment factors are as follows:



### T ABLE 

### 15

Female ..... age <65 years ............ 1.11 age 65

– 79 years ......... 1.00 age >79 years ............ 1.16 

### T ABLE 

### 15

— Continued

Male ......... age <65 years ............ 1.21 age 65

– 79 years ......... 1.17 age >79 years ............ 1.23
AIDS ........ ..................................... 1.15
PVD ......... ..................................... 1.07



### While the magnitude of some of the patient specific case-mix adjustments appears to be significant, facility variation in the case-mix is limited. This is because of the overall similarity of the distribution of patients among the eight case-mix classification categories across facility classification groups. This is reflected by the average case-mix adjustment based on 2002 data for the various types of ESRD facilities shown in the table below.



### T ABLE 

### 16

Facility type Average casemix adjustment

All .......................................... 1.1919 Independent .......................... 1.1917 Hospital Based ..................... 1.1936
Urban .................................... 1.1931
Rural ..................................... 1.1865 Small (<5k treatments/yr.) .... 1.1911 Medium (5

– 10k treatments/

yr.) ..................................... 1.1910 Large (>10k treatments/yr.) .. 1.1924 Non-profit .............................. 1.1924 For-profit ............................... 1.1918



### As illustrated from this table, regardless of the type of provider, the average case-mix adjustments for patient characteristics do not vary significantly. We are continuing research to develop a more fully bundled proposed model that is not constrained by the existing composite rate. We will continue to study the predictive value of comorbidities and facility and patient level variables as part of the ongoing research. In addition, we are aware that by limiting the number of variables for the patient characteristics adjustment applicable to the composite payment rate, we are limiting the predictive power of the model. We are planning to consider additional variables to refine and update the proposed patient characteristics. Once we have implemented this basic case-mix system, we will continue to analyze comorbidities (on the reported claims file) and will consider expanding the list of variables used in the patient classification adjustment. In addition, we will be working with our fiscal intermediaries to improve the reporting of comorbidities on claims. 5. Technical Description of Model Used To Develop the Proposed Patient Characteristic Adjustments

Both facility and patient level variables were used for the development of the proposed case-mix adjustment. Facility costs are based on Medicare allowable costs reported by facilities for dialysis and related services for which they are reimbursed through the composite rate. The sources of the cost data are the Medicare Independent Renal Dialysis Facility Cost Reports (Form CMS 265

– 94) and the Medicare Hospital Cost Reports (Form CMS 2552

– 96). We used the most current set of facility cost reports available (cost reports updated through December 2003 and made publicly available in March 2004).

All cost reports spanning any part of calendar years 2000, 2001 or 2002 were included in the development of the case mix adjusters. While for most facilities, especially independent facilities, a single cost report encompasses the entire calendar year; data for some facilities, most notably those whose reporting period spans two calendar years (for example, October through September rather than January through December) were pro-rated to calculate the average treatment cost during a calendar year. The resulting numbers of cost reports used in the analyses are shown in the table below by facility type and year. Note that currently there are fewer cost reports available for analysis in 2002 because many facilities have not yet submitted cost reports for that year. The final version of this regulation will contain the most recent data available.



### T ABLE 

### 17

2000 2001 2002

Independent facilities ............ 3,027 3,034 2,508 Hospital-based

facilities ......... 477 466 456



### The average treatment cost per dialysis session for each facility was calculated by dividing the total reported cost for dialysis and related services by the total number of dialysis treatments. The source of the reported cost for independent facilities was Worksheet B from Form CMS 265

– 94 and, for hospital-based facilities, Worksheet I

– 2 (Form CMS 2552

– 96). The source for the total number of dialysis treatments for independent facilities was worksheet
Form CMS265

– 94 and, for hospitalbased facilities, worksheet I

– 4 (Form
CMS 2552

– 96). Note that, for CMS Form

2552

– 96 and CMS Form 265

– 94, values


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in the fields for renal dialysis and home program dialysis were used in the cost and treatment calculations. For the CMS
Form 265

– 94 and the CMS Form 2552

– 96 (Worksheet C, and worksheet I

– 4, respectively) values in the field home program CAPD and home program CCPD were stated in terms of patient weeks, rather than the number of treatments. These cells were multiplied by three to make them comparable to the number of hemodialysis sessions per week. The method used was consistent with the research (Dor, Held, Pauley 1992, Hirth, et.al. , 1999, Griffiths, et.al.

, 1994, and Ozgen and Ozcan, 2002).

This method created an average Medicare allowable cost per dialysis treatment for each facility year of observation. Using the facility ’ s Medicare billing number, cost report data were linked to claims data. For some facilities more than one billing number appears on claims and a list of correspondence among billing was used to link the claims to the cost report facility identifiers. This linkage was somewhat ambiguous for hospital facilities with satellite centers.

Patient level data was obtained from the Medicare claims data, and the Medical Evidence Form (CMS 2728). ESRD patients were identified using the Renal Beneficiary and Utilization System (REBUS), Medical Evidence andMaster Patient File Records. Dialysisrelated services (for example, the number of dialysis sessions) were identified for ESRD patients by Billing source (72x: renal dialysis facility bills), revenue center codes and the Healthcare Common Procedure Coding System (HCPCS).
6. Study Sample

Regression models for the average cost per session were used to estimate the typical cost per session. The average cost per session can be influenced by facilities with exceptional costs or with exceptional case-mix measures. To insure that the sample would characterize the patterns across the majority of facilities rather than beinginfluenced by a few exceptional, nonrepresentative facilities, the following facilities were excluded:

• Facilities with missing data from the cost reports or claims data. Twelve percent of the facilities lacked reported data.

• Facilities with high or low average

costs.

• Facilities with exceptions.

• Facilities with extremely high or low proportions of patients with relevant medical cormorbidities.

• Small facilities. Facilities with high or low average costs were determined based upon their composite rate. Facilities, having values for the log of the ratio of average costs to the composite rate of less than minus 0.5 or greater than 1.0 were excluded. This excluded less than 1 percent of facilities. Some facilities, that is, those with extremely high or low values based on selected patient characteristics (for example, percent of patients having a specific comorbidities such as AIDs, HIV, or alcohol and drug dependence) and selected facility characteristics (for example, facility size or URR). As with average costs, facilities with extreme variables did not represent the normal distribution of patient characteristics across facilities. This excluded 1.6 percent of the facilities. In addition, we excluded small facilities with less than 20 full patient years of dialysis during the year because it was difficult toassess the relationship between casemix and facility costs based on the experience of a small number of patients. Facilities treating a small number of patients represented approximately 6.9 percent of the total facilities.

The sample excluded facilities with exceptional reimbursement levels. These included facilities with exceptions, facilities with higher than average payments, for example, with $3.00 or greater than the predicted composite rate payments. We excluded facilities based on our list of exceptions granted from November 1993 to July 2001. Some facilities were not included within the sample because their average payments were greater than the calculated (predicted) composite rate for the individual facility. While for the majority of the facilities, average composite rate payments were exactly as predicted, for some facilities, the payments were $3.00 greater than the predicted rate. These facilities were excluded because they were likely to be facilities with errors in reporting or facilities with exceptions. Of all of the facilities in the sample, 7.5 of the facilities were excluded from the sample.
7. Developing Case-Mix Measures at Each Facility Based on Patient-Specific
Data

Facility-level case-mix measures were defined using certain demographic and comorbidity indicators for the Medicare dialysis patients in each facility for CYs 2000 to 2002. In aggregating patient data by facility, case-mix measures for each patient were weighted by the number of hemodialysis-equivalent dialysis sessions received in each facility. This process gives approximately 12 times as much weight to the characteristics of patients receiving a full year of dialysis care at a particular facility as compared to a patient receiving only one month of care at that facility. The resulting facility-level case-mix measures reflect how case-mix is distributed across individual treatments provided in the facility for Medicare dialysis patients. The number of dialysis sessions for each patient in each facility was obtained from Medicare outpatient institutional dialysis claims. The number of peritoneal dialysis patient days reported on each claim was multiplied by 3/7 toyield the number of hemodialysisequivalent dialysis sessions provided during the time period covered by each claim. (For additional information see Phase I KECC Report, dated August 2002, p. 43).

8. Statistical Models

We explored a number of statistical methods to model the relationship between composite rate costs and patient/facility characteristics. We explored both linear and log-linear ordinary least squares regression models for each year from 2000 to 2002 to predict the natural log of the ratio of each facility ’ s composite rate costs divided by that facility ’ s composite payment rate (without regard to exception payments).

i. Choice of Estimation Method

We are proposing to use the log linear model in the methodology explained below in order to yield an easily administered case-mix adjuster which can be multiplied by the patient ’ s otherwise applicable composite payment rate. This case-mix adjustment system also controls for selected variables.

We used the cost to payment ratio (that is, the natural log of the ratio of reported costs compared to the composite rate calculated for each facility) as the dependent variable in the models. The analysis that supports our decision is described in detailed below. In order to determine how reimbursement levels could be adjusted to reflect the costs of treating different patients, estimates of how the cost of providing dialysis services (that is, the composite rate) varies according to the patient characteristics (for example, age gender and comorbidities) were completed. Because the reported cost per treatment for each facility, in part, reflects the level of reimbursement (for example, Medicare payments) that the facility received, the measure of facility costs used is defined as the ratio relative to the current standard reimbursement level for each facility. For the purposes


## 47533 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

of these analyses, the standard Medicare reimbursement payments for composite rate services (excluding those facilities with payment exceptions) were used. These currently vary across facilities based on the application of the area wage index used to develop the patient characteristics adjustment. This wage index (that is, labor costs) was used to account for regional differences in labor costs, and includes an adjustment for hospital based versus independent facility status.

As we have indicated, the costs of treatment varies from the composite rate payment for a number of reasons, including differences in the patient case-mix. The ratio of average reported costs at each facility were compared with the calculated composite rate payment in order to measure any variation in costs (that is, facility costs) from the composite rate. This cost to payment ratio measures the extent to which costs at a facility are higher or lower than the payment that would be expected based on their labor costs and facility type. Regression analysis was used to determine the extent to whichthe ratio varied with the average casemix for each facility.

The analysis indicated that a log transformation of this cost to payment ratio was less skewed and a better fit (that is, the predicted variables were closer to the actual values using the log transformation).

ii. Control Variables

Apart from patient clinical and demographic characteristics, the proposed model also controls for selected other variables. These selected control variables include the wage index, the natural log of facility size(number of annual treatments), hospitalbased/independent status, chain affiliation, and percent of patients with urea reduction ratios (URRs) greater than or equal to 65 percent. These control variables were included in the proposed model in order to account for the separate effect of facility variables and one readily available outcome variable on composite rate costs. These control variables were included in order to reduce potential distortion in the patient specific case-mix adjustors attributable to facility characteristics. We included the wage index to account for differences among facilities in area wage levels. We used facility size as a control factor because larger facilities, on average, have lower per treatment costs than smaller facilities. The hospital-based/independent classification was used because hospitalbased providers tend to have higher selfreported costs. Chain ownership is included in the model to account for differences among chains due to reporting conventions, as well as reflect similarities among facilities within chains. The URR was included as a control variable to account for a quality of care outcome measure at each facility, thereby mitigating any potential bias between composite rate costs and quality of care on the model ’ s coefficients.
iii. The Log-Linear Model for Facility
Costs

We identified a limited number of comorbidities that are strong predictors of composite rate costs and developed an estimated adjustment factor for each of these comorbidities. In order to yield an adjustor that can be multiplied with the composite rate payment, the model was used to estimate the facility ’ s reported composite rate costs per treatment, divided by the composite payment rate calculated for each facility. The resulting ratio was modeled using case-mix and control variables. Analysis indicated that a log transformation of this ratio was less skewed and was better fit by the model (that is, predicted values were closer to actual values using the log transformation, especially for high cost facilities).

For facility j, the case-mix is measured by a vector of values, denoted by X j 

### . These values include both control variables and case-mix measures. The log of the ratio of cost per session (C j 

### ) to composite rate (R j 

### ) is denoted by
Y

j 

### =log(C j 

### /R j 

### ). The multiple observations for three years are not indicated explicitly. The model equation is Y j 

### = X j 

### b + e j 

### , where b is the vector of coefficients for the predictor variables and e j 

### is an error term. This model is equivalent to the following model for cost for patient i, with a vector of individual characteristics X ij 

### , at facility j: C ij 

### = R j 

### e Xij 

### b

. 9. Identifying Factors for Case-Mix Adjustment

An evaluation of individual case-mix factors as potential risk adjusters was performed using several criteria to explain variation in facility costs. Consideration was also given to the validity of these potential case adjustors to costs based on clinical judgment, the stability of this relationship over time, the objectivity and accuracy of the data used to compute the factors, the reliability of information reported by different providers, and the feasibility of including them as risk adjusters.

Case-mix factors that explained statistically significant variation in facility costs were identified based on a regression model that used a stepwise selection method. Unless otherwise specified, case-mix measures represent the fraction of dialysis sessions in each facility that were provided to patients having the relevant characteristic or comorbidity. Case-mix measures that were considered for selection in the model included age/gender groups (ages
<65, 65

– 79 and 80+ years, separately for females and males), less than one year of treatment for ESRD, average weight among adult dialysis patients (ages ≥ 20), low body mass index among adult dialysis patients (BMI<18.5 kg/m 2 

### ) and the presence of individual comorbidities that were previously described that were developed from a combination of data from the Medicare claims history file and the CMS Form 2728.
10. Using the Model To Apply a PatientSpecific Case-Mix Adjustment to the Composite Rate

The regression coefficients that are estimated using facility cost model we discuss above can be used to apply a patient-specific case mix adjustment to the composite rate. This is accomplished by re-transforming the estimated coefficients to obtain relative factors for case mix adjustment. Based on a facility level cost model, where X

n 

### is the proportion of patients in a facility having a specific characteristic (for example, a specific comorbidity), a one unit change in X

n 

### can be used to characterize the difference between having and not having a specific patient characteristic. The coefficient for X

n 

### , b

n 

### , then estimates the change in the dependent variable (the natural log of the ratio of average composite rate costs to the composite rate) corresponding to whether or not a patient has that characteristic. The estimated coefficients can be re-transformed as e

Xin 

### b tv to obtain relative factors for n=1 to N case-mix measures included in the model.

The relative factors can then be applied multiplicatively to the composite rate in order to derive a case mix adjusted composite rate. Since these relative factors were all estimated to have values of 1.00 or greater, an adjustment to the composite rate based on these factors would necessarily lead to higher payments by Medicare. However, the MMA provision requires that the modification to the composite rate payment system be budget neutral. For the purpose of this example only, a budget neutrality factor that is less than 1.00 must, therefore, also be applied, with the same factor being applied to all patients and all facilities.

For patient i in facility j, a case-mix adjusted composite rate, AR ij 

### is


## 47534 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

calculated as a function of the current composite rate, R ij 

### , the estimated budget neutrality factor, N (to be determined), and an overall relative factor for case mix adjustment, A ij 

### , where AR ij 

### = R j 

### *
N * A ij 

### , R j 

### = ( r B j 

### W j 

### + (1

¥ r )B j 

### , and A ij



### = e Xij 

### b

.

In the above equations, r is the fraction of costs attributed to labor and therefore subject to an adjustment for geographic differences in wages, 1- r isthe fraction of costs attributed to nonlabor inputs, B j 

### is the base rate for facility j, W j 

### is the CMS/BLS wage index for facility j (with 0.9 and 1.3 representing the minimum and maximum values for W j 

### , respectively),
X ij 

### is a vector of case-mix measures for patient i at facility j, and B is the vector of coefficients estimated by the regression model. Parameters P j 

### and B j 

### vary according to whether facilities are independent or hospital-based and may also vary over time, while W j 

### is determined either by the MSA in which each facility is located or by the state location for facilities not in an MSA.

As suggested by the equations above, the coefficients estimated by the cost model can be used to derive an aggregate relative adjustment factor for each patient (A ij 

### ) based on their individual characteristics (X i 

### ). By applying this factor in a multiplicative fashion to the composite rate, it is also being applied multiplicatively to the wage index, so that the dollar effect of the case-mix adjustment also varies across facilities according to regional differences in labor costs. That is, the case-mix adjustment will be larger in magnitude for facilities that face relatively high labor costs. This is appropriate if we expect the higher level of care that may be necessary for certain types of patients, such as those with PVD, to require additional staff time or more highly trained staff in locales with differential wage levels. An overall relative case-mix adjustment factor for patient i, A i 

### , can be calculated based on the model as A i 

### = e Xi 

### b = e X1i 

### b 1 

### + X2i 

### b 2



### + + Xpi 

### b p



### .

However, since this is equivalent to A i



### = e Xi 

### b = e X1i 

### b 1 

### *e X2i 

### b 2 

### * . . . *e Xni 

### b n



### , the overall relative case-mix adjustment factor, or patient multiplier, can be calculated by multiplying together therelative adjustment factors for each casemix measure. For every n=1 to p, X pi 

### corresponds to a 1 if that characteristic is present and a 0 if that characteristic is not present. For any characteristic that is not present, X pi 

### =0 and e Xpi 

### b p 

### =1, such that the equation can be simplified by including only those terms that are relevant for each patient. For characteristics that are present, X pi 

### =1, and the equation can be further simplified by dropping X pi


### .

Where the individual factors for casemix adjustment are age/gender, PVD and AIDS, the equation used to calculate the relative factor for case mix adjustment can then be expressed as A i



### =e β 

### = e β AS 

### *e β PVD 

### *e β AIDS 

### where e β AS 

### is the relative factor for the appropriate age and sex category (one of six age/sex groups), e β PVD 

### is the relative factor for the relevant PVD category (whether PVD is present or absent) and e β AIDS 

### is the relative factor for the appropriate AIDS category (whether AIDS is present or absent).
11. Example

To illustrate, the proposed adjustment factors in section 4. above were used to derive a case-mix multiplier for a 7-year old male who has been diagnosed with PVD, but not AIDS. Using the proposed adjustment factors that correspond to males between the ages of 65 and 79 years and the presence of PVD, the overall case-mix multiplier for this patient is calculated as A = e Xb 

### =

e β AS 

### *e β PVD 

### = 1.17 × 1.07 = 1.2519.

A detailed example of the computation of the adjusted composite payment rate that includes the patient characteristics adjustments, as well as the applicable adjustments related to the ESRD drug payment revisions and budget neutrality, is provided later in this section I. below.
e. Geographic Index

Section 623(d)(1) of the MMA provides that the Secretary shall adjust the payment rates under this section by a geographic index as the Secretary determines to be appropriate. This section also specifies that, if the Secretary revises the current geographic adjustments applied to the composite payment rate, the revised adjustments must be phased in over a period of time. The current geographic adjustment (wage index) is a blend of two wage indexes, one based on hospital wage data collected by us from fiscal year 1986 and the other developed from 1980 hospital wage and employment data from the Bureau of Labor Statistics (BLS). The hospital and BLS proportions of the blended wage index are 40 percent and 60 percent. Theactual wage index values and MSA/nonMSA designations currently used in connection with the composite rates were published in the August 15, 1986 Federal Register (51 FR 29412

– 29417). For the reasons discussed below, we have decided not to propose any changes to the current wage index adjustments at this time. On June 6, 2003, OMB issued Bulletin

03

– 04 that announced new MSAs and two new sets of statistical areas, Micropolitan Statistical Areas and Combined Statistical Areas (CSAs). We recognize that the new OMB definitions will have implications for the various payment systems we administer that reflect payment distinctions based on geographic location. Any changes adopted will not only result in payment redistributions among ESRD facilities, but will also affect hospitals, home health agencies, skilled nursing facilities, and rehabilitation providers.

Therefore, it is essential that we evaluate any proposals to revise the area definitions and assess the impact of changes in geographical areas on those payment systems that incorporate adjusters for area wage levels among urban and rural locations.

Although the MMA gives the Secretary discretion to revise the outdated wage indexes used in the composite rates, we believe that we should take no action to replace them with revised measures pending completion of our assessments.

Therefore, we are proposing to take no action at this time to revise the current set of composite rate wage indexes and the urban and rural definitions used to develop them. Once revisions to the urban and rural definitions are adopted, we may be in a better position to propose revisions to the geographic adjustments applied to the case-mix adjusted composite payment rates.

For purposes of applying the required geographic adjustments to the case-mix adjusted composite rate payment system, we are proposing to continue using the wage index values and urban and rural designations that are currently applied to the composite payment rates.

Section 1881(b)(12)(E)(i) of the Act, as added by section 623(d)(1) of the MMA, requires that the basic case-mix adjusted composite rate system be designed to result in the same aggregate amount of expenditure for such services, as estimated by the Secretary, as would have been made for 2005 if that paragraph did not apply. Therefore, the drug add-on adjustment and the patient characteristics case-mix adjustment required by section 623(d)(1) of the MMA must result in the same aggregate expenditures for 2005 as if these adjustments were not made.

With respect to the drug payment add-on adjustment the total estimated difference between the current drug payment based on 95 percent of AWP and the payment amount generated from payment based on ASP minus 3 percent is reflected in the proposed adjustment which is designed so that aggregate


## 47535 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

payments are budget neutral. (See section H.4.c.2. of this proposed rule formore detailed explanation of drug addon adjustment).

In order to account for the payment effect related to the case-mix adjustment, we standardized the composite rate by dividing the rate by the average case-mix modifier of 1.1919. (See section 4.ii Proposed Cormorbidity Adjustments). The resulting adjustment to the composite rate is .8390. However,we were not able to simulate the casemix effects from the ESRD billing file because comorbidities are generally not included on the ESRD bill. (See section H.3. of this proposed rule for the discussion of the data issues.) We propose to refine our adjustments for case-mix once we have more complete data on the ESRD bill.
F. Payment Exceptions and the Revised Composite Payment Rates

Before the enactment of BIPA, an ESRD facility could apply for and receive prospective adjustments or exceptions to its otherwise applicable composite payment rate under specified circumstances. Section 1881(b)(7) of the Act and § 413.182 contain the statutory and regulatory authorities for the provision of exceptions to the composite payment rates. Section 422(a)(2) of BIPA prohibited the granting of new exceptions to the composite payment rates on or after December 31, 2000, except under very limited circumstances, which expired July 1, 2001. That prohibition remains in effect, with one exception. Section 623(b) of the MMA amended section 422(a)(2) of BIPA to afford pediatric facilities the opportunity to seek exceptions provided they did not have an exception rate in effect as of October 1, 2002. The statute defines a pediatric facility as a renal facility, 50 percent of whose patients are under age 18. On April 1, 2004, we opened an exception window for pediatric facilities. The exception window closes September 27, 2004.

Section 422(a)(2)(C) of BIPA provided that any ESRD composite rate exception in effect on December 31, 2000 would continue as long as the exception rate exceeds the applicable composite payment rate. The MMA did not revise that provision. Comparisons of a provider ’ s exception rate and the standard composite payment rate are straightforward, because each payment rate was applied on a facility specificbasis, without any adjustments for casemix. However, in this proposed rule, we are proposing revised composite payment rates that are case-mix adjusted. The wage adjusted composite payment rates listed for each urban and rural area noted in Tables I and II at the end of this section, although applied on a per treatment basis, are subject to case mix adjustments in accordance with section 623(d)(1) of the MMA. The proposed methodology for applying patient characteristic adjusters applicable to each treatment will determine the case-mix adjustment which will vary for each patient. Thus, an ESRD facility ’ s average composite rate per treatment will depend on its unique case mix.

Our policy was not to increase any ESRD facility ’ s exception rate when there has been a congressionally mandated update to the ESRD composite payment rates. When computing an exception amount, we take into consideration the ESRD facility ’ s patient population and the higher costs relating to the patient mix. Since ESRD facilities can maintain their current exception rates, we would expect them to compare the exception rate to the basic case-mix adjusted composite rate to determine the best payment rate for their facility. We are proposing to allow each dialysis facility the option of continuing to be paid at its exception rate or at the basic case-mix adjusted composite rate (which includes all the MMA 623 payment adjustments). If the facility retains its exception rate, it would not be subject to any of the adjustments specified in section 623 of the MMA. Whether a provider ’ s exception rate in effect on December 31, 2000 will exceed its average case-mix adjusted composite payment rate is impossible for us to accurately determine. We believe that projections as to whether an ESRD facility ’ s exception rate per treatment will exceed its average case-mix adjusted composite rate per treatment are best left to the entities affected. Therefore, we are proposing that each ESRD facility with composite rate exceptions currently in effect, and each pediatric ESRD facility granted an exception, must notify its fiscal intermediary in writing if it wishes to withdraw its exception and be subject to the basic case-mix adjusted composite payment rate methodology set forth in this notice.

We are proposing to allow an ESRD facility to notify its fiscal intermediary at any time if it wishes to give up its exception rate. Once a facility has notified its fiscal intermediary of its election to give up its exception rate, it would lose that exception rate, regardless of basis or amount, and be subject to the proposed case-mix adjusted composite payment rates beginning 30 days after the intermediary ’ s receipt of the facility ’ s notification letter. Facilities with exception rates will be required to notify their fiscal intermediaries only if they wish to forego their exceptions. ESRD facilities electing to retain their exceptions do not need to notify their intermediaries. ESRD facilities without exceptions, of course, will be subject to the composite payment rates determined using the basic case-mix methodology described in this notice beginning January 1, 2005.
G. Summary of Composite Rate Revisions and Proposed Implementation

As set forth in this proposed rule, we will increase the ESRD composite payment rates by 1.6 percent effective January 1, 2005 in accordance with section 623(a) of the MMA. Also, the composite payment rates will be increased to reflect revisions to the drug pricing methodology for separately billable drugs, as discussed in section H.4.b. of this proposed rule. That increase represents the spread or difference between the payment amounts for separately billable drugs and biologicals and their acquisition costs based on the OIG ’ s May 2004 report to the Secretary. The development and computation of the drug add-on adjustment are described in section H.4.c of this proposed rule. We have also proposed a basic case-mix methodology for adjusting the composite payment rates based on a limited number of patient characteristics, as prescribed in section 623(d) of the MMA. The development and application of the case-mix adjusters are explained in section H.4.d.4 of this proposed rule. The MMA requires that the basic case-mix adjusted composite payment rates be effective for services furnished beginning January 1, 2005. Despite the law ’ s specificity with respect to effective date, the systems and operational changes necessary to apply the case-mix adjusters cannot be completed in time for a prospective January 1, 2005 effective date.

The 1.6 percent statutory increase and 11.3 drug add-on for independent and hospital-based facilities for separately billable drugs will be applied to the composite rates for all ESRD facilities beginning January 1, 2005. However, the computation of the case mix adjusters depends on age, sex, and specific comorbidities which must be obtained from the bills for each ESRD facility. Therefore, the combination of case-mix adjusters used to increase a provider ’ s otherwise applicable composite payment rate depends on a provider ’ sunique patient profile and is facilityspecific. The correct computation of these facility-specific case-mix adjusters will require numerous programming,


## 47536 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

systems, billing, and instructional changes by us, fiscal intermediaries, and system maintainers. In addition, providers and their fiscal intermediaries will require education and training not only on the basic features of the new ESRD PPS, but also on the proper reporting of patient and clinical information on the bills, essential for an accurate case mix adjustment in connection with each patient ’ s claims.

Given these requirements, the lead time necessary for systems changes, and the anticipated time necessary for providers and their fiscal intermediaries to familiarize themselves with and correctly apply the basic case-mix adjustments, we are proposing an April 1, 2005 effective date.

As an alternative to an April 1, 2005 effective date for the patient characteristic case mix adjustments, we considered two options for an April 1, 2005 prospective implementation date that would effectively comply with the
MMA ’ s January 1, 2005 effective date. Under the first option, we would implement the patient characteristic adjustments on April 1, 2005 and reprocess bills and adjust payments to January 1, 2005. Under this option, the budget neutrality adjustment related to the patient characteristic factors would not be applied to the composite rate until bills are reprocessed.

The second option that we considered was to make payment to facilities starting January 1, 2005, at the budget neutralized composite rate, until the systems changes for the case-mix adjustment can be implemented, April 1, 2005. Payment at this rate would avoid overpayments, and thus, the need to recoup moneys that may occur when we retroactively process the claims for case-mix adjustments on April 1, 2005. Under this option, facilities would receive approximately 16 percent less than they would otherwise be entitled to on January 1, 2005.

We rejected both of these alternatives. Both options require the reprocessing and adjustment of bills for the first quarter of 2005. In addition, because of the likelihood of payment error due to the complexity of the process and costly implementation and potential disruption of payment to ESRD facilities, we believe that these options are problematic. Given that the expected impact of the patient characteristic adjustments on ESRD facility payments will, for the most part, be minimal, we believe that applying the adjustments prospectively from April 1, 2005 provides a smoother transition to the new payment methodology.

Finally, this notice provides for a budget neutrality reduction of .8390 percent to the case-mix adjusted composite payment rates. Our budget neutrality methodology is explained in section H.4.f. of this proposed rule. Because section 623(d) of the MMA requires that budget neutrality be applied in the context of implementing the case-mix adjusted composite rate payment system, we are proposing that the effective date of the budget neutrality adjustment should also be April 1, 2005. If we applied the budget neutrality adjustment in January, rather than when the case-mix adjustment is applied in April, the result would be that all the composite rates would go down.

We are specifically soliciting comments on these options of the proposed rule. However, the 1.6 percent statutory increase to the composite payment rates, and the drug add-on for separately billable drugs, will be effective January 1, 2005, as these adjustments are easily implemented prospectively.
IV. Example of Payment Calculation Under the Proposed Case-Mix Adjusted Composite Rate System

The following example presents 2 patients dialyzing at Neighbor Dialysis, an independent facility in Baltimore, MD. Patient #1, John Smith, is a 71-year old male who has been diagnosed with PVD and AIDS. Patient #2, Jane Doe, is a 59-year old female who has been diagnosed with PVD.
Calculation of Basic Composite Rate for Neighbor Dialysis
Wage adjusted Composite Rate for

independent facilities in Baltimore, Md. (Table I): $134.93 Wage adjusted Composite Rate

increased by proposed drug add-on adjustment ($134.93 x 1.113): $150.18 Adjusted Facility Composite Rate after

budget neutrality (150.18 x .8490): $126.00
Calculation of Case-mix Adjusted Payments

Patient #1

— John Smith: Male age 65

– 79 years: 1.17
AIDS: 1.15

PVD: 1.07 Case-mix adjusted rate for John Smith

($126.00 x 1.17 x 1.15 x 1.07): $181.40

Patient #2

— Jane Doe: Female age < 65 years: 1.11

PVD: 1.07 Case-mix adjusted rate for Jane Doe

($126.00 x 1.11 x 1.07): $149.65



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MSA code Name of MSA State Hospital Independent

0040 .................. ABILENE .................................................................................................. ....... TX ................ 127.58 123.18 0060 .................. AGUADILLA ................................................................................................ .... PR ............... 127.57 123.18 0080 .................. AKRON .................................................................................................... ....... OH ............... 137.39 133.68
0120 .................. ALBANY ................................................................................................... ....... GA ............... 127.57 123.18 0160 .................. ALBANY-SCHENECTADY-TROY .................................................................. NY .............. . 129.93 125.70 0200 .................. ALBUQUERQUE ............................................................................................ NM ............... 135.60 131.77 0220 .................. ALEXANDRIA ............................................................................................... .. LA ................ 129.70 125.46 0240 .................. ALLENTOWN-BETHLEHEM .......................................................................... PA-NJ ....... ... 134.75 130.87 0280 .................. ALTOONA .................................................................................................. ..... PA ............... 133.79 129.84 0320 .................. AMARILLO ................................................................................................. ..... TX ................ 130.03 125.80 0360 .................. ANAHEIM-SANTA ANA .................................................................................. CA .... ........... 145.72 142.64 0380 .................. ANCHORAGE ................................................................................................ . AK ............... 146.35 146.35 0400 .................. ANDERSON ................................................................................................. ... IN ................ 131.74 127.63 0405 .................. ANDERSON ................................................................................................. ... SC ............... 127.57 123.18 0440 .................. ANN ARBOR ................................................................................................ .. MI ................ 145.80 142.71 0450 .................. ANNISTON ................................................................................................. .... AL ................ 127.57 123.18 0460 .................. APPLETON-OSHKOSH-NEENAH ................................................................. WI ............... . 132.60 128.56 0470 .................. ARECIBO .................................................................................................. ...... PR ............... 127.57 123.18 0480 .................. ASHEVILLE ................................................................................................ .... NC ............... 130.57 126.39 0500 .................. ATHENS ................................................................................................... ...... GA ............... 127.57 123.18


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0520 .................. ATLANTA .................................................................................................. ...... GA ............... 130.07 125.84 0560 .................. ATLANTIC CITY ............................................................................................ . NJ ................ 134.72 130.82 0600 .................. AUGUSTA .................................................................................................. ..... GA-SC ......... 130.08 125.85 0620 .................. AURORA-ELGIN ............................................................................................. IL ................. 140.21 136.70 0640 .................. AUSTIN ................................................................................................... ........ TX ................ 135.14 131.29 0680 .................. BAKERSFIELD .............................................................................................. . CA ............... 141.64 138.25 0720 .................. BALTIMORE ................................................................................................ ... MD ............... 138.55 134.93 0733 .................. BANGOR ................................................................................................... ..... ME ............... 129.34 125.09 0760 .................. BATON ROUGE ............................................................................................. L A ................ 131.80 127.71 0780 .................. BATTLE CREEK ............................................................................................. MI ................ 134.05 130.11 0840 .................. BEAUMONT-PORT ARTHUR ........................................................................ TX ........... ..... 130.85 126.67 0845 .................. BEAVER COUNTY ......................................................................................... PA . .............. 138.52 134.89 0860 .................. BELLINGHAM ............................................................................................... .. WA .............. 132.87 128.85 0870 .................. BENTON HARBOR ........................................................................................ MI .. .............. 127.57 123.18 0875 .................. BERGEN-PASSAIC ........................................................................................ NJ . ............... 142.22 140.71 0880 .................. BILLINGS ................................................................................................. ....... MT ............... 132.16 128.08 0920 .................. BILOXI-GULFPORT ........................................................................................ MS ............... 127.57 123.18 0960 .................. BINGHAMTON ............................................................................................... . NY ............... 130.00 125.77 1000 .................. BIRMINGHAM ............................................................................................... .. AL ................ 131.83 127.73 1010 .................. BISMARCK ................................................................................................. .... ND ............... 130.64 126.47 1020 .................. BLOOMINGTON ............................................................................................. I N ................ 129.78 125.54 1040 .................. BLOOMINGTON-NORMAL ............................................................................ IL ......... ........ 129.69 125.45 1080 .................. BOISE CITY ............................................................................................... ..... ID ................ 135.23 131.39 1123 .................. BOSTON-SALEM-BROCKTON ...................................................................... MA ............ ... 139.45 135.89 1125 .................. BOULDER-LONGMONT ................................................................................. CO ...... ......... 140.62 137.15 1140 .................. BRADENTON ................................................................................................ . FL ................ 128.79 124.47 1145 .................. BRAZORIA ................................................................................................. ..... TX ................ 134.02 130.08 1150 .................. BREMERTON ................................................................................................ . WA .............. 129.14 124.87 1163 .................. BRIDGEPORT-NORWALK-DANBURY .......................................................... CT ............... 141. 49 138.08 1240 .................. BROWNSVILLE-HARLINGEN ........................................................................ TX .......... ...... 129.79 125.56 1260 .................. BRYAN-COLLEGE STATION ......................................................................... TX ......... ....... 128.68 124.37 1280 .................. BUFFALO .................................................................................................. ..... NY ............... 133.55 129.59 1300 .................. BURLINGTON ............................................................................................... . NC ............... 127.57 123.18 1303 .................. BURLINGTON ............................................................................................... . VT ................ 131.37 127.24 1310 .................. CAGUAS ................................................................................................... ...... PR ............... 127.57 123.18 1320 .................. CANTON ................................................................................................... ...... OH ............... 131.51 127.40 1350 .................. CASPER ................................................................................................... ...... WY .............. 136.29 132.52 1360 .................. CEDAR RAPIDS ............................................................................................. IA ................. 131.05 126.92 1400 .................. CHAMPAIGN-URBANA-RANTOUL ................................................................ IL ............... .. 133.39 129.39 1440 .................. CHARLESTON ............................................................................................... SC ............... 131.44 127.33 1480 .................. CHARLESTON ............................................................................................... WVA ............ 135.86 132.06 1520 .................. CHARLOTTE-ROCK HILL .............................................................................. NC-SC ... ...... 129.79 125.57 1540 .................. CHARLOTTESVILLE ...................................................................................... VA .. ............. 133.15 129.15 1560 .................. CHATTANOOGA ............................................................................................ TN -GA ......... 132.45 128.39 1580 .................. CHEYENNE ................................................................................................. ... WY .............. 131.21 127.06 1600 .................. CHICAGO .................................................................................................. ..... IL ................. 142.79 139.48 1620 .................. CHICO .................................................................................................... ........ CA ............... 139.53 135.98 1640 .................. CINCINNATI ............................................................................................... .... OH-KY-IN .... 137.22 133.50 1660 .................. CLARKSVILLE-HOPKINSVILLE ..................................................................... TN-KY ....... .. 127.57 123.18 1680 .................. CLEVELAND ................................................................................................ ... OH ............... 141.66 138.27 11720 ................ COLORADO SPRINGS .................................................................................. CO ...... ......... 135.83 132.03 1740 .................. COLUMBIA ................................................................................................. .... MO .............. 140.08 136.56 1760 .................. COLUMBIA ................................................................................................. .... SC ............... 130.43 126.24 1800 .................. COLUMBUS ................................................................................................. ... GA-AL ......... 128.15 123.79 1840 .................. COLUMBUS ................................................................................................. ... OH ............... 134.12 130.19 1880 .................. CORPUS CHRISTI ......................................................................................... TX ................ 131.52 127.41 1900 .................. CUMBERLAND ............................................................................................... MD-WVA ..... 128.22 123.87 1920 .................. DALLAS ................................................................................................... ....... TX ................ 134.47 130.56 1950 .................. DANVILLE ................................................................................................. ...... VA ............... 127.57 123.18 1960 .................. DAVENPORT-MOLINE ................................................................................... IA-IL . ........... 133.12 129.11 2000 .................. DAYTON-SPRINGFIELD ................................................................................ OH ..... .......... 137.82 134.14 2020 .................. DAYTONA BEACH ......................................................................................... FL . ............... 127.85 123.47 2030 .................. DECATUR .................................................................................................. ..... AL ................ 127.57 123.18 2040 .................. DECATUR .................................................................................................. ..... IL ................. 131.69 127.57 2080 .................. DENVER ................................................................................................... ...... CO ............... 143.60 140.35 2120 .................. DES MOINES ............................................................................................... .. IA ................. 135.21 131.36 2160 .................. DETROIT .................................................................................................. ...... MI ................ 143.03 139.73 2180 .................. DOTHAN ................................................................................................... ...... AL ................ 127.57 123.18 2200 .................. DUBUQUE .................................................................................................. .... IA ................. 132.63 128.61 2240 .................. DULUTH ................................................................................................... ...... MN-WI ......... 130.10 125.88 2290 .................. EAU CLAIRE ............................................................................................... ... WI ................ 128.84 124.53


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2320 .................. EL PASO .................................................................................................. ...... TX ................ 128.41 124.08 2330 .................. ELKHART-GOSHEN ....................................................................................... IN .. .............. 129.30 125.01 2335 .................. ELMIRA ................................................................................................... ........ NY ............... 132.63 128.60 2340 .................. ENID ..................................................................................................... .......... OK ............... 129.51 125.24 2360 .................. ERIE ..................................................................................................... ........... PA ............... 131.82 127.74 2400 .................. EUGENE-SPRINGFIELD ................................................................................ OR ..... .......... 133.37 129.37 2440 .................. EVANSVILLE ............................................................................................... ... IN-KY ........... 134.10 130.16 2520 .................. FARGO-MOORHEAD ..................................................................................... ND-MN . ....... 133.83 129.88 2560 .................. FAYETTEVILLE ............................................................................................. . NC ............... 127.57 123.18 2580 .................. FAYETTEVILLE-SPRINGDALE ...................................................................... AR .......... ..... 127.57 123.18 2640 .................. FLINT .................................................................................................... .......... MI ................ 141.83 138.45 2650 .................. FLORENCE ................................................................................................. ... AL ................ 127.57 123.18 2655 .................. FLORENCE ................................................................................................. ... SC ............... 127.57 123.18 2670 .................. FORT COLLINS-LOVELAND ......................................................................... CO ......... ...... 131.49 127.38 2680 .................. FT LAUDERDALE-POMPANO BEACH ......................................................... FL ................ 137 .23 133.51 2700 .................. FORT MYERS-CAPE CORAL ........................................................................ FL .......... ...... 129.73 125.49 2710 .................. FORT PIERCE .............................................................................................. .. FL ................ 130.09 125.87 2720 .................. FORT SMITH ............................................................................................... ... AR-OK ......... 128.97 124.67 2750 .................. FORT WALTON BEACH ................................................................................ FL ...... .......... 127.57 123.18 2760 .................. FORT WAYNE ............................................................................................... . IN ................ 129.32 125.05 2800 .................. FORT WORTH-ARLINGTON ......................................................................... TX .......... ...... 133.06 129.04 2840 .................. FRESNO ................................................................................................... ...... CA ............... 142.09 138.72 2880 .................. GADSDEN .................................................................................................. .... AL ................ 128.48 124.17 2900 .................. GAINESVILLE .............................................................................................. ... FL ................ 130.25 126.06 2920 .................. GALVESTON-TEXAS CITY ............................................................................ TX ....... ......... 137.86 134.20 2960 .................. GARY-HAMMOND .......................................................................................... IN . ............... 138.47 134.85 2975 .................. GLENS FALLS .............................................................................................. .. NY ............... 128.98 124.68 2985 .................. GRAND FORKS ............................................................................................. N D ............... 129.26 124.98 3000 .................. GRAND RAPIDS ............................................................................................ M I ................ 133.41 129.44 3040 .................. GREAT FALLS .............................................................................................. . MT ............... 132.09 128.01 3060 .................. GREELEY .................................................................................................. ..... CO ............... 134.34 130.43 3080 .................. GREEN BAY ................................................................................................ ... WI ................ 133.34 129.33 3120 .................. GREENSBORO-WINSTON SALEM-HIGH PT ............................................... NC ............... 129.67 12 5.42 3160 .................. GREENVILLE-SPARTANBURG ..................................................................... SC ............ ... 130.15 125.95 3180 .................. HAGERSTOWN .............................................................................................. M D ............... 132.79 128.78 3200 .................. HAMILTON-MIDDLETOWN ............................................................................ OH ........ ....... 134.87 130.98 3240 .................. HARRISBURG-LEBANON-CARLISLE ........................................................... PA ............... 13 3.92 129.97 3283 .................. HARTFORD-NEW BRITAIN-BRISTOL .......................................................... CT ............... 14 0.38 136.90 3290 .................. HICKORY .................................................................................................. ...... NC ............... 127.57 123.18 3320 .................. HONOLULU ................................................................................................. ... HI ................ 141.73 138.34 3350 .................. HOUMA-THIBODAUX .................................................................................... LA .... ............ 128.02 123.66 3360 .................. HOUSTON .................................................................................................. .... TX ................ 137.24 133.53 3400 .................. HUNTINGTON-ASHLAND .............................................................................. WVA-KY-OH 130.11 125.88 3440 .................. HUNTSVILLE ............................................................................................... ... AL ................ 127.57 123.18 3480 .................. INDIANAPOLIS ............................................................................................. .. IN ................ 135.16 131.30 3500 .................. IOWA CITY ................................................................................................ ..... IA ................. 143.23 140.37 3520 .................. JACKSON .................................................................................................. ..... MI ................ 134.43 130.53 3560 .................. JACKSON .................................................................................................. ..... MS ............... 128.82 124.51 3580 .................. JACKSON .................................................................................................. ..... TN ............... 127.57 123.18 3600 .................. JACKSONVILLE ............................................................................................. FL ................ 130.77 126.58 3605 .................. JACKSONVILLE ............................................................................................. NC ............... 127.75 123.37 3620 .................. JANESVILLE-BELOIT ..................................................................................... WI . ............... 128.39 124.05 3640 .................. JERSEY CITY .............................................................................................. ... NJ ................ 138.46 134.84 3660 .................. JOHNSON CITY-BRISTOL ............................................................................ TN-VA .... ..... 127.57 123.18 3680 .................. JOHNSTOWN ................................................................................................ . PA ............... 133.36 129.36 3690 .................. JOLIET ................................................................................................... ......... IL ................. 140.66 137.19 3710 .................. JOPLIN ................................................................................................... ........ MO .............. 127.97 123.61 3720 .................. KALAMAZOO ................................................................................................ .. MI ................ 143.25 139.98 3740 .................. KANKAKEE ................................................................................................. .... IL ................. 130.84 126.66 3760 .................. KANSAS CITY .............................................................................................. .. MO-KS ........ 133.22 129.21 3800 .................. KENOSHA .................................................................................................. .... WI ................ 137.39 133.69 3810 .................. KILLEEN-TEMPLE .......................................................................................... T X ................ 128.12 123.75 3840 .................. KNOXVILLE ................................................................................................ .... TN ............... 127.83 123.45 3850 .................. KOKOMO ................................................................................................... ..... IN ................ 132.39 128.34 3870 .................. LA CROSSE ................................................................................................ ... WI ................ 131.00 126.87 3880 .................. LAFAYETTE ................................................................................................ ... LA ................ 132.84 128.83 3920 .................. LAFAYETTE ................................................................................................ ... IN ................ 128.65 124.33 3960 .................. LAKE CHARLES ............................................................................................. LA ................ 130.17 125.97 3965 .................. LAKE COUNTY .............................................................................................. IL ................. 141.41 137.98 3980 .................. LAKELAND-WINTER HAVEN ........................................................................ FL .......... ...... 127.57 123.18 4000 .................. LANCASTER ................................................................................................ .. PA ............... 135.38 131.54


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4040 .................. LANSING-EAST LANSING ............................................................................. MI ...... .......... 135.98 132.18 4080 .................. LAREDO ................................................................................................... ...... TX ................ 127.57 123.18 4100 .................. LAS CRUCES ............................................................................................... .. NM ............... 127.57 123.18 4120 .................. LAS VEGAS ................................................................................................ .... NV ............... 141.01 137.58 4150 .................. LAWRENCE ................................................................................................. ... KS ............... 131.82 127.73 4200 .................. LAWTON ................................................................................................... ...... OK ............... 130.27 126.08 4243 .................. LEWISTON-AUBURN ..................................................................................... ME ... ............ 128.39 124.06 4280 .................. LEXINGTON-FAYETTE .................................................................................. KY .... ........... 130.21 126.01 4320 .................. LIMA ..................................................................................................... ........... OH ............... 133.29 129.29 4360 .................. LINCOLN .................................................................................................. ...... NE ............... 129.96 125.72 4400 .................. LITTLE ROCK-N LITTLE ROCK .................................................................... AR .......... ..... 135.96 132.17 4420 .................. LONGVIEW-MARSHALL ................................................................................ TX ...... ......... 127.57 123.18 4440 .................. LORAIN-ELYRIA ............................................................................................ . OH ............... 134.22 130.30 4480 .................. LOS ANGELES-LONG BEACH ...................................................................... CA ........... .... 146.35 145.02 4520 .................. LOUISVILLE ............................................................................................... .... KY-IN ........... 134.40 130.50 4600 .................. LUBBOCK .................................................................................................. ..... TX ................ 129.87 125.63 4640 .................. LYNCHBURG ................................................................................................ . VA ............... 128.00 123.63 4680 .................. MACON-WARNER ROBINS .......................................................................... GA .......... ..... 129.46 125.19 4720 .................. MADISON .................................................................................................. ..... WI ................ 135.45 131.63 4763 .................. MANCHESTER-NASHUA ............................................................................... NH ....... ........ 131.20 127.04 4800 .................. MANSFIELD ................................................................................................ ... OH ............... 130.40 126.20 4840 .................. MAYAGUEZ ................................................................................................. ... PR ............... 127.57 123.18 4880 .................. MCALLEN-EDINBURG-MISSION .................................................................. TX ............. ... 127.57 123.18 4890 .................. MEDFORD .................................................................................................. .... OR ............... 133.00 128.99 4900 .................. MELBOURNE-TITUSVILLE ............................................................................ FL ....... ......... 130.19 125.99 4920 .................. MEMPHIS .................................................................................................. ..... TN-AR-MS ... 135.10 131.23 4940 .................. MERCED ................................................................................................... ..... CA ............... 138.45 134.83 5000 .................. MIAMI-HIALEAH ............................................................................................ . FL ................ 138.47 134.85 5015 .................. MIDDLESEX-HUNTERDON ........................................................................... NJ ......... ....... 134.87 130.99 5040 .................. MIDLAND .................................................................................................. ...... TX ................ 135.10 131.24 5080 .................. MILWAUKEE ................................................................................................ .. WI ................ 136.75 133.02 5120 .................. MINNEAPOLIS-ST PAUL ............................................................................... MN-WI .. ....... 136.11 132.33 5160 .................. MOBILE ................................................................................................... ....... AL ................ 129.00 124.70 5170 .................. MODESTO .................................................................................................. .... CA ............... 138.05 134.41 5190 .................. MONMOUTH-OCEAN .................................................................................... NJ ..... ........... 133.08 129.06 5200 .................. MONROE ................................................................................................... ..... LA ................ 129.18 124.90 5240 .................. MONTGOMERY ............................................................................................. AL ................ 130.14 125.92 5280 .................. MUNCIE ................................................................................................... ....... IN ................ 131.36 127.22 5320 .................. MUSKEGON ................................................................................................. .. MI ................ 131.68 127.57 5345 .................. NAPLES ................................................................................................... ....... FL ................ 130.55 126.35 5360 .................. NASHVILLE ................................................................................................ .... TN ............... 132.71 128.70 5380 .................. NASSAU-SUFFOLK ....................................................................................... NY .. ............. 146.35 144.35 5403 .................. NEW BEDFORD-FALL RIVER-ATTELBORO ................................................ MA ............... 131.79 1 27.70 5483 .................. NEW HAVEN-WATERBURY-MERIDEN ........................................................ CT ............... 137.5 0 133.80 5523 .................. NEW LONDON-NORWICH ............................................................................ CT ......... ...... 137.24 133.52 5560 .................. NEW ORLEANS ............................................................................................. L A ................ 130.68 126.50 5600 .................. NEW YORK ................................................................................................. ... NY ............... 146.35 146.35 5640 .................. NEWARK ................................................................................................... ..... NJ ................ 141.09 137.67 5700 .................. NIAGARA FALLS ............................................................................................ NY ............... 130.31 126.11 5720 .................. NORFOLK-NEWPORT NEWS ....................................................................... VA ............ ... 129.67 125.42 5775 .................. OAKLAND .................................................................................................. ..... CA ............... 146.35 145.92 5790 .................. OCALA .................................................................................................... ........ FL ................ 128.79 124.48 5800 .................. ODESSA ................................................................................................... ...... TX ............... 129.63 125.38 5880 .................. OKLAHOMA CITY .......................................................................................... OK ............... 134.67 130.78 5910 .................. OLYMPIA .................................................................................................. ...... WA .............. 135.49 131.66 5920 .................. OMAHA .................................................................................................... ....... NE-IA ........... 132.99 128.98 5950 .................. ORANGE COUNTY ........................................................................................ NY .. ............. 132.46 128.39 5960 .................. ORLANDO .................................................................................................. .... FL ................ 132.46 128.39 5990 .................. OWENSBORO ................................................................................................ KY ............... 127.57 123.18 6000 .................. OXNARD-VENTURA ...................................................................................... CA ... ............ 146.28 145.05 6015 .................. PANAMA CITY .............................................................................................. . FL ................ 127.57 123.18 6020 .................. PARKERSBURG-MARIETTA ......................................................................... WVA-OH ..... 1 30.89 126.73 6025 .................. PASCAGOULA ............................................................................................... MS ............... 135.50 131.67 6080 .................. PENSACOLA ................................................................................................ .. FL ................ 128.26 123.91 6120 .................. PEORIA ................................................................................................... ....... IL ................. 136.83 133.10 6160 .................. PHILADELPHIA ............................................................................................. . PA-NJ .......... 141.48 138.07 6200 .................. PHOENIX .................................................................................................. ...... AZ ................ 137.96 134.32 6240 .................. PINE BLUFF ............................................................................................... .... AR ............... 127.57 123.18 6280 .................. PITTSBURGH ............................................................................................... .. PA ............... 138.69 135.09 6323 .................. PITTSFIELD ............................................................................................... ..... MA ............... 133.87 129.91 6360 .................. PONCE .................................................................................................... ....... PR ............... 127.57 123.18


## 47540 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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— C OMPOSITE 

### P AYMENT 

### R ATES 

### E FFECTIVE 

### J ANUARY 

### 1, 2005

— Continued

[For urban renal facilities]

MSA code Name of MSA State Hospital Independent

6403 .................. PORTLAND ................................................................................................. ... ME ............... 132.96 128.94 6440 .................. PORTLAND ................................................................................................. ... OR ............... 139.91 136.40 6453 .................. PORTSMOUTH-DOVER-ROCHESTER ......................................................... NH-ME ........ 128.29 12 3.95 6460 .................. POUGHKEEPSIE ........................................................................................... NY ............... 135.84 132.03 6483 .................. PROVIDENCE-PAWTUCKET-WOONSOCKET ............................................. RI ................ 134.58 130. 69 6520 .................. PROVO-OREM ............................................................................................... UT ............... 130.42 126.22 6560 .................. PUEBLO ................................................................................................... ...... CO ............... 137.23 133.52 6600 .................. RACINE ................................................................................................... ....... WI ................ 129.52 125.26 6640 .................. RALEIGH-DURHAM ....................................................................................... NC .. ............. 132.93 128.90 6660 .................. RAPID CITY ............................................................................................... ..... SD ............... 128.78 124.47 6680 .................. READING .................................................................................................. ...... PA ............... 133.16 129.15 6690 .................. REDDING .................................................................................................. ..... CA ............... 138.98 135.39 6720 .................. RENO ..................................................................................................... ......... NV ............... 144.32 142.52 6740 .................. RICHLAND-KENNEWICK ............................................................................... WA ...... ........ 131.96 127.89 6760 .................. RICHMOND-PETERSBURG .......................................................................... VA .......... ..... 129.76 125.53 6780 .................. RIVERSIDE-SAN BERNARDINO ................................................................... CA ............ ... 143.65 140.40 6800 .................. ROANOKE .................................................................................................. .... VA ............... 130.33 126.13 6820 .................. ROCHESTER ................................................................................................ . MN ............... 134.23 130.31 6840 .................. ROCHESTER ................................................................................................ . NY ............... 134.50 130.60 6880 .................. ROCKFORD ................................................................................................. .. IL ................. 136.62 132.85 6920 .................. SACRAMENTO ............................................................................................... CA ............... 144.16 141.12 6960 .................. SAGINAW-BAY CITY-MIDLAND .................................................................... MI ........... ..... 138.22 134.57 6980 .................. ST CLOUD ................................................................................................. ..... MN ............... 129.55 125.29 7000 .................. ST JOSEPH ................................................................................................ .... MO .............. 132.19 128.12 7040 .................. ST LOUIS ................................................................................................. ...... MO-IL .......... 135.07 131.21 7080 .................. SALEM .................................................................................................... ........ OR ............... 136.70 132.96 7120 .................. SALINAS-SEASIDE-MONTEREY .................................................................. CA ............. .. 144.09 140.88 7160 .................. SALT LAKE CITY-OGDEN ............................................................................. UT ...... ......... 131.27 127.13 7200 .................. SAN ANGELO ............................................................................................... . TX ................ 127.57 123.18 7240 .................. SAN ANTONIO .............................................................................................. . TX ................ 129.30 125.03 7320 .................. SAN DIEGO ................................................................................................ .... CA ............... 144.75 142.04 7360 .................. SAN FRANCISCO .......................................................................................... CA ............... 146.35 145.92 7400 .................. SAN JOSE ................................................................................................. ..... CA ............... 146.35 145.68 7440 .................. SAN JUAN ................................................................................................. ..... PR ............... 127.57 123.18 7480 .................. SANTA BARBARA-LOMPOC ......................................................................... CA .......... ..... 139.14 135.58 7485 .................. SANTA CRUZ ............................................................................................... .. CA ............... 140.64 137.18 7490 .................. SANTA FE ................................................................................................. ..... NM ............... 129.81 125.59 7500 .................. SANTA ROSA-PETALUMA ............................................................................ CA ........ ....... 146.35 145.59 7510 .................. SARASOTA ................................................................................................. ... FL ................ 131.98 127.90 7520 .................. SAVANNAH ................................................................................................. ... GA ............... 129.72 125.48 7560 .................. SCRANTON-WILKES BARRE ....................................................................... PA ........... .... 133.66 129.70 7600 .................. SEATTLE .................................................................................................. ...... WA .............. 136.87 133.14 7610 .................. SHARON ................................................................................................... ...... PA ............... 132.08 128.00 7620 .................. SHEBOYGAN ................................................................................................ . WI ................ 129.28 125.01 7640 .................. SHERMAN-DENISON .................................................................................... TX .... ............ 127.57 123.18 7680 .................. SHREVEPORT ............................................................................................... LA ................ 133.23 129.23 7720 .................. SIOUX CITY ............................................................................................... .... IA-NE ........... 132.47 128.40 7760 .................. SIOUX FALLS .............................................................................................. ... SD ............... 130.62 126.44 7800 .................. SOUTH BEND-MISHAWAKA ......................................................................... IN .......... ...... 130.13 125.92 7840 .................. SPOKANE .................................................................................................. ..... WA .............. 138.38 134.75 7880 .................. SPRINGFIELD .............................................................................................. .. IL ................. 137.27 133.56 7920 .................. SPRINGFIELD .............................................................................................. .. MO .............. 129.48 125.21 8003 .................. SPRINGFIELD .............................................................................................. .. MA ............... 133.39 129.39 8050 .................. STATE COLLEGE .......................................................................................... PA ............... 137.91 134.25 8080 .................. STEUBENVILLE-WEIRTON ........................................................................... OH-WVA .... . 131.46 127.35 8120 .................. STOCKTON ................................................................................................. ... CA ............... 146.35 145.06 8160 .................. SYRACUSE ................................................................................................. ... NY ............... 141.36 139.77 8200 .................. TACOMA ................................................................................................... ...... WA .............. 136.53 132.76 8240 .................. TALLAHASSE ............................................................................................... .. FL ................ 129.91 125.67 8280 .................. TAMPA-ST PETERSBURG-CLEARWATER .................................................. FL ................ 132.27 128.21 8320 .................. TERRE HAUTE .............................................................................................. IN ................ 127.57 123.18 8360 .................. TEXARKANA ................................................................................................ .. TX-AR ......... 135.59 131.75 8400 .................. TOLEDO ................................................................................................... ...... OH ............... 140.91 137.45 8440 .................. TOPEKA ................................................................................................... ...... KS ............... 135.89 132.10 8480 .................. TRENTON .................................................................................................. ..... NJ ................ 135.66 131.82 8520 .................. TUCSON ................................................................................................... ...... AZ ................ 134.02 130.07 8560 .................. TULSA .................................................................................................... ........ OK ............... 133.31 129.30 8600 .................. TUSCALOOSA ............................................................................................... AL ................ 133.86 129.91 8640 .................. TYLER .................................................................................................... ........ TX ............... 132.17 128.09 8680 .................. UTICA-ROME ............................................................................................... .. NY ............... 130.41 126.22 8720 .................. VALLEJO-FAIRFIELD-NAPA .......................................................................... CA ....... ........ 146.35 146.18


## 47541 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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— C OMPOSITE 

### P AYMENT 

### R ATES 

### E FFECTIVE 

### J ANUARY 

### 1, 2005

— Continued

[For urban renal facilities]

MSA code Name of MSA State Hospital Independent

8725 .................. VANCOUVER ................................................................................................ . WA .............. 139.12 135.53 8750 .................. VICTORIA ................................................................................................. ...... TX ............... 127.57 123.18 8760 .................. VINELAND-MILLVILLE-BRIDGETON ............................................................ NJ ............... . 132.48 128.41 8780 .................. VISALIA-PORTERVILLE ................................................................................ CA .... ........... 142.02 140.48 8800 .................. WACO ..................................................................................................... ........ TX ................ 127.81 123.43 8840 .................. WASHINGTON ............................................................................................... DC-MD-VA .. 141.74 138.35 8920 .................. WATERLOO-CEDAR FALLS ......................................................................... IA .......... ....... 129.50 125.24 8940 .................. WAUSAU ................................................................................................... ..... WI ................ 130.90 126.74 8960 .................. WEST PALM & DELRAY BEACH .................................................................. FL ............. ... 131.84 127.75 9000 .................. WHEELING ................................................................................................. .... WVA-OH ..... 131.83 127.74 9040 .................. WICHITA .................................................................................................. ....... KS ............... 136.67 132.93 9080 .................. WICHITA FALLS ............................................................................................ . TX ................ 127.57 123.18 9140 .................. WILLIAMSPORT ............................................................................................. PA ............... 130.24 126.04 9160 .................. WILMINGTON ............................................................................................... .. DE-NJ-MD ... 136.71 132.97 9200 .................. WILMINGTON ............................................................................................... .. NC ............... 128.74 124.42 9243 .................. WORCESTER-LEOMINSTER ........................................................................ MA ........... .... 132.43 128.37 9260 .................. YAKIMA ................................................................................................... ....... WA .............. 132.24 128.18 9280 .................. YORK ..................................................................................................... ......... PA ............... 132.45 128.39 9320 .................. YOUNGSTOWN-WARREN ............................................................................ OH .......... ..... 137.25 133.54 9340 .................. YUBA CITY ................................................................................................ ..... CA ............... 137.02 133.29



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### P AYMENT 

### R ATES 

### E FFECTIVE 

### J ANUARY 

### 1, 2005

[For rural renal facilities]

MSA Code Name of MSA State Hospital Independent

AL ...................... ALABAMA ................................................................................................ ....... AL ................ 127.57 123.18 AK ..................... ALASKA .................................................................................................. ........ AK ............... 146.35 146.35 AZ ..................... ARIZONA ................................................................................................. ....... AZ ................ 128.68 124.35 AR ..................... ARKANSAS ................................................................................................ .... AR ............... 127.57 123.18 CA ..................... CALIFORNIA .............................................................................................. .... CA ............... 137.00 133.27 CO ..................... COLORADO ................................................................................................ ... CO ............... 128.21 123.86 CT ..................... CONNECTICUT ............................................................................................. . CT ............... 136.02 132.22
DE ..................... DELAWARE ................................................................................................ .... DE ............... 128.76 124.44 FL ...................... FLORIDA ................................................................................................ ........ FL ................ 127.75 123.37 GA ..................... GEORGIA ................................................................................................. ...... GA ............... 127.57 123.18
HI ...................... HAWAII ................................................................................................. .......... HI ................ 140.40 136.92 ID ...................... IDAHO .................................................................................................. ........... ID ................ 127.83 123.45 IL ....................... ILLINOIS .............................................................................................. ........... IL ................. 127.57 123.18
IN ...................... INDIANA ................................................................................................ ......... IN ................ 127.57 123.18 IA ....................... IOWA .................................................................................................. ............ IA ................. 127.57 123.18 KS ..................... KANSAS .................................................................................................. ....... KS ............... 127.57 123.18 KY ..................... KENTUCKY ................................................................................................ .... KY ............... 127.57 123.18 LA ...................... LOUISIANA .............................................................................................. ....... LA ................ 127.57 123.18
ME ..................... MAINE ................................................................................................... .......... ME ............... 127.57 123.18
MD .................... MARYLAND ................................................................................................. ... MD ............... 130.27 126.08 MA ..................... MASSACHUSETTS ........................................................................................ MA . .............. 135.99 132.19 MI ...................... MICHIGAN ............................................................................................... ....... MI ................ 132.98 128.97 MN .................... MINNESOTA ................................................................................................ ... MN ............... 127.57 123.18 MS ..................... MISSISSIPPI ............................................................................................. ...... MS ............... 127.57 123.18 MO .................... MISSOURI ................................................................................................. ..... MO .............. 127.57 123.18 MT ..................... MONTANA ................................................................................................. ..... MT ............... 127.87 123.50 NE ..................... NEBRASKA ................................................................................................ .... NE ............... 127.57 123.18
NV ..................... NEVADA .................................................................................................. ....... NV ............... 133.20 129.20 NH ..................... NEW HAMPSHIRE ......................................................................................... NH ............... 132.24 128.18 NM .................... NEW MEXICO ............................................................................................... . NM ............... 128.68 124.36 NY ..................... NEW YORK ................................................................................................ .... NY ............... 127.78 123.40 NC ..................... NORTH CAROLINA ........................................................................................ NC ............... 127.57 123.18 ND ..................... NORTH DAKOTA ........................................................................................... N D ............... 127.70 123.31 OH ..................... OHIO .................................................................................................... ........... OH ............... 128.66 124.34 OK ..................... OKLAHOMA ................................................................................................ .... OK ............... 127.57 123.18 OR ..................... OREGON .................................................................................................. ...... OR ............... 132.66 128.64 PA ..................... PENNSYLVANIA ............................................................................................ PA ............... 132.54 128.48 PR ..................... PUERTO RICO ............................................................................................. .. PR ............... 127.57 123.18 RI ...................... RHODE ISLAND ........................................................................................... .. RI ................ 130.86 126.69 SC ..................... SOUTH CAROLINA ........................................................................................ SC ............... 127.57 123.18 SD ..................... SOUTH DAKOTA ........................................................................................... S D ............... 127.57 123.18 TN ..................... TENNESSEE ............................................................................................... ... TN ............... 127.57 123.18 TX ..................... TEXAS ................................................................................................... ......... TX ............... 127.57 123.18


## 47542 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 19.

— C OMPOSITE 

### P AYMENT 

### R ATES 

### E FFECTIVE 

### J ANUARY 

### 1, 2005

— Continued

[For rural renal facilities]

MSA Code Name of MSA State Hospital Independent

UT ..................... UTAH .................................................................................................... .......... UT ............... 128.56 124.24 VT ..................... VERMONT ................................................................................................. ..... VT ................ 127.57 123.18 VA ..................... VIRGINIA ................................................................................................ ........ VA ............... 127.57 123.18 WA .................... WASHINGTON ............................................................................................... WA .............. 131.35 127.21 WV .................... WEST VIRGINIA ............................................................................................ . WV .............. 128.43 124.09 WI ...................... WISCONSIN .............................................................................................. ..... WI ................ 127.57 123.18 WY .................... WYOMING .................................................................................................. .... WY .............. 131.29 127.15



### T ABLE 

### 20.

— C OMORBIDITIES

AIDS 042 ............................................................... Human immunodeficiency disease Peripheral vascular disease 0400 ............................................................. Gas gangrene 4151 ............................................................. Pulmonary embolism and infarction 41511 ........................................................... Pulmonary embolism and infarction, iatrogenic pulmonary embolis m and infarction 440 ............................................................... Atherosclerosis 4400 ............................................................. Atherosclerosis of aorta 4401 ............................................................. Atherosclerosis of renal artery 4402 ............................................................. Atherosclerosis of native arteries of the extremities 44020 ........................................................... Atherosclerosis of native arteries of the extremities, unspecif ied 44021 ........................................................... Atherosclerosis of native arteries of the extremities, with int ermittent claudication 44022 ........................................................... Atherosclerosis of native arteries of the extremities, with res t pain 44023 ........................................................... Atherosclerosis of the extremities with ulceration 44024 ........................................................... Atherosclerosis of the extremities with gangrene 44029 ........................................................... Atherosclerosis of native arteries of the extremities, with ulc eration 4403 ............................................................. Atherosclerosis of bypass graft of the extremities 44030 ........................................................... Atherosclerosis of bypass graft of the extremities of unspecifi ed graft 44031 ........................................................... Atherosclerosis of bypass graft of the extremities of autologou s vein bypass graft 44032 ........................................................... Atherosclerosis of bypass graft of the extremities of nonautolo gous biological bypass graft 441 ............................................................... Aortic aneurysm and dissection 4410 ............................................................. Aortic aneurysm and dissection, dissection of aorta 44100 ........................................................... Aortic aneurysm and dissection, dissection of aorta, unspecifie d site 44101 ........................................................... Aortic aneurysm and dissection, dissection of aorta, thoracic 44102 ........................................................... Aortic aneurysm and dissection, dissection of aorta, abdominal 44103 ........................................................... Aortic aneurysm and dissection, dissection of aorta, thoracoabd ominal 4411 ............................................................. Thoracic aneurysm, ruptured 4412 ............................................................. Thoracic aneurysm without mention of rupture 4413 ............................................................. Abdominal aneurysm, ruptured 4414 ............................................................. Abdominal aneurysm without mention of rupture 4415 ............................................................. Aortic aneurysm of unspecified site, ruptured 4416 ............................................................. Thoracoabdominal aneurysm, ruptured 4417 ............................................................. Thoracoabdominal aneurysm without mention of rupture 4419 ............................................................. Aortic aneurysm and dissection of unspecified site without men tion of rupture 442 ............................................................... Other aneurysm 4420 ............................................................. Other aneurysm of artery of upper extremity 4421 ............................................................. Other aneurysm of renal artery 4422 ............................................................. Other aneurysm of iliac artery 4423 ............................................................. Other aneurysm of artery of lower extremity 4428 ............................................................. Other aneurysm of other specified artery 44281 ........................................................... Other aneurysm of other specified artery, artery of neck 44282 ........................................................... Other aneurysm of other specified artery, subclavian artery 44283 ........................................................... Other aneurysm of other specified artery, splenic artery 44284 ........................................................... Other aneurysm of other specified artery, other visceral artery 44289 ........................................................... Other aneurysm of other specified artery, other 4429 ............................................................. Other aneurysm of unspecified site 443 ............................................................... Other peripheral vascular disease 4430 ............................................................. Other peripheral vascular disease, Raynaud ’ s syndrome 4431 ............................................................. Other peripheral vascular disease, thromboangiitis obliterans [Buerger ’ s disease] 4432 ............................................................. Other peripherovascular diseases, other arterial dissection 44321 ........................................................... Other peripherovascular diseases, other arterial dissection, di ssection of carotid artery 44322 ........................................................... Other peripherovascular diseases, other arterial dissection, di ssection of iliac artery 44323 ........................................................... Other peripherovascular diseases, other arterial dissection, di ssection of renal artery 44324 ........................................................... Other peripherovascular diseases, other arterial dissection, di ssection of vertebral artery 44329 ........................................................... Other peripherovascular diseases, other arterial dissection, di ssection of other artery 4438 ............................................................. Other peripheral vascular disease, other specified peripheral vascular disease 44381 ........................................................... Other peripheral vascular disease, other specified peripheral v ascular disease, peripheral angiopathy in diseases classified elsewhere 44389 ........................................................... Other peripheral vascular disease, other specified peripheral v ascular disease, other 4439 ............................................................. Peripheral vascular disease, unspecified


## 47543 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 20.

— C OMORBIDITIES

444 ............................................................... Arterial embolism and thrombosis 4440 ............................................................. Arterial embolism and thrombosis, of abdominal aorta 4441 ............................................................. Arterial embolism and thrombosis, of thoracic aorta 4442 ............................................................. Arterial embolism and thrombosis, of arteries of the extremiti es 44421 ........................................................... Arterial embolism and thrombosis, of arteries of the extremitie s, upper extremity 44422 ........................................................... Arterial embolism and thrombosis, of arteries of the extremitie s, lower extremity 4448 ............................................................. Arterial embolism and thrombosis, of other specified artery 44481 ........................................................... Arterial embolism and thrombosis, of other specified artery, up per extremity 44489 ........................................................... Arterial embolism and thrombosis, of other specified artery, lo wer extremity 449 ............................................................... Arterial embolism and thrombosis, of unspecified artery 4450 ............................................................. Atheroembolism, of extremities 44501 ........................................................... Atheroembolism, of extremities, upper extremity 44502 ........................................................... Atheroembolism, of extremities, lower extremity 446 ............................................................... Polyarteritis nodosa and allied conditions 4460 ............................................................. Polyarteritis nodosa and allied conditions, polyarteritis nodo sa 451 ............................................................... Phlebitis and thrombophlebitis 4510 ............................................................. Phlebitis and thrombophlebitis of superficial vessels of lower extremities 4511 ............................................................. Phlebitis and thrombophlebitis, of deep vessels of lower extre mities 45111 ........................................................... Phlebitis and thrombophlebitis, of deep vessels of lower extrem ities, femoral vein 45119 ........................................................... Phlebitis and thrombophlebitis, of deep vessels of lower extrem ities, other 4512 ............................................................. Phlebitis and thrombophlebitis, of lower extremities, unspecif ied 45181 ........................................................... Phlebitis and thrombophlebitis, of other sites, iliac vein 45182 ........................................................... Phlebitis and thrombophlebitis, of other sites, of superficial veins of upper extremities 45183 ........................................................... Phlebitis and thrombophlebitis, of other sites, of deep veins o f upper extremities 45184 ........................................................... Phlebitis and thrombophlebitis, of upper extremities, unspecifi ed 45189 ........................................................... Phlebitis and thrombophlebitis, other 4519 ............................................................. Phlebitis and thrombophlebitis, unspecified 453 ............................................................... Other venous embolism and thrombosis 4530 ............................................................. Other venous embolism and thrombosis, Budd-Chiari syndrome 4531 ............................................................. Other venous embolism and thrombosis, Thrombophlebitis migrans 4532 ............................................................. Other venous embolism and thrombosis of vena cava 4533 ............................................................. Other venous embolism and thrombosis of renal vein 4538 ............................................................. Other venous embolism and thrombosis of other specified sites 4539 ............................................................. Other venous embolism and thrombosis of unspecified site



### I. Section 731(b)

— Coverage for Routine Costs of Category A Clinical Trials [If you choose to comment on issues in this section, please include the caption

‘‘ Section 731(b) ’’ at the beginning of your comments.]

Section 1862(m) of the Act, as added by Section 731(b) of the MMA, prohibits the Secretary from excluding payment for the routine costs of care furnished to a Medicare beneficiary participating in a clinical trial of a Category A device based on a determination that such care
is not ‘‘ reasonable and necessary ’’ under section 1862(a)(1). In effect, this section authorizes Medicare to cover the routine costs of clinical trials involving Category A devices. Category A (experimental/investigational) devices are defined in § 405.201 as innovative medical devices about which the Food and Drug Administration (FDA) has major questions about safety and effectiveness.

For a trial to qualify for payment of routine costs, it must meet certain criteria established by the Secretary to ensure that the trial conforms to appropriate scientific and ethical standards. Current criteria are established in the National Coverage Determination Manual (CMS Pub. 100

– 3, Manual section 310.1). In addition, the MMA established additional criteria for trials initiated before January 1, 2010 to ensure that the devices involved in these trials be intended for use in the diagnosis, monitoring, or treatment of an immediately life-threatening disease or condition. Guidelines for determining if a device meets this requirement will be defined through the NCD process.

Section 411.15(o) currently precludes Medicare payment for Category A devices. We would not revise this section because the MMA does not require Medicare to pay for the cost of the Category A device (as opposed to the cost of routine care associated with the trial of a Category A device).

We are proposing changes to § 405.207. As currently written, this section precludes coverage of services related to a noncovered device. Since the Category A device is noncovered, we would amend this section to allow coverage of routine care services related to a noncovered Category A device. Inaddition, we propose language to crossreference § 405.201 concerning coverage of Category B (nonexperimental/ investigational) devices. We would not be changing coverage of Category B devices, but providing consistency by placing information on Category A and Category B devices in the same section.

J. Section 629

— Part B Deductible
[If you choose to comment on issues in this section, please include the caption

‘‘ Section 629 ’’ at the beginning of your comments.]

Section 629 of the MMA provides for regular updates to the Medicare Part B deductible in consideration of inflationary changes in the nation ’ s economy. Since 1991, the Medicare Part B deductible has been $100 per year. The MMA stipulates that the Medicare Part B deductible will be $110 for calendar year 2005, and, for a subsequent year, the deductible will be the previous year ’ s deductible increased by the annual percentage increase in the monthly actuarial rate under section 1839(a)(1) of the Act, ending with that subsequent year (rounded to the nearest dollar). Section 1839(a)(1) of the Act requires the Secretary of Health and Human Services to calculate the monthly actuarial rate for Medicare enrollees age 65 and over.

We propose to update § 410.160(f),

‘‘ Amount of the Part B annual deductible, ’’ to conform to the MMA and to reflect that the Medicare Part B deductible is $100 for calendar years


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1991 through 2004. Finally, we plan to publish an annual notification in the Federal Register , announcing each upcoming year ’ s Part B deductible. This notification for the Part B deductible will be included as part of the annual notice we currently publish announcing Medicare ’ s Part B premiums and actuarial rates.

K. Section 512

— Hospice Consultation [If you choose to comment on issues in this section, please include the caption

‘‘ Section 512 ’’ at the beginning of your comments.]
1. Coverage of Hospice Consultation
Services

Effective January 1, 2005, section 512 of the MMA provides for payment to be made to a hospice for specified services furnished by a physician who is either the medical director of or employee of a hospice agency. Payment will be made on behalf of a beneficiary who is terminally ill (which is defined as having a prognosis of 6 months or less if the disease or illness runs its normal course), has not made a hospice election, and has not previously received the pre-election hospice services specified in section 1812(a)(1)(5) of the Act as added by section 512 of the MMA. These services comprise an evaluation of an individual ’ s need for pain and symptom management, counseling the individual regarding hospice and other care options, and may include advising the individual regarding advanced care planning.

The decision to elect hospice services is a personal choice and is generally a decision made between the individual and his or her physician (probably the physician making the terminal diagnosis). Therefore, we believe that most individuals will seek this type of service from their own physician. Thus, we do not expect that the services of a hospice physician would be necessary for all individuals who elect hospice. However, a beneficiary, or his/her physician may seek the expertise of a hospice medical director or physician employee of a hospice to assure that a beneficiary ’ s end-of-life options for care and pain management are discussed and evaluated.

Currently, beneficiaries are able to receive this evaluation, pain management, counseling, and advice through other Medicare benefits. For example, physicians, typically those who determine the beneficiary ’ s terminal diagnoses, can provide for these evaluation and management services as well as for pain and symptom management under the physician fee schedule. Beneficiaries may also obtain assistance with decisions pertaining to end-of life issues through discharge planning in hospitals and through services of social workers, case managers, and other health care professionals. To the extent that beneficiaries have already received Medicare-covered evaluation and counseling with respect to end-of-life care, the hospice evaluation and counseling would seem duplicative. We intend to monitor data regarding these services to assess whether Medicare is paying for duplicative services.

We are proposing to cover the services described above for a terminally ill beneficiary, at the request of the beneficiary or the beneficiary ’ s physician. The service would, in accordance with the statute, be available on a one-time basis to a beneficiary who has not elected or previously used the hospice benefit, but who might benefit from evaluation and counseling with a hospice physician regarding the beneficiary ’ s decision-making process or to provide recommendations for pain and symptom management. Since the beneficiary or his/her physician decides to obtain this service from the hospice medical director or physician employee, the evaluation and counseling service may not be initiated by the hospice, that is, the entity receiving payment for the
service.

The statute specifies that payment will be made to the hospice when the physician providing the service is an employee physician or medical director of a hospice. Therefore, other hospice personnel, such as nurse practitioners, nurses, or social workers, cannot furnish the services. The statute requires the physicians to be employed by a hospice; therefore, the service cannot be furnished by a physician under contractual arrangements with the hospice or by the beneficiary ’ s physician, if that physician is not an employee of the hospice. Moreover, if the beneficiary ’ s physician is also the medical director or physician employee of a hospice, that physician already possesses the expertise necessary to furnish end-of-life evaluation, management, and counseling services and is providing these services to the beneficiary and is receiving payment for these services through the use of evaluation and management (E&M) codes.

In the event that the individual ’ s physician initiates the request for services of the hospice medical director or physician, we would expect that appropriate documentation guidelines would be followed. The request or referral would be in writing, and the hospice medical director or employee physician would be expected to provide a written note on the patient ’ s medical chart. The hospice employee physician providing these services would be required to maintain a written record of this service. If the beneficiary initiates the services, we would expect that the hospice agency would maintain a written record of the service and that communication between the hospice medical director or physician and the beneficiary ’ s physician would occur, with the beneficiary ’ s permission, to the extent necessary to ensure continuity of

care.

We propose to add new § 418.205 and § 418.304(d) to implement section 512 of the MMA.
2. Payment for Hospice Consultation
Services

Section 512(b) of the MMA amends section 1414(i) of the Act and establishes payment for this service at

an amount ‘‘ equal to an amount established for an office or other outpatient visit for evaluation and management associated with presenting problems of moderate severity and requiring medical decision-making of low complexity under the physician fee schedule, other than the portion of such amount attributable to the practice expense component. ’’ No existing CPT or HCPCS code specifically represents these services. We are proposing to establish a new HCPCS code, G0xx4 Hospice

— evaluation and counseling services, pre-election . The hospice would use this HCPCS code to submit claims to the Regional Home Health Intermediary (RHHI) for payment for these services. Utilization of this code would allow us to provide payment for this service as well as enable us to monitor the frequency with which the code is used and to assess whether the code is used appropriately. Payments by hospices to physicians or others in a position to refer patients for services furnished under this provision may implicate the Federal anti-kickback

statute.

In accordance with the statute, we are proposing that the payment amount for this service would be based on the work and malpractice expense RVUs for CPT code 99203 multiplied by the CF (1.34 Work RVU + 0.10 Malpractice RVU)* (CF). This CPT code for an office or outpatient visit for the evaluation and management of a new patient represents a detailed history, detailed examination and medical decision making of low complexity, which, we believe, is quite similar to the components of this new service provided by a medical director or physician employed by the hospice


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agency. Assuming that there are no changes in RVUs for CPT code 99203 and that the CY 2005 update to the physician fee schedule is the 1.5 percent specified in the MMA, the national payment amount for this service would be $54.57 for this service (1.44 * 37.8975).

L. Section 302

— Clinical Conditions for Coverage of Durable Medical Equipment (DME) [If you choose to comment on issues in this section, please include the caption

‘‘ Section 302 ’’ at the beginning of your comments.]
1. Legislative Requirement

Section 1832(a)(1)(E) of the Act, as added by section 302(a)(2) of the MMA, requires the Secretary to establish clinical conditions for payment of covered items of durable medical equipment (DME). The law requires the Secretary to establish types or classes of covered items that require a face-to-face examination of the individual by a physician or practitioner and also require a prescription for these items.

Covered items of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) have already been divided into classes of covered items, as established by the local medical review policies (LMRP) and local coverage determinations (LCD) issued by the durable medical equipment regional carriers (DMERCs). For example, the contractors have developed policies on long term home oxygen therapy, canes, crutches, wheelchairs, hospital beds, urological supplies, spinal orthoses, surgical dressing, and enteral and parenteral nutrition therapy. These and other policies for each of the four DMERCs are entered into the Medicare Coverage Database at http:// www.cms.hhs.gov/coverage

.

These policies are developed based on clinical evidence and after discussion with clinical experts in the area. There are already a number of local coverage determinations and national coverage determinations that outline the clinical conditions for which these items are covered. These determinations outline the conditions for coverage, payment, and the documentation or testing necessary to establish medical necessity. We propose to continue developing these clinical conditions of coverage through the local and national coverage determination process.

We are also proposing to expand the requirement for clinical conditions of coverage to medical supplies, appliances and devices defined in 42 CFR 410.36. These are commonly referred to as prosthetics, orthotics and supplies (POS). We believe items of POS require the same level of medical intervention and skill as DME. As with DME, there are already a number of local and national coverage determinations outlining appropriate clinical conditions for coverage and propose to continue this process.

From a clinical perspective, we believe that it is appropriate for beneficiaries requiring DMEPOS to be under the care of a physician and for DMEPOS orders to occur in the context of routine clinical care. We believe it is good clinical practice for the beneficiary to be seen by the physician for their medical condition and the physician to decide whether or not an item ofDMEPOS is appropriate during the faceto-face examination of the beneficiary. Since we expect a beneficiary to be seen by their physician for a specific medical condition, we do not believe that a requirement for a face-to-face examination for initial orders and at the time of the prescription renewals for items of continued need (those DMEPOS items where an order is good for only a certain period of time and requires a follow-up examination by the physician) would place a burden on the physician or beneficiary, as it would be part of a necessary examination. We believe this to be the current practice in

most cases.

Our goal is to encourage quality care, to mitigate any proliferation of use of these products and ensure that only patients that need items of DMEPOS receive them. To comply with the requirements of section 302(a)(2) of the MMA and to enhance quality and reduce fraud, we would establish basic requirements that apply to all items of durable medical equipment, prosthetics, orthotics, and supplies. We have identified a proliferation of use for some items of DMEPOS and we believe that engaging the physician or practitioner early in the process of ordering DMEPOS will assist us in mitigating any unnecessary proliferation of use.

This regulation proposes to make a face-to-face exam by the physician to determine the medical necessity and ordering an item of DMEPOS an explicit requirement for all initial orders of DMEPOS and at the time of prescription renewal for all DMEPOS continued need items. However, we seek specific comments about whether specific items of DMEPOS should be exempt from the face-to-face examination requirement.

In order for us to verify the medical necessity for an item, the prescribing physician ’ s or practitioner ’ s records must document the need at the time the physician or practitioner examines the beneficiary. For example, a letter to the supplier or to us dated months after the date the examination was conducted and the order was written would not be sufficient verification.

2. Provisions Related to DMEPOS

To implement the provisions of the MMA, we would

—

• Establish a requirement for a faceto-face examination by a physician, physician assistant (PA), clinical nurse specialist (CNS), or nurse practitioner (NP), as they are defined in the Act (the prescribing physician or practitioner) to determine the medical necessity of durable medical equipment, orthotics and prosthetics.

• Require that the prescribing physician or practitioner be independent from the DMEPOS supplier and may not be a contractor or an employee of the supplier.

• Establish a requirement that the face-to-face examination should be for the purpose of evaluating and treating the patient ’ s medical condition and not for the sole purpose of obtaining the prescribing physician ’ s or practitioner ’ s order for the DMEPOS. We expect the prescribing physician or practitioner to conduct a sufficient examination of the patient ’ s medical condition to ascertain the appropriate overall treatment plan and to order the DMEPOS as only one aspect of that treatment plan.

• Require an order prior to delivery for all items of durable medical equipment, prosthetics, or orthotics.

• Require that the order be dated andsigned within 30 days after the face-toface examination and include verification of the examination. We are soliciting comments on the appropriate verification process.

• Require the prescribing physician or practitioner to maintain appropriate and timely documentation in the medical records that support the need for all DMEPOS ordered.

• Provide that we would promulgate through contractor instructions other criteria required for payment, such as for prescription renewal requirements, repair, minor revisions and replacement. We are interested in comments on whether the Agency should establish national renewal requirements or permit contractor discretion.

• Provide that we would promulgate through the national coverage determination process or through the local coverage determination process additional clinical conditions for items of DMEPOS.

We propose to revise language in § 410.36 and § 410.38 to implement section 302(a)(2) of the MMA.


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M. Section 614

— Payment for Certain Mammography Services [If you choose to comment on issues in this section, please include the caption

‘‘ Section 614 ’’ at the beginning of your comments.]

Medicare covers an annual screening mammogram for all beneficiaries who are women age 40 and older, and one baseline mammogram for beneficiaries who are women age 35 through 39. Medicare also covers medically necessary diagnostic mammograms. Payment for screening mammography, regardless of setting, is paid under the physician fee schedule, but diagnostic mammography performed in the hospital outpatient department is currently paid under the hospital outpatient prospective payment system (OPPS).

Section 614 of the MMA amended section 1833(t)(1)(B)(iv) of the Act to exclude payment for screening and diagnostic mammograms from the OPPS. In the OPPS proposed rule, we will discuss our proposal for payment for diagnostic mammograms using the payments established under the physician fee schedule. This proposal will parallel the current practice used for the payment of screening mammography services provided in the OPPS setting and will be effective January 1, 2005.

N. Section 305

— Payment for Inhalation Drugs [If you choose to comment on issues in this section, please include the caption

‘‘ Section 305 ’’ at the beginning of your comments.]
1. Background

Lung diseases such as chronic obstructive pulmonary disease (COPD) affect large numbers of Medicare beneficiaries. COPD is the fourth largest cause of death in America behind heart disease, certain cancers, and stroke. We hope to reduce the number of new COPD cases by educating Americans about the disease, its causes, and ways to prevent it. We hope to improve the lives of Medicare beneficiaries and improve beneficiary access to treatment for those who already suffer from these conditions.

Depending on an individual ’ s age and health, a number of steps can be taken to treat or prevent this. Because approximately 85 percent of those with COPD are smokers, the first step to avoid the disease is to stop smoking. Smoking has been linked to a large number of health problems and is a leading cause of cancer and pulmonary disease. The Department of Health and Human Services (HHS) has been actively encouraging Americans to quit smoking through its smoking cessation initiatives. Americans who quit smoking will enjoy longer, healthier lives and avoid diseases such as COPD.

We have also recently approved services to address the needs of Americans suffering from COPD, including lung-volume reduction surgery, which, performed in more serious cases, removes the diseased lung tissue, allowing the rest of the lung to function better. Specifically, effective January 1, 2004, Medicare expanded coverage of lung volume reduction surgery to include patients, who are not high-risk surgical patients, who either have severe, upper-lobe emphysema, or have severe, non-upper-lobe emphysema with low exercise capacity.

A number of drugs are available to treat the persons with asthma or who develop COPD. These include agents, often inhaled, that expand the bronchial tubes, allowing the patient to breathe more freely. Access to these drugs for Medicare beneficiaries has been expanded by the MMA.

Nebulizers and metered dose inhalers (MDIs) are two different delivery methods to administer inhalation drugs to a beneficiary. A nebulizer works by aerosolizing liquefied inhalation drugs so that the medication can be more easily inhaled into the lungs. For about 10 to 30 minutes, a beneficiary breathes the mist via compressor tubing hooked up to the nebulizer. An MDI consists of a canister of pressurized medication that is propelled directly into the airways of the lungs when a beneficiary presses on the inhaler and breathes in through the mouth, thereby allowing the medicine to take effect quickly.

Medicare Part B currently pays for nebulizers and inhalation drugs. However, Medicare Part B does not cover MDIs and, therefore, does not pay for inhalation drugs delivered by an MDI. An MDI is considered to be an item of disposable medical equipment (for which there is no current Part B benefit category) while a nebulizer is considered to be an item of DME.

The Part D drug benefit improves beneficiary access to inhalation therapy by covering MDIs (including the inhalation drugs they furnish) beginning January 1, 2006. In addition, the prescription drug discount card began offering discounts on MDIs effective June 1, 2004.

Since Medicare currently covers inhalation drugs provided through nebulizers, but not alternative forms of inhalation therapy, there are strong financial incentives toward use of the former compared to alternatives. Our review of the literature over the past decade did not find that bronchodilators delivered via nebulizers were more effective than bronchodilators delivered via metered dose inhalers.

Since one delivery method is not clinically superior to the other, when Medicare covers both methods of delivery of inhalation therapy, the decision to prescribe one over the other will be made by the physician and beneficiary based on beneficiary needs and preferences consistent with applicable standards of medical practice. It would not be unlikely for many beneficiaries to choose the convenience of MDIs over nebulizers once the Medicare coverage imbalance is removed in 2006. Since MDIs are less expensive, very portable, and easier to use, it is likely there will be a substantial shift of Medicare beneficiaries from nebulizers to MDIs beginning in 2006, even absent the Medicare payment changes for nebulizers and inhalation drugs in 2005.
2. What Medicare Part B Currently
Covers

Medicare Part B currently covers and pays for five separate items related to nebulizers. All of the items are subject to the standard Part B deductible and
coinsurance.

a. Nebulizers

Medicare Part B currently covers the rental of nebulizers. Nebulizers are in the ‘‘ capped rental ’’ category of DME for payment purposes. Payment is made on a monthly basis during the period of medical need. Medicare pays 10 percent of the payment amount during the first three months and 7.5 percent during the next 12 months. Section 1834(a) of the Act specifies that the payment amount is equal to the amount paid for purchase of the nebulizer in 1986, indexed to current levels by the cumulative DME update factor specified in this subsection. Thus, Medicare will pay up to a cumulative total of 120 percent of the payment amount for 15 months of renting a nebulizer.

If the beneficiary needs a nebulizer for more than 15 months, and continues to rent it, Medicare makes no further payment for the equipment because the equipment has already been paid for. Medicare does continue to pay for maintenance and servicing of the nebulizer, as well as the inhalation drugs, but the supplier retains title to the equipment.

During the 10th month of continuous rental of a nebulizer, the supplier is required to offer the beneficiary a purchase option, and if the beneficiary accepts the offer and exercises the


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purchase option, the supplier transfers title to the nebulizer in the 13th month. In this case, Medicare would make its final monthly rental payment in the 13th month, and the title then would transfer to the beneficiary. About 3 percent of beneficiaries exercise the purchase option.

In 2003, the average Medicare monthly rental payment for nebulizers was $19.07 for the first three months and $14.30 for the fourth through fifteenth month. Thus, Medicare would pay $228.81 for a nebulizer if the beneficiary ’ s period of medical need were 15 months. There are various types of nebulizers (compressor, ultrasonic, portable, disposable) and nebulizer accessories (breathing circuits, air filters, tubing extensions, mouthpieces, spare battery packs, DC adapters) available. Internet prices for compressor nebulizers range from $50 to $100, and prices for portable nebulizers range from $100 to $200, depending on the specific features of the nebulizer. The Medicare payment amount includes payment for delivery of the equipment. (Shipping costs for nebulizers available for purchase on the Internet range from free shipping up to $25).
b. Maintenance and Servicing of Nebulizers

Medicare Part B makes an additional separate payment to the supplier for maintenance and servicing of the equipment (for parts and labor not covered by the supplier ’ s or manufacturer ’ s warranty). For nebulizers that are not purchased, but are used for more than 21 months, the servicing fee covers six-month periods beginning after the 21st month of use. As required by section 1834(a)(7) of the Act, Medicare ’ s payment for maintenance and servicing is equal to the lesser of a reasonable and necessary maintenance and servicing fee, or 10 percent of the total purchase price of the equipment. For nebulizers that are purchased, Medicare may make a payment to the supplier for any necessary maintenance and servicing that is performed.

In 2003, the average service fee for nebulizers was $19.07 per six-month period. Other than routine cleaning of the unit (that is, cleaning and changing filters, cleaning and disinfecting nebulizers, tubing, and mouthpieces), very little maintenance is required to maintain a nebulizer ’ s peak performance. There is usually no scheduled maintenance for the nebulizer. Medicare pays for the usual frequency for replacement of accessories. Maintenance kits and replacement parts are available through online suppliers for approximately $5 to $15.
c. Inhalation Drugs

Medicare Part B pays for drugs that the nebulizer furnishes to a beneficiary. Unlike nebulizers, inhalation drugs are not an explicit benefit covered by statute. However, there was an administrative decision made early in the program ’ s history to cover inhalation drugs as a supply so that the nebulizer could work. Without the inhalation drugs, the nebulizer would not be effective for a beneficiary.

The two most common inhalation drugs used by beneficiaries are albuterol sulfate (a beta-adrenergic bronchodilator) and ipratropium bromide (an anticholinergic bronchodilator). A beneficiary may use one or the other of these inhalation drugs, and they are frequently prescribed together. Both albuterol sulfate and ipratropium bromide are manufactured in powder form, but are generally liquefied and furnished to beneficiaries in liquid form for use in a nebulizer. The beneficiary may use a solution of one drug, or a combination of both drugs, in addition to saline if necessary, with the nebulizer. The beneficiary may mix the solution, or thesupplier may furnish the drug in a premixed form (either commercially premixed or pharmacy compounded). The shelf life of these drugs is at least 18 to 24 months, and they do not require any special storage arrangements such as refrigeration.

Medicare also pays for other inhalation drugs, such as budesonide (an inhaled corticosteroid), which are used in conjunction with albuterol sulfate and ipratropium bromide. These drugs can also be administered using a nebulizer or an MDI.
d. Dispensing Fee

Medicare has paid a monthly $5 dispensing fee for each covered inhalation drug or combination of drugs used in a nebulizer. The dispensing fee is paid for each drug dispensed, not the number of unit dose vials provided to the beneficiaries. Additionally, if two or more drugs are combined in single unit dose vials, only one dispensing fee will be paid per drug combination per month. A dispensing fee for saline is not separately billable or payable. Inhalation drugs are the only drugs for which Medicare Part B currently pays a separate dispensing fee.
e. Beneficiary Training.

In 2003, CPT code 94664 was revised to include beneficiary training by a physician or physician ’ s staff regarding use of a nebulizer, MDI, aerosol generator, or intermittent positive pressure breathing (IPPB) machine. The narrative terminology for the code currently is

— Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB machine. ’’ The 2004 Medicare physician fee schedule payment for this service is $13.44. This service has no physician work relative value units reflecting that the training is typically performed by physician office staff. In 2004, this service has 0.32 practice expense relative value units (RVUs) and 0.04 malpractice RVUs. Additionally, the supplier of the nebulizer, under § 424.57(c)(12), must

‘‘ document that it or another qualified party has at an appropriate time, provided beneficiaries with necessary information and instructions on how to use Medicare covered-items safely and effectively. ’’ Beneficiary training by a physician or physician ’ s staff regarding use of a nebulizer would meet the definition of ‘‘ another qualified party ’’ for purposes of this supplier requirement.
3. Medicare Spending for Nebulizers and Inhalation Drugs

In 2003, Medicare spent about $1.6 billion for nebulizers and inhalation drugs. This amount includes

—

(a) About $130 million for nebulizers (both rental and purchase) and nebulizer related accessories and supplies;

(b) About $13 million for servicing/ maintenance fees;

(c) About $1.3 billion for albuterol sulfate and ipratropium bromide and another $120 million for other inhalation drugs for a total of approximately $1.4 billion. (This represents about 88 percent of Medicare spending for inhalation therapy.);

(d) About $35.5 million for 7.1 million dispensing fees; and

(e) About $4.5 million for beneficiary training under CPT code 94664 (though this figure also includes training for other items as well as nebulizers).

Medicare spending for inhalation drugs has grown rapidly. Preliminary data indicate that between 2001 and 2003, Medicare spending increased by 77 percent for albuterol sulfate and ipratropium bromide.
4. Inspector General and General Accounting Office Studies

The HHS IG issued 10 reports between February 1996 and January 2004 about Medicare payments for albuterol sulfate and ipratropium bromide in excess of acquisition costs. In a report issued in September 2001,


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the General Accounting Office (GAO) also concluded that Medicare payment for these drugs was in excess of acquisition costs.

Table 1 of the Interim Final Rule regarding Changes to Medicare Payment for Drugs and Physician Fee Schedule Payments for Calendar Year 2004, published in the January 7, 2004 Federal Register (69 FR 1084), showed that the acquisition cost (averaging IG and GAO results) was 34 percent of the Average Wholesale Price (AWP) for ipratropium bromide and 17 percent for albuterol sulfate. Prior to 2004, Medicare paid 95 percent of the AWP for each of these drugs and beneficiary coinsurance was 20 percent of the Medicare payment amount. In the case of albuterol sulfate, the beneficiary coinsurance was more than the actual acquisition cost for the drug. During 2004, Medicare payment is 80 percent of the AWP for each of these drugs. Beginning with 2005, Medicare payment will be 106 percent of the Average Sales Price (ASP).

The IG report issued in January 2004 again concluded that Medicare payments were far in excess of acquisition costs for both albuterol sulfate and ipratropium bromide. The IG found that the Medicare 2004 payment (and payment in prior years) was a multiple of the actual acquisition costs for both drugs based on a comparison to the median price that the drug was available through wholesalers/ distributors and group purchasing organizations (GPOs) and comparison to the manufacturer-reported Wholesale Acquisition Cost (WAC).
5. Inhalation Drug Spread

In 2003, ipratropium bromide and albuterol sulfate were the third and seventh largest drugs in terms of Medicare spending for carrier paid drugs. The differences between Medicare ’ s payment amount and acquisition costs (that is, spread) for albuterol sulfate and ipratropium bromide are among the largest spreads for drugs studied by the IG and GAO. Based on the actual acquisition costs determined by IG and GAO studies, in 2003, Medicare paid an estimated nearly $900 million in excess of acquisition costs for albuterol sulfate and ipratropium bromide.

The IG and GAO findings of large differences between Medicare payment amounts and acquisition costs for inhalation drugs provided the foundation for Congressional enactment of section 305 of the MMA. This section of the MMA sets Medicare payment for inhalation drugs at 106 percent of the ASP. (The Congressional Budget Office ’ s November 20, 2003 pricing of the MMA estimated section 305 as having savings of $4.2 billion over 10 years.)

Suppliers argue that inhalation drug spread has allowed them to fund activities related to care for beneficiaries with asthma or COPD that otherwise do not have a Medicare Part B benefit category. These other activities may include the following:

• Respiratory therapists on staff or in networks available on-call for home visits or telephone consultations.

• On-call pharmacists.

• Monthly calls to schedule medication refills.

• Continuous education on disease states, including monthly follow-ups.

• 24-hour support lines.

• On-call and/or monthly home delivery of medication and supplies.

• Quality improvement programs.

6. Nebulizers vs. MDIs

Medicare Part B currently covers only one type of inhalation therapy, nebulizers and inhalation drugs. Although Medicare Part B does not cover MDIs and the inhalation drugs they furnish, the new Part D benefit beginning in 2006 will cover these alternative hand-held inhalation therapy devices (MDIs). In addition, the discount card and $600 transitional assistance payment for low-income beneficiaries will help seniors buy inhalers in 2004 and 2005, helping to bridge the gap until 2006 when coverage begins.

MDIs are the quickest and easiest way to take inhalation medication for most asthmatics and patients with COPD. The medication is propelled directly into the lungs, allowing it to take effect more quickly, and with fewer medication side effects. An MDI contains a specific number of ‘‘ metered inhalations, ’’ and is made to deliver the prescribed amount of medication for the labeled number of doses (typically 200 doses, which is 8 doses per day for 25 days). Inhalation accessory devices, such as holding chambers and spacers, are used to improve the direction and deposition of medication delivered by MDIs, making it easier for beneficiaries to use an MDI and making the MDI more effective in delivering the medicine to the lungs.

Since Medicare currently covers nebulizers and inhalation drugs, but not alternative forms of inhalation therapy, there are strong financial incentives toward use of the former compared to alternatives. Our review of the literature over the past decade, including two meta-analyses and over two dozen individual studies applicable to adults, did not find that bronchodilators delivered via nebulizer were more effective than when delivered via metered dose inhaler.

Since one delivery method is not clinically superior to the other, when Medicare covers both methods of delivery of inhalation therapy, the decision to prescribe one over the other will be made by the physician and beneficiary based on beneficiary needs and preferences consistent with applicable standards of medical practice. It would not be unlikely for many beneficiaries to choose the convenience of MDIs over nebulizers once the Medicare coverage imbalance is removed in 2006. Since MDIs are less expensive, very portable, and easier to use, it is likely there will be a substantial shift of Medicare beneficiaries from nebulizers to MDIs beginning in 2006, even absent the Medicare payment changes for nebulizers and inhalation drugs in 2005.

Some claim that beneficiaries cannot use MDIs because they do not have the dexterity to use them. Use of an MDI requires proper inhalation techniques in order to receive the full benefit possible from the amount of medication included in each dose. Spacers and holding chambers extend the mouthpiece of the inhaler and increase the air volume into which the medication is atomized, allowing more time for the patient to breathe the medication and avoid misdirecting the medication onto the soft tissues inside the mouth where it will have little effect on lung function.

A nebulizer may also require a certain level of dexterity (that is, operating, maintaining, and cleaning the nebulizer correctly). There may also be beneficiaries who do not have the dexterity to use either an MDI or nebulizer, which would require the availability of alternative therapies, such as an IPPB machine to aid in the delivery of aerosol medication by increasing the depth of breathing more than the patient alone can achieve.

7. Payments Beginning in 2005 Including Provisions of the Proposed Rule

Our goal is to assure that each beneficiary who needs inhalation therapy has access to the most appropriate medication and delivery method. We expect that the combined changes to cover MDIs, adjust payments for inhalation drugs, and provide for an appropriate dispensing fee will improve beneficiary access and choice. We seek comments about an appropriate amount for a dispensing fee that would assure beneficiary access to inhalation medications provided through nebulizers.


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We believe that a dispensing fee is intended to cover a pharmacy ’ s activities to get inhalation drugs to beneficiaries. We seek data and information on the additional services these pharmacies provide to Medicare beneficiaries, the extent to which inhalation drugs can be furnished without these additional services and the extent to which such services are covered under Medicare. We are concerned about significant shifts in beneficiary access to inhalation therapy prior to implementation of the Part D drug benefit in light of the reduction in Medicare payment for inhalation drugs beginning in 2005, and also seek comments about whether the dispensing fee should include a somewhat higher, transitional payment.

Below we discuss, changes in payment for inhalation drugs and nebulizers beginning in 2005.

a. Nebulizers

Section 1834(a)(21) of the Act, as amended by section 302(c)(2) of the MMA, requires a reduction in Medicare payment, beginning with 2005, for specified items of DME, including nebulizers paid under code E0570. The reduction is the difference in payment amounts under Medicare and the median Federal Employees Health Benefits (FEHB) plan, as identified in IG testimony before the Senate Committee of Appropriations on June 12, 2002. Other codes for nebulizers and related equipment are not affected by the payment reduction.
b. Maintenance and Servicing of Nebulizers

Since the maintenance and servicing fee is equal to the first month ’ s rental payment, the maintenance and servicing fee for nebulizers will also be reduced
in 2005.
c. Inhalation Drugs

As discussed in the ASP payment section of this proposed rule, for the first quarter of 2005, the Medicare payment at ASP plus 6 percent is estimated to be $0.04 per milligram for albuterol sulfate and $0.30 per milligram for ipratropium bromide. While these figures represent estimated reductions from 2004 payment levels of about 90 percent, they are not necessarily the actual payment amounts for the first quarter of 2005. The actual payment amounts will be based on
ASP ’ s calculated from the manufacturer ASP to be submitted for the third quarter of 2004.

Both albuterol sulfate and ipratropium bromide are generic drugs that have multiple manufacturers. Since these ASPs are average figures across all manufacturers, a pharmacy should be able to acquire albuterol sulfate and ipratropium bromide at these prices. Moreover, to the extent there is price variation among manufacturers, there will be some manufacturers with lower prices than others. In this case, a pharmacy might be able to obtain albuterol sulfate and ipratropium bromide at a price below the average.

The Medicare payment amount includes a 6 percent add-on. Assuming that ASP remains constant between the first and third quarters of 2004, the 6 percent add-on would be about $1.00 for a typical month ’ s supply of 450 milligrams of albuterol sulfate and about $3.00 for a 90-day supply. Similarly, the 6 percent add-on would be about $1.60 for a typical month ’ s supply of 93 milligrams of ipratropium bromide and about $4.80 for a 90-day supply. Because albuterol sulfate and ipratropium bromide are often prescribed together, Medicare payment at 106 percent of ASP would include, as additional payments above the acquisition cost of the drugs, a total payment to the supplier of about $2.60 for a 30-day supply and about $7.80 for a 90-day supply of both drugs.
d. Dispensing Fee

Given the overall reduction in payment for inhalation drugs, we are concerned about beneficiary access to these drugs. Because shipping, handling, compounding, and other pharmacy activities would usually exceed the 6 percent payment above the drug acquisition cost, we believe that it is appropriate for Medicare to continue to pay a separate dispensing fee to pharmacies that furnish inhalation drugs to beneficiaries.

We propose to establish a separate dispensing fee for inhalation drugs. This separate dispensing fee will be in addition to the difference between the supplier ’ s acquisition cost and the Medicare payment for the drug. For example, if a supplier is acquiring albuterol and ipratropium bromide for the average sales price, the supplier would receive a separate dispensing fee amount plus their acquisition cost plus $7.80 for a 90-day supply. The $7.80 is the amount included in the payment for the drug itself since Medicare pays 6 percent above the average sales price.

As noted above, Medicare has paid a $5 monthly dispensing fee for each covered inhalation drug or combination of drugs used in a nebulizer. Dispensing fees are paid by Medicaid and private insurers; we seek information about these dispensing fees for inhalation drugs and their applicability to Medicare. In addition, we seek comments about an appropriate dispensing fee amount to cover the shipping, handling, compounding, and other pharmacy activities required to get these inhalation medications to Medicare beneficiaries. We seek data and information that explains the direct labor and non-labor costs as well as indirect costs of overhead for these pharmacy activities as they relate to dispensing of inhalation drugs.

Consideration of dispensing fees needs to be viewed in the context of several important changes and clarifications in Medicare policy and billing requirements.

First, we are proposing to allow a prescription for inhalation drugs covering a 90-day period to be written by a physician and filled by a pharmacy. Current guidelines are that a pharmacy generally should not fill a prescription for inhalation drugs for more than a month ’ s supply for a beneficiary. We believe that this requirement needs revision in the case of inhalation drugs for two key reasons. Most beneficiaries who use inhalation drugs use them for extended periods of time and often use them for the rest of their lives. In addition, we understand that many inhalation drugs are delivered to a beneficiary through the mail. We understand that a mail-order prescription drug model works well for a 90-day prescription. We believe that there will be significant savings in shipping for a 90-day prescription rather than a monthly prescription.

We would expect that reasonableness would govern filling a monthly vs. a 90- day prescription with a physician writing and a pharmacy filling a monthly or a 90-day prescription depending on the circumstances of the beneficiary. For example, it would be reasonable to expect that the first time a beneficiary receives a prescription for a nebulizer and inhalation drugs that the prescription would be for a month. Similarly, it would be reasonable to expect that refill prescriptions for beneficiaries would be for a 90-day period. Carriers would continue to assess claims for dispensed quantities greater than what would be reasonable based on usual dosing guidelines. We would expect that the bulk of prescriptions would be for 90-day periods.

Second, we recently revised the guidelines regarding the time frame for delivery of refills of DMEPOS products to occur no sooner than ‘‘ approximately 5 days prior to the end of the usage for the current product ’’ . As previously noted, inhalation drugs are often furnished to a beneficiary by mail. It has


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been suggested that Medicare guidelines for refill prescriptions allowed too short of a window between shipping the next month ’ s prescription and the end of the current month. It was argued that as a result, a pharmacy ‘‘ effectively ’’ had to ship the product to a beneficiary using an overnight delivery service.

On January 2, 2004, we revised the guidelines (effective February 2, 2004) regarding the time frame for subsequent deliveries of refills of DMEPOS products to occur no sooner than ‘‘ approximately 5 days prior to the end of the usage for the current product ’’ (see section 4.26.1 of Chapter 4

— Benefit Integrity of the Medicare Program Integrity Manual). This change allows shipping of inhalation drugs on ‘‘ approximately ’’ the 25th day of the month in the case of a month ’ s supply, and on

‘‘ approximately ’’ the 85th day in the case of a 90-day supply. We emphasize the word ‘‘ approximately ’’ ; while we believe that normal ground service shipping would allow delivery in 5 days, if there were circumstances where ground service could not occur in 5 days, the guideline would still be met if the shipment occurs in 6 or 7 days. ( ‘‘ Days ’’ refers to business days or shipping days applicable to the shipper, that is, a 6 day week in the case of the U.S. Postal Service.). We believe that this change eliminates the need for suppliers to use overnight shipping methods and allows shipping of inhalation drugs by less expensive ground service.

Third, we understand that some pharmacies believe that Medicare has a requirement that a pharmacy must obtain an original signed prescription before each prescription is dispensed. The Program Integrity Manual (section 5.1 of Chapter 5) addresses the ordering requirement for DMEPOS items. The Manual indicates that most DMEPOS items, including drugs, can be dispensed based on a verbal order from a physician. The Manual further indicates that a written order must be obtained before submitting a claim, but that such written order may be faxed, photocopied, electronic or pen and ink. The order for inhalation drugs must specify the name of the drug, the concentration (if applicable), dosage, and frequency of administration. We hope that clarification of this requirement would reduce a pharmacy ’ s costs of supplying covered inhalation drugs to Medicare beneficiaries to the extent that pharmacies are currently applying an original signed prescription requirement.

Fourth, Medicare regulations ( § 424.57) specify the requirements a DMEPOS supplier must meet in order to receive payment for a Medicare covered item. Section 424.57(c)(12) contains the proof of delivery requirement and indicates that a ‘‘ supplier must be responsible for the delivery of Medicare covered items to beneficiaries and maintain proof of delivery. ’’ We recently revised the Program Integrity Manual (section 4.26 of Chapter 4) to address proof of delivery requirements for suppliers. As discussed in the Manual, the burden of proving delivery is left to the supplier. The Manual provides examples of the types of proof that are reasonable and acceptable, but it does not provide an all-inclusive list. Other acceptable proof-of-delivery methods may exist and may be employed by suppliers. This documentation is normally only requested by the contractor when a complaint is received that the item was not provided or received. The documentation is necessary to investigate the allegation. We believe that the current provisions on proof of delivery are adequate and appropriate for inhalation drugs.

Fifth, in section IV.H (Assignment of Medicare Claims

— Payment to the Supplier) of this proposed rule, we propose to change current regulations at § 424.55 to eliminate the requirement that beneficiaries assign claims to suppliers in situations where suppliers are required by section 1842(o)(3) of the Act to accept assignment. This change would eliminate the need for suppliers to have a signed Assignment of Benefits (AOB) form from a beneficiary in order for Medicare to make payment. Because such section of the Act requires Medicare to make payment for drugs only on an assigned basis, this change would eliminate a billing requirement for drugs, including inhalation drugs. We believe that this change would reduce a pharmacy ’ s costs of supplying covered inhalation drugs to Medicare beneficiaries to the extent that pharmacies are requiring a signed AOB form before submitting a claim.

We believe that the amount of dispensing fee needs to be considered in conjunction with

—

(1) Our proposal to allow 90-day prescriptions;

(2) Our recent revision to allow the next month ’ s refill prescription to be shipped approximately 5 business days prior to the end of usage for the product, that is, to allow shipping on the 25th of the month for a month ’ s supply, and shipping or 85th day in the case of a 90- day period;

(3) Our policy clarification regarding signed original orders before a prescription is filled;

(4) Our proof of delivery requirement revisions; and (5) Our proposed change regarding the Assignment of Benefits form.
e. Beneficiary Training

Medicare Part B will continue to pay for beneficiary training by a physician ’ s staff regarding use of a nebulizer, MDI, aerosol generator, or IPPB machine. Section 424.57(c)(12) specifies that ‘‘ The supplier must document that it or another qualified party has at an appropriate time, provided beneficiaries with necessary information and instructions on how to use Medicare covered-items safely and effectively. ’’ Beneficiary training by a physician or physician ’ s staff regarding use of a nebulizer would meet the definition of

‘‘ another qualified party ’’ for purposes of this supplier requirement.

IV. Other Issues
A. Proposals Related to Therapy
Services
1. Outpatient Therapy Services Performed ‘‘ Incident To ’’ Physicians ’ Services [If you choose to comment on issues in this section, please include the caption

‘‘ Therapy

— Incident To ’’ at the beginning of your comments.]

In last year ’ s proposed rule, we requested comments on clarifying that the personnel qualifications of therapists in home health settings at § 484.4 apply consistently to all therapy settings, including the offices of physical and occupational therapists, physicians, and nonphysician practitioners. We received comments from therapists, physicians, nontherapist health care providers and their representative organizations. After consideration of all comments, we now propose to revise 42 CFR 410.26, 410.59, 410.60 and 410.62 to reflect that physical therapy, occupational therapy, and speech-language pathology services provided incident to a physician ’ s professional services are subject to certain limitations as described at section 1862(a)(20) of the Act.

Regulations in 42 CFR 485.705 specify that, in almost all settings, outpatient rehabilitative therapy services, (physical therapy (PT), occupational therapy (OT), or speech-language pathology (SLP)) can be furnished only by the following individuals meeting the qualifications
in § 484.4: physical therapists, occupational therapists, appropriately supervised physical therapist assistants, appropriately supervised occupational therapy assistants, and speech-language pathologists. Some States permit licensed physicians, physician assistants, clinical nurse specialists, and nurse practitioners to furnish PT, OT,


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and SLP services also. Therapy services, and those who provide therapy services, must also meet the standards and conditions as specified in Medicare manuals.

Section 1862(a)(20) of the Act permits payment for therapy services furnished incident to a physician ’ s professional services only if the practitioner meets the standards and conditions that would apply to such therapy services if they were furnished by a therapist, with the exception of the licensing requirement. We are proposing to amend the regulations to include the statutory requirement that only individuals meeting the existing qualification and training standards for therapists (with the exception of licensure) consistent with § 484.4 qualify to provide therapy services incident to physicians ’ services.

Section 1862(a)(20) of the Act refers only to PT, OT, and SLP services and not to any other type of therapy or service. This section applies to services of the type described in section 1861(p), 1861(g) and 1861(ll) of the Act; it does not, for example, apply to therapy provided by qualified clinical psychologists. This section also does not apply to services that are not covered either as therapy or as evaluation and management services provided incident to a physician or nonphysician practitioner such as recreational therapy, relaxation therapy, athletic training, exercise physiology, kinesiology, or massage therapy
services.
2. Qualification Standards and Supervision Requirements in Therapy Private Practice Settings [If you choose to comment on issues in this section, please include the caption

‘‘ Therapy Standards and Requirements ’’ at the beginning of your comments.]

Section 1861(p) includes services furnished to individuals by physical and occupational therapists meeting licensing and other standards prescribed by the Secretary if the services meet the necessary conditions for standards for health and safety. These services include those furnished in the therapist ’ s office or the individual ’ s home. By regulation, we have defined therapists under this provision as physical or occupational therapists in private practice (PTPPs and OTPPs).

Under Medicare Part B, outpatient therapy services, including physical and occupational therapy services, are generally covered when reasonable and necessary and when provided by physical and occupational therapists meeting the qualifications set forth at § 484.4. Services provided by qualified therapy assistants, including physical therapist assistants (PTAs) and occupational therapy assistants (OTAs), may also be covered by Medicare when furnished under the specified level of therapist supervision that is required for the setting in which the services are provided (institutions and private practice therapist offices). For PTPPs and OTPPs, the regulations specify that the PT or OT meets only State licensure or certification standards and do not currently refer to the professional qualification requirements at § 484.4.

Since 1999, when therapy services are provided by PTAs and OTAs in the PT or OT private practice setting, the services must be personally supervised by the PTPP or OTPP. In response to a requirement to report to Congress on State standards for supervision of PTAs, CMS contracted with the Urban Institute. The Urban Institute found that no State has the strict, full-time

‘‘ personal ’’ supervision requirement, for any setting, that Medicare places on PTAs in PTPPs (the report only examined PTAs, which are more heavily regulated than OTAs). The Urban Institute study found that only 7 States require any ‘‘ personal ’’ PTA supervision by the PT, and all 7 required this level of supervision only periodically, every 14, 30 or 60 days. The remaining States and Washington, DC all have less stringent PTA supervision requirements, including: 7 States and Washington, DC require full-time on-site supervision, which corresponds to Medicare ’ s direct supervision level; 16 States require the equivalent of Medicare ’ s general supervision level, which does not require the PT to be on site, but requires the PT to be in contact via telecommunication; and another 16 States have rules for periodic on-site PT visits. Most States permit a supervision level similar to the Medicare ‘‘ general ’’ supervision requirement for physical therapy services delivered in institutional settings. To provide a consistent therapy assistant supervision policy, we are proposing to revise the regulations at 410.59 and 410.60 to require direct supervision of PTAs and OTAs when therapy services are provided by PTs or OTs in private practice. This proposed change would no longer require the personal presence of the PTPP or OTPP when their PTAs or OTAs provide services in the private practice setting. We are particularly interested in receiving comments regarding the proposed PTA supervision change, from personal to direct, for the private practice setting as whether or not it will have implications for the quality of services provided, or for Medicare spending, either through increased capacity to provide these services, or, alternatively, in the event that the Congress again extends the moratorium on the implementation of the limits on Medicare reimbursement for therapy services imposed by the Balanced Budget Act of 1997.

Currently, the OTPP or PTPP regulations at § 410.59(c) and § 410.60(c) do not reference qualification requirements for therapy assistants, or other staff, working for PTs and OTs in private practices. These qualification requirements were removed during 1998 rulemaking

— when the coverage conditions requiring survey and certification, at § 486 Subpart D, for independently practicing PTs and OTs were replaced with a simplified carrier enrollment process for PTPPs and OTPPs. In our 1998 rule, at 63 FR 58868, we deleted the references at § 410.59 and § 410.60 to the requirements at § 484.4 for PTs and OTs in private practice. At that time, the qualifications for the staff of the PTPP and OTPP, including PTAs and OTAs, were inadvertently removed because the coverage conditions at § 486 Subpart D were no longer applicable. In order to provide a consistent policy regarding requirements for therapists and therapy assistants, we are proposing to restore the qualifications by adding at § 410.59 and § 410.60 the cross-reference to the qualifications at § 484.4 for privately practicing therapists and their therapy
assistants.

3. Other Technical Revisions
[If you choose to comment on issues in this section, please include the caption

‘‘ Therapy Technical Revisions ’’ at the beginning of your comments.]

We are making technical corrections

to § 410.62 to refer consistently to speech-language pathology in this section (currently the terms ‘‘ speech pathology ’’ and ‘‘ speech-language pathology ’’ are used interchangeably) and are revising § 410.62(a)(2)(iii) to appropriately reference § 410.61 (the current reference is to § 410.63).

We are also removing subpart D, Conditions for Coverage: Outpatient Physical Therapy Services Furnished by Physical Therapists, from part 486. Our November 1998 rule (63 FR 58868) discussed replacing this subpart with a simplified carrier enrollment process for physical or occupational therapists in private practice; however, the conforming regulatory change to remove Subpart D was never made.

In addition, we are making a technical change at § 484.4 to correct the title

‘‘ physical therapy assistant ’’ to

‘‘ physical therapist assistant. ’’


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We are also amending § 410.59(e) and § 410.60(e) to include a reference to the 2-year moratorium on the therapy caps established by section 624 of the MMA.

B. Low Osmolar Contrast Media [If you choose to comment on issues in this section, please include the caption

‘‘ LOW OSMOLAR CONTRAST MEDIA ’’ at the beginning of your comments.]

Contrast media are used to enhance the images produced by various types of diagnostic radiological procedures. High osmolar contrast media (HOCM), initially developed for use with these procedures, was relatively inexpensive and payment for HOCM is subsumed in the payment for the technical component of these procedures. When the more expensive low osmolar contrast media (LOCM) were developed, estimates showed that if all radiologic studies requiring contrast media were to use LOCM, the costs to the Medicare program would have been substantial. At that time, there were no definitive studies showing that the benefits of using LOCM justified the very high additional costs.

When the Medicare physician fee schedule was established, findings of studies of patients receiving both types of contrast media had been published, and the American College of Radiology (ACR) had adopted criteria for the use of LOCM. We determined that the older, less expensive contrast media (HOCM) could be used safely in a large percentage of the Medicare population. However, we also decided that separate payment for LOCM should be made for patients with certain medical characteristics. We adopted the ACR criteria, with some modification, as the basis for a policy that separate payments be made for the use of LOCM in radiological procedures for patients meeting certain criteria. These criteria were established at § 414.38. Specifically, separate payment is made for all intrathecal, intravenous, and intra-arterial injections of LOCM, when it is used for nonhospital patients who have one or more of the following five medical conditions

—

• A history of previous adverse reactions to contrast media, with the exception of a sensation of heat, flushing, or a single episode of nausea or vomiting;

• A history of asthma or allergy;

• Significant cardiac dysfunction, including recent or imminent cardiac decompensation, severe arrhythmias, unstable angina pectoris, recent myocardial infarction, and pulmonary hypertension;

• Generalized debilitation;

• Sickle cell disease. Under these conditions, we pay for LOCM, utilizing HCPCS codes A4644 through A4646. The payment amount for LOCM is calculated according to the rules applicable to drugs provided incident to a physician ’ s service. The amount is reduced by 8 percent to account for the allowance for contrast media already included in the technical component of the service.

ACR has requested that we allow further separate payment for LOCM by either expanding or eliminating the conditions. According to ACR, use of LOCM has become the standard in most radiology practices and benefits both physicians and patients. The benefits of uniform use of LOCM would include

—

• The reduction of patient discomfort arising when HOCM is used instead of LOCM; and

• A reduction in physician resources now required to screen for high-risk patients.
The price differential between HOCM and LOCM is also decreasing. Universal use of LOCM, along with declining prices, will result in an efficient, and safer alternative to HOCM.

We are proposing to revise the regulations at § 414.38 to eliminate the restrictive criteria for the payment of LOCM. This proposal would make Medicare payment for LOCM consistent across settings. Before January 1, 2003, the criteria in § 414.38 were also used to determine payment in the hospital setting. However, as instructed in our Program Memorandum A

– 02

– 120, issued November 22, 2002, hospitals that are subject to the outpatient prospective payment system (OPPS) no longer use these criteria. Instead, payment for both ionic and non-ionic contrast media (including LOCM) is packaged into the APC payment for the procedure. Under OPPS there is no longer a payment difference between LOCM and other contrast materials.

Effective January 1, 2005, payment for LOCM would be made on the basis of the average sales price plus six percent in accordance with the standard methodology for drug pricing established by the MMA. However, because the technical portions of radiology services are currently valued in the nonphysician workpool and the CPEP inputs for these services are not used in calculating payment, we will continue to reduce payment for LOCM by eight percent to avoid any duplicate payment for contrast media. C. Payments for Physicians and Practitioners Managing Patients on Dialysis
[If you choose to comment on issues in this section, please include the caption

‘‘ MANAGING PATIENTS ON
DIALYSIS ’’ at the beginning of your comments.]

1. ESRD-Related Services Provided to Patients in Observation Settings

In response to comments received on billing procedures when the patient is hospitalized during the month, we stated in the November 7, 2003 Federal Register (68 FR 63220) that the physician may bill the code that reflects the number of visits during the month on days when the patient was not in the hospital (either admitted as an inpatient or in observation status). (We refer to Medicare ’ s payment amount below as the monthly capitation payment or MCP and the patient ’ s normal attending physician for ESRD-related services as the MCP physician).

In comments on the August 15, 2003 proposed rule, the Renal Physicians Association (RPA) indicated that the observation area is not an uncommon setting for outpatient face-to-face encounters to occur and the observationarea should be an approved site-ofservice for physician-dialysis patient encounters that count toward the MCP visit total. We indicated in the final rule, however, that observation services would not be counted as a visit under the MCP, but would be paid separately. Prior to this, long-standing Medicare policy had subsumed ESRD-related observation visits within the MCP.

Upon further review of this issue, we now agree with RPA ’ s comment and propose that ESRD-related visits provided to patients by the MCP physician in an observation setting would be counted as visits for purposes of billing the MCP codes.
2. Payment for Outpatient ESRD-Related Services for Partial Month Scenarios

Since changing our payments for managing patients on dialysis, we have received a number of comments from the nephrology community requestingguidance on billing for outpatient ESRDrelated services provided to transient patients and in partial month scenarios where the comprehensive visit may not have been furnished: for example, when the patient is hospitalized during the month, or receives a kidney transplant before the monthly comprehensive visit is furnished. To address this issue, we propose to change the description of the G codes for ESRD-related home dialysis services, less than full month, as


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identified by G0324 through G0327. The new descriptor would include other partial month scenarios, in addition to patients dialyzing at home. The proposed descriptors for G0324 through G0327 are as follows:

‘‘ G0324: End stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients under two years of age. ’’

‘‘ G0325: End stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients between two and eleven years of age. ’’

‘‘ G0326: End stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients between twelve and nineteen years of age. ’’

‘‘ G0327: End stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients twenty years of age and over. ’’

The G codes G0324 through G0327 would be used to bill for outpatient ESRD-related services provided in the following scenarios:

• Transient patients

— Patients traveling away from home (less than full month);

• Home Dialysis Patients (less than full month);

• Partial month where there was one or more face-to-face visits without the comprehensive visit and either the patient was hospitalized before a complete assessment was furnished, dialysis stopped due to death, or the patient had a transplant.

We believe that modifying the definition of the per diem G codes (as identified by G0324 through G0327) would provide a consistent way to bill for these partial month scenarios. However, this proposed change to the descriptions of G0324 through G0327 is intended to accommodate unusual circumstances when the outpatient ESRD-related services would not be paid for under the MCP. Use of these per diem codes would be limited to the scenarios listed above. Physicians who have an on-going formal agreement with the MCP physician to provide cursory visits during the month (for example

‘‘ rounding physicians ’’ ) may not use the per diem codes.
Clarification on Billing for Transient
Patients

For transient patients who are away from their home dialysis site, and at another site for fewer than 30 consecutive days, the revised per diem G codes (G0324 through G0327) would be billed by the physician or practitioner responsible for the transient patient ’ s ESRD-related care. Only the physician or practitioner responsible for the traveling ESRD patient ’ s care would be permitted to bill for ESRD-related services using the per diem G codes (G0324 through G0327).

If the transient patient is under the care of a physician or practitioner other than his or her regular MCP physician for a complete month, the physician or practitioner responsible for the transient patient ’ s ESRD-related care cannot bill using the per diem codes. In this case the transient physician or practitioner treating the patient must furnish acomplete assessment and bill for ESRDrelated services under the MCP.

We are currently evaluating the criteria for defining a transient patient and welcome comments on when a patient should be considered transient.

D. Technical Revision [If you choose to comment on issues in this section, please include the caption

‘‘ TECHNICAL REVISION ’’ at the beginning of your comments.]

In § 411.404, Medicare noncoverage of all obesity-related services is used as an example. Since we are currently revising this coverage policy, we are proposing to omit this example.
E. Diagnostic Psychological Tests [If you choose to comment on issues in this section, please include the caption

‘‘ DIAGNOSTIC PSYCHOLOGICAL
TESTS ’’ at the beginning of your comments.]

All diagnostic tests covered under section 1861(s)(3) of the Act and payable under the physician fee schedule must be furnished under the appropriate level of supervision by a physician as defined in section 1861(r) of the Act. Additionally, the physician or nonphysician practitioner who is treating the patient must order all diagnostic tests in order for these tests to be considered reasonable and necessary. These tests must be furnished under at least a general level of physician supervision, that is, the test is furnished under the physician ’ s overall direction and control, but the physician ’ s presence is not required during the performance of the procedure.

However, certain diagnostic tests require either direct or personal supervision. Direct supervision in the office setting means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed. Personal supervision means the physician must be in attendance in the room during the performance of the procedure. Physician supervision at the specified level is required throughout the performance of the test. Services furnished without the required level of supervision are not reasonable and necessary, and Medicare payment is precluded.

Section 410.32(b)(2)(iii) does permit an exception to these physician supervision level requirements for clinical psychologists and independently practicing psychologists (who are not clinical psychologists) to personally perform diagnostic psychological testing services without physician supervision. However, diagnostic psychological tests performed by anyone other than a clinical psychologist or independently practicing psychologist must be provided under the general supervision of a physician as defined above. Accordingly, clinical psychologists and independently practicing psychologists have not been permitted to supervise others in the administration of diagnostic psychological tests.

In § 410.71(d), we require a clinical psychologist who furnishes diagnostic, assessment, preventive, and therapeutic services directly to individuals to hold a doctoral degree in psychology and to be licensed or certified, on the basis of the doctoral degree in psychology, by the State in which he or she practices. Program instructions define an independently practicing psychologist as an individual who is not a clinical psychologist and practices independently of an institution, agency, or physician ’ s office. Examples include, but are not limited to, educational psychologists and counseling psychologists. Any psychologist who is licensed or certified to practice psychology in the State or jurisdiction where he or she is furnishing services may qualify as an independent psychologist. It is our understanding that all States, the District of Columbia, and Puerto Rico license psychologists, but that some trust territories do not. In the jurisdictions that do not issue licenses, an independently practicing psychologist may be any practicing psychologist.

The American PsychologicalAssociation (APA) requested that we reevaluate our regulations regarding clinical psychologists ’ supervision of diagnostic psychological tests. The APA also provided additional information concerning provision of these services.

According to the APA, clinical psychologists generally have seven years of graduate education in the study of human behavior and are highly trained in the selection, administration,


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and interpretation of psychological tests. In addition, according to our payment data, the majority of health care practitioners, other than physicians, performing psychological and neuropsychological testing services under the central nervous system codes (CPT codes 96100 through 96117) are psychologists. We agree that clinical psychologists possess core knowledge in test measurement and development, psychometric theory, specialized psychological assessment techniques, statistics, and the psychology of behavior that uniquely qualifies them to direct test selection and interpret test data.

Therefore, we are proposing to change the supervision requirements regarding who can supervise diagnostic psychological testing services.

Having ancillary staff supervised by clinical psychologists would enable these practitioners with a higher level of expertise to oversee psychological testing. It could also potentially relieve burdens on physicians and healthcare facilities.

Additionally, in rural areas, we anticipate that permitting psychologists to supervise diagnostic psychological testing services would reduce delays in testing, diagnosis, and treatment that could result from the unavailability of physicians to supervise the tests.

We propose that the appropriate level of supervision of diagnostic psychological tests by clinical psychologists be general supervision, the level required of physicians supervising the same services.

We are proposing to revise the regulations at § 410.32(b)(2)(iii) to permit clinical psychologists to supervise the performance of diagnostic psychological and neuropsychological testing services. This proposal extends solely to clinical psychologists, and it does not include independently practicing psychologists.
F. Care Plan Oversight [If you choose to comment on issues in this section, please include the caption

‘‘ CARE PLAN OVERSIGHT ’’ at the beginning of your comments.]

Care Plan Oversight (CPO) refers to the supervision of patients under Medicare-covered home health orhospice care requiring complex multidisciplinary care modalities, including regular development and review of plans of care. In the December 8, 1994 physician fee schedule final rule (59 FR 63423), we established separate payment for CPO when performed by physicians. The Balanced Budget Act (BBA) of 1997 extended to nonphysician practitioners (NPPs) the right to receive payment for Medicare physicians ’ services that fall within their scope of practice under State law. In the November 1, 2000 final rule (65 FR 65407), we created HCPCS codes G0181 and G0182 for reporting home health and hospice CPO, respectively. We also clarified in that rule that services of NPPs, practicing within the scope of State law applicable to their services, could be billed as CPO services.

To certify a patient for home health services, a physician must review the patient records and sign the plan of care. Our policy has been that the physician who bills for CPO must be the same physician who signs the plan of care and that, according to the statute, (sections 1814(a)(2)(C) and 1835(a)(2)(A) of the Act), only a physician can sign the plan of care for home health services. The effect of these two provisions, both of which were in place prior to the BBA of 1997, created a problem with respect to an NPP billing for CPO in the home health setting.

We propose to revise § 414.39 to clarify that NPPs can perform home health CPO even though they cannot certify a patient for home health services and sign the plan of care. However, we are also proposing the conditions under which NPP services may be billed for CPO; we established these conditions in consultation with our contractor medical directors and CMS medical staff. In general, the proposed conditions are meant to ensure that the NPP has seen and examined the patient and that the appropriate and established relationship exists between the physician who certifies the patient for home health services and the NPP who will provide the home health CPO.
G. Assignment of Medicare Claims

— Payment to the Supplier [If you choose to comment on issues in this section, please include the caption

‘‘ Assignment ’’ at the beginning of your comments.]

Current regulations require the beneficiary (or the person authorized to request payment on the beneficiary ’ s behalf) to assign a claim to the supplier for an assignment to be effective. Over time, however, the Act has been amended in various sections to require suppliers, in some instances, to accept assignment for a Medicare covered service regardless of whether or not the beneficiary actually assigns the claim to the supplier. (This would include situations in which services are furnished by a participating physician or supplier.) In these instances, the requirement in our current regulations

at § 424.55(a) that the beneficiary assign the claim to the supplier is now unnecessary. Therefore, we are proposing to create an exception to the general rule in § 424.55(a). New § 424.55(c) would eliminate the requirement that beneficiaries assign claims to suppliers in situations where suppliers are required by statute to accept assignment.

We believe the creation of this exception to the requirement for beneficiaries to assign benefits in situations where benefits can by statute only be paid on an assigned basis will reduce the paperwork burden on beneficiaries and suppliers.

V. Collection of Information Requirements

Under the Paperwork Reduction Act of 1995 (PRA), we are required to provide 60-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether OMB should approve an information collection, section 3506(c)(2)(A) of the PRA 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.

Section 410.16 requires the furnishing of education, counseling, and referral services as part of an initial preventive physical examination, a written plan for obtaining the appropriate screening and other preventive services which are also covered as separate Medicare B Part
services.

The burden associated with this requirement is the time required of the physician or practitioner to provide beneficiaries with education, counseling, and referral services and to develop and provide a written plan for obtaining screening and other preventive services.

While these requirements are subject to the PRA, we believe the burden associated with these requirements to be reasonable and customary business practice; therefore, the burden for this collection requirement is exempt under 5 CFR 1320.3(b)(2)&(3).

Section 411.404 requires that written notice must be given to a beneficiary, or someone acting on his or her behalf, that


## 47555 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

the services were not covered because they did not meet Medicare coverage guidelines.

Although this section is subject to the PRA, the burden associated with this requirement is currently captured and accounted for in two currently approved information collections under OMB numbers 0938

– 0566 and 0938

– 0781.

Sections 410.36 and 410.38 require that the physician must document in the medical records the need for the prosthetic, orthotic, durable medical equipment, and/or supplies being ordered.

While these information collection requirements are subject to the PRA, the burden associated with them is exempt as defined in 5 CFR 1320.3(b)(2).

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, Attn: Melissa Musotto (CMS

– 1429

– P), Room C5

– 13

– 28, 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: Christopher Martin, CMS Desk Officer (CMS

– 1429

– P), Christopher

l

Martin@omb.eop.gov. FAX (202) 395

– 6974.
VI. 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.
VII. 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 16, 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 1 year, or would adversely affect in a material way the economy, a sector of the economy, productivity, competition, jobs, the environment, public health or safety, or State, local, or tribal governments or communities). As indicated in more detail below, we estimate that the physician fee schedule provisions included in this proposed rule will redistribute more than $100 million in 1 year. We are also estimating that the combined effect of several provisions of the MMA implemented in this proposed rule will increase spending by more than $100 million. Other MMA provisions implemented in this proposed rule are estimated to reduce spending by more than $100 million. 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 that we analyze regulatory options for small businesses and other entities. We prepare a regulatory flexibility analysis unless we certify that a rule would not have a significant economic impact on a substantial number of small entities. The analysis must include a justification concerning the reason action is being taken, the kinds and number of small entities the rule affects, and an explanation of any meaningful options that achieve the objectives with less significant adverse economic impact on the small entities.

Section 1102(b) of the Act requires us to prepare a regulatory impact analysis for any 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 431 hospital-based ESRD facilities located in rural areas, only 40 are affiliated with hospitals with fewer than 100 beds.

For purposes of the RFA, physicians, nonphysician practitioners, and suppliers are considered small businesses if they generate revenues of $6 million or less. Approximately 95 percent of physicians are considered to be small entities. There are about 875,000 physicians, other practitioners and medical suppliers that receive Medicare payment under the physician fee schedule. There are in excess of 20,000 physicians and other practitioners that receive Medicare payment for drugs. (As noted previously in this proposed rule and described further below, we are proposing significant changes to the payments for drugs.) These physicians are concentrated in the specialties of oncology, urology, and rheumatology. Of the physicians in these specialties, approximately 40 percent are in oncology and 45 percent in urology.

For purposes of the RFA, approximately 98 percent of suppliers of durable medical equipment (DME) and prosthetic devices are considered small businesses according to the Small Business Administration ’ s (SBA) size standards. We estimate that 106,000 entities bill Medicare for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) each year. Total annual estimated Medicare revenues for DME suppliers exceed approximately $4.0 billion. Of this amount, approximately $1.6 billion are for DME drugs.

In addition, most ESRD facilities are considered small entities, either based on nonprofit status, or by having revenues of $29 million or less in any year. We consider a substantial number of entities to be affected if the proposed rule is estimated to impact more than 5 percent of the total number of small entities. Based on our analysis of the 697 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 rule would have a 1.6 percent increase in payments relative to current composite rate payments.

The analysis and discussion provided in this section, as well as elsewhere in this proposed rule, complies with the RFA requirements. Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in expenditures in any year by State, local,


## 47556 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

or tribal governments, in the aggregate, or by the private sector, of $110 million. Medicare beneficiaries are considered to be part of the private sector for this purpose. The net impact of the provisions of this rule, including those related to the MMA, are estimated to result in a savings to beneficiaries of nearly $270 million for FY 2005. The specific effects of the provisions being implemented in this proposed rule are explained in greater detail below.

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. It explains the rationale for and purposes of the rule; details the costs and benefits of the rule; analyzes alternatives; and presents the measures we propose to use to minimize the burden on small entities. As indicated elsewhere in this proposed rule, we propose to refine resource-based practice expense RVUs and make a variety of other changes to our regulations, payments, or payment policy to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. We are also proposing several changes resulting from the MMA, including changes to Medicare payment rates for outpatient drugs, changes to the payment for renal dialysis services, creating new preventive health care benefits and creating incentive payment program improvements for physician scarcity.

We are providing 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. Resource-Based Practice Expense and Malpractice Relative Value Units

Under section 1848(c)(2) of the Act, adjustments to RVUs may not cause the amount of expenditures to differ by more than $20 million from the amount of expenditures that would have resulted without such adjustments. We are proposing several changes that would result in a change in expenditures that would exceed $20 million if we made no offsetting adjustments to either the conversion factor or RVUs.

With respect to practice expense, ourpolicy has been to meet the budgetneutrality requirements in the statute by incorporating a rescaling adjustment in the practice expense methodologies. That is, we estimate the aggregate number of practice expense RVUs that will be paid under current and proposed policy in CY 2005. We apply a uniform adjustment factor to make the aggregate number of proposed practice expense RVUs equal the number estimated that would be paid under current policy.

Table 21 shows the specialty level impact on payment of changes being proposed for CY 2005. Our estimates of changes in Medicare revenues for physician fee schedule services compare payment rates for 2005 with payment rates for 2004 using 2003 Medicare utilization for both years. We are using 2003 Medicare claims processed and paid through June 30, 2004 that we estimate are 96.7 complete and have adjusted the figures to reflect a full year of data. Thus, because we are using a single year of utilization, the estimated changes in revenues reflect payment changes only between 2004 and 2005. To the extent that there are year-to-year changes in the volume and mix of services provided by physicians, the actual impact on total Medicare revenues will be different than those shown here. The payment impacts reflect averages for each specialty based on Medicare utilization. The payment impact for an individual physician would be different from the average, based on the mix of services the physician provides. The average change in total revenues would be less than the impact displayed here because physicians furnish services to both Medicare and non-Medicare patients and specialties may receive substantial Medicare revenues for services that are not paid under the physician fee schedule. For instance, independent laboratories receive approximately 80 percent of their Medicare revenues from clinical laboratory services that are not paid under the physician fee schedule. The table shows only the payment impact on physician fee schedule
services.

We modeled the impact of changes to the practice expense methodology and illustrated the effect in table 21 below. The column labeled ‘‘ Practice Expense RVU Refinements ’’ shows the effect of the refinements we are making to the practice expense methodology for 2005. For instance, we are incorporating refined practice expense inputs recommended by the PEAC into the methodology as well as updating the prices of medical equipment. We are also adding 2003 utilization data for codes that did not exist in the 1997 through 2002 period.

In general, updating the methodology with 2003 utilization data has little or no impact on total payments to a specialty but the practice expense values for specific services may change. In general, the largest changes to a practice expense RVU will occur when a code was established after 2002 and we did not have any Medicare utilization data to determine the specialty that performs the service. In these cases, we either assigned the code to a specialty cost pool based on the specialty most likely to do the service or we used the ‘‘ all physician ’’ scaling factors to determine the code ’ s practice expense RVUs. While we are trying to minimize instability in the practice expense RVUs for new services by assigning the specialty that is most likely to perform the service when we have no utilization data, the addition of utilization to the methodology may still result in some change to the practice expense RVUs during the first few years a code is in existence.

The practice expense refinements will reduce payments to audiologists by approximately 4 percent. Virtually all of the reduction in payment is due to the refinement of procedure code 92547. We accepted the PEAC recommendation to reduce the clinical staff time of the audiologist involved in this add-on service from 71 minutes to 1 minute. The refinement of clinical staff and equipment resulted in a reduction from 1.15 to 0.08 practice expense RVUs producing the nearly 4 percent reduction in payments shown in table

21.

Payments to vascular surgeons will increase approximately 3 percent as a result of the refinements. The increase in payment is attributed to the repricing of medical equipment used in performing noninvasive vascular diagnostic tests that will increase the practice expense RVUs for procedure codes 93880, 93923, 93925, 93970 and other codes in that family. The estimated 2 percent increase in payment from the practice expense refinements for interventional radiology is primarily due to the establishment of nonfacility pricing for procedure codes 35470 to 35476. The 3 percent increase in payment to oral and maxillofacial surgeons is largely attributed to the refinement of medical supplies for procedure codes 21210 and 21215. The 1 percent decrease in payment to nurse practitioners and geriatricians is attributed to the refinement of the nonfacility practice expense RVUs for


## 47557 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

nursing facility visits (procedure codes 99301 through 99316). As stated in the November 7, 2003 Federal Register (68 FR 63204), the changes to the nonfacility practice expense RVUs for these codes were delayed by 1 year to allow the PEAC to reconsider its earlier recommendation to us to reflect input from representatives of specialties that provide these services in nursing homes. The PEAC reconsidered its recommendations with input from these specialties. Our acceptance of the PEAC recommendations is resulting in a decrease in the nonfacility practice expense RVUs for the nursing facility visit codes.

The column labeled ‘‘ Survey Data ’’ shows the impact on payment from using the supplemental practice expense survey from the College of American Pathologists (CAP). Using this survey together with making the technical component practice expense RVUs equal to the difference between the global and professional component practice expense RVUs and the other practice expense refinements will increase payments to pathologists by approximately 2 percent and independent laboratories by more than 6 percent. As we indicated above, independent laboratories receive approximately 20 percent of their total Medicare revenues from physician fee schedule services. The remaining 80 percent of their Medicare revenues are from clinical diagnostic laboratory services that will be unchanged by use of the CAP survey data. Thus, total Medicare revenues to independent laboratories as a result of using the CAP survey will increase by slightly more than 1 percent (or 20 percent of the 6 percent increase in physician fee schedule revenues). There will be little or no impact on all other specialties from use of the CAP survey.

The column labeled ‘‘ Total ’’ in Table 21 below shows the payment impact by specialty of all the changes described above. If we change any of these proposals following our consideration of comments, these figures may change.



### T ABLE 

### 21.

— I MPACT OF 

### P RACTICE 

### E XPENSE 

### RVU C HANGES ON 

### T OTAL 

### M EDICARE 

### A LLOWED 

### C HARGES BY 

### P HYSICIAN



### , P RACTITIONER AND 

### S UPPLIER 

### S UBCATEGORY

Specialty Medicare allowed charges ($ in millions) Practice expense RVU refinements (percent) Survey data (percent) Total (percent)

Physicians: ALLERGY/IMMUNOLOGY ....................................................................... 161

¥ 1 0

¥ 1 ANESTHESIOLOGY ................................................................................. 1,416 0 0 0 CARDIAC SURGERY ............................................................................... 359 0 0 0 CARDIOLOGY .......................................................................................... 6,583 0 0 0 COLON AND RECTAL SURGERY .......................................................... 111 0 0 0 CRITICAL CARE ...................................................................................... 130 0 0 0 DERMATOLOGY ...................................................................................... 1,870 0 0 0 EMERGENCY MEDICINE ........................................................................ 1,672 0 0 0 ENDOCRINOLOGY .................................................................................. 280 0 0 0 FAMILY PRACTICE ................................................................................. 4,448 0 0 0 GASTROENTEROLOGY .......................................................................... 1,636 0 0 0 GENERAL PRACTICE ............................................................................. 998 0 0 0 GENERAL SURGERY .............................................................................. 2,258 0 0 0 GERIATRICS ............................................................................................ 117

¥ 1 0

¥ 1 HAND SURGERY ..................................................................................... 57 1 0 1 HEMATOLOGY/ONCOLOGY ................................................................... 1,753 0 0 0 INFECTIOUS DISEASE ........................................................................... 401 0 0 0 INTERNAL MEDICINE ............................................................................. 8,846 0 0 0 INTERVENTIONAL RADIOLOGY ............................................................ 190 2 0 2 NEPHROLOGY ........................................................................................ 1,248 1 0 1 NEUROLOGY ........................................................................................... 1,200 0 0 0 NEUROSURGERY ................................................................................... 490 0 0 0 NUCLEAR MEDICINE .............................................................................. 85 0 0 0 OBSTETRICS/GYNECOLOGY ................................................................ 582 0 0 0 OPHTHALMOLOGY ................................................................................. 4,583

¥ 1 0

¥ 1 ORTHOPEDIC SURGERY ....................................................................... 2,902 0 0 0 OTOLARNGOLOGY ................................................................................. 815 0 0 0 PATHOLOGY ........................................................................................... 869

¥ 1 3 2 PEDIATRICS ............................................................................................ 59

¥ 1 0

¥ 1 PHYSICAL MEDICINE ............................................................................. 677 0 0 0 PLASTIC SURGERY ................................................................................ 281 0 0 0 PSYCHIATRY ........................................................................................... 1,093 0 0 0 PULMONARY DISEASE .......................................................................... 1,446 0 0 0 RADIATION ONCOLOGY ........................................................................ 1,164 0 0 0 RADIOLOGY ............................................................................................ 4,690 0 0 0 RHEUMATOLOGY ................................................................................... 413 0 0 0 THORACIC SURGERY ............................................................................ 463 0 0 0 UROLOGY ................................................................................................ 1,699 0 0 0 VASCULAR SURGERY ............................................................................ 487 3 0 3
Practitioners: AUDIOLOGIST ......................................................................................... 28

¥ 4 0

¥ 4 CHIROPRACTOR ..................................................................................... 656 0 0 0 CLINICAL PSYCHOLOGIST .................................................................... 490 0 0 0 CLINICAL SOCIAL WORKER .................................................................. 313 0 0 0 NURSE ANESTHETIST ........................................................................... 481 0 0 0


## 47558 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 21.

— I MPACT OF 

### P RACTICE 

### E XPENSE 

### RVU C HANGES ON 

### T OTAL 

### M EDICARE 

### A LLOWED 

### C HARGES BY 

### P HYSICIAN



### , P RACTITIONER AND 

### S UPPLIER 

### S UBCATEGORY



### — Continued

Specialty Medicare allowed charges ($ in millions) Practice expense RVU refinements (percent) Survey data (percent) Total (percent)

NURSE PRACTITIONER ......................................................................... 552

¥ 1 0

¥ 1 OPTOMETRY ........................................................................................... 664 0 0 0 ORAL/MAXILLOFACIAL SURGERY ........................................................ 36 3 0 3 PHYSICAL/OCCUPATIONAL THERAPY ................................................. 990

¥ 1 0

¥ 1 PHYSICIAN ASSISTANT ......................................................................... 410 0 0 0 PODIATRY ............................................................................................... 1,383 0 0 0 Suppliers: DIAGNOSTIC TESTING FACILITY .......................................................... 876 1 0 1 INDEPENDENT LABORATORY .............................................................. 530 0 6 6 PORTABLE X-RAY SUPPLIER ................................................................ 91 0 0 0 Other: ALL OTHER .............................................................................................. 93 0 2 2 ALL PHYSICIAN FEE SCHEDULE .......................................................... 66,395 0 0 0



### As discussed in Section II.C of this rule, we are proposing changes to the malpractice RVUs based on more current malpractice premium data. As anticipated from past revisions to the malpractice RVUs, use of more current malpractice premium data results in minimal proposed impacts on the specialty level payments. See Table 22, ‘‘ Specialty Impact of Malpractice RVUs
Revisions ’’ , for a breakdown of the impacts of these revisions on individual specialties. Of the 54 specialties shown, 15 specialties (representing a total of 40 percent of Medicare allowed charges) experience no estimated change. Total Medicare payments for an additional 32 specialties are estimated to increase or decrease between 0.1 percent and 0.5 percent. We estimate that 7 specialties will experience a total payment increase or decrease of more than 0.5 percent as a result of the malpractice RVU changes. If we change any of these proposals following our consideration of comments, these figures may change.



### T ABLE 

### 22.

— S PECIALTY 

### I MPACT OF 

### M ALPRACTICE 

### RVU R EVISIONS

Specialty Allowed charges 1 Percent of total charges Percent change 2

DERMATOLOGY ................................................................................................................... 1 ,870,318,730 2.8 0.7 PLASTIC SURGERY ............................................................................................................. 280 ,508,065 0.4 0.6 ORAL/MAXILLOFACIAL SURGERY ..................................................................................... 35,598,814 0.1 0 .6 COLON AND RECTAL SURGERY ....................................................................................... 110,683,908 0.2 0.6 GASTROENTEROLOGY ....................................................................................................... 1,635,61 6,057 2.5 0.5 GENERAL SURGERY ........................................................................................................... 2,257 ,836,035 3.4 0.5 CRITICAL CARE .................................................................................................................. . 130,256,300 0.2 0.5 INFECTIOUS DISEASE ........................................................................................................ 395,1 95,230 0.6 0.4 GERIATRICS ..................................................................................................................... .... 116,547,182 0.2 0.3 PSYCHIATRY ..................................................................................................................... ... 1,092,801,668 1.7 0.3 PULMONARY DISEASE ....................................................................................................... 1,445,1 80,432 2.2 0.3 NURSE PRACTITIONER ...................................................................................................... 549,723 ,060 0.8 0.2 PATHOLOGY ...................................................................................................................... ... 868,617,850 1.3 0.2 NEUROLOGY ...................................................................................................................... .. 1,199,069,489 1.8 0.2 PHYSICAL MEDICINE .......................................................................................................... 676, 516,230 1.0 0.2 INDEPENDENT LABORATORY ........................................................................................... 529,571,661 0. 8 0.2 OPTOMETRY ...................................................................................................................... .. 664,163,601 1.0 0.2 NEPHROLOGY ..................................................................................................................... . 1,247,164,211 1.9 0.1 VASCULAR SURGERY ......................................................................................................... 486,26 3,563 0.7 0.1 OBSTETRICS/GYNECOLOGY ............................................................................................. 578,322,768 0 .9 0.1 INTERNAL MEDICINE .......................................................................................................... 8,82 1,789,552 13.4 0.1 ENDOCRINOLOGY ............................................................................................................... 279 ,359,088 0.4 0.1 ANESTHESIOLOGY .............................................................................................................. 1,4 15,251,017 2.1 0.0 HEMATOLOGY/ONCOLOGY ................................................................................................ 1,553,937,40 1 2.4 0.0 CARDIOLOGY ..................................................................................................................... .. 6,580,625,617 10.0 0.0 OPHTHALMOLOGY .............................................................................................................. 4,58 3,221,470 7.0 0.0 NURSE ANESTHETIST ........................................................................................................ 481,06 0,016 0.7 0.0 THORACIC SURGERY ......................................................................................................... 463,42 8,857 0.7 0.0 RADIATION ONCOLOGY ..................................................................................................... 1,162,75 4,357 1.8 0.0 ALL OTHER ...................................................................................................................... ..... 92,826,859 0.1 0.0 CLINICAL SOCIAL WORKER ............................................................................................... 313,327,45 5 0.5 0.0 GENERAL PRACTICE .......................................................................................................... 995,1 88,403 1.5 0.0 UROLOGY ........................................................................................................................ ..... 1,689,047,785 2.6 0.0 INTERVENTIONAL RADIOLOGY ......................................................................................... 189,980,663 0. 3 0.0 EMERGENCY MEDICINE ..................................................................................................... 1,671,77 3,516 2.5 0.0 FAMILY PRACTICE ............................................................................................................... 4 ,442,795,644 6.7 0.0 DIAGNOSTIC TESTING FACILITY ....................................................................................... 876,242,174 1 .3 0.0


## 47559 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 22.

— S PECIALTY 

### I MPACT OF 

### M ALPRACTICE 

### RVU R EVISIONS



### — Continued

Specialty Allowed charges 1 Percent of total charges Percent change 2

PHYSICIANS ASSISTANT .................................................................................................... 409,700 ,298 0.6 -0.1 PEDIATRICS ..................................................................................................................... .... 58,880,964 0.1 -0.1 AUDIOLOGIST .................................................................................................................... .. 27,930,180 0.0 -0.1 CLINICAL PSYCHOLOGIST ................................................................................................. 490,006,1 76 0.7 -0.1 CARDIAC SURGERY ............................................................................................................ 359, 324,850 0.5 -0.1 PORTABLE X-RAY SUPPLIER ............................................................................................. 91,026,934 0.1 -0.1 HAND SURGERY .................................................................................................................. 5 6,595,222 0.1 -0.1 OTOLARNGOLOGY .............................................................................................................. 814, 914,443 1.2 -0.1 RHEUMATOLOGY ................................................................................................................ 405 ,622,764 0.6 -0.1 NUCLEAR MEDICINE ........................................................................................................... 85,2 39,821 0.1 -0.1 CHIROPRACTOR .................................................................................................................. 6 56,312,519 1.0 -0.2 RADIOLOGY ...................................................................................................................... .... 4,689,652,801 7.1 -0.3 PODIATRY ....................................................................................................................... ...... 1,382,552,109 2.1 -0.4 ORTHOPEDIC SURGERY .................................................................................................... 2,902,084 ,841 4.4 -0.4 NEUROSURGERY ................................................................................................................ 489 ,366,546 0.7 -0.6 ALLERGY/IMMUNOLOGY .................................................................................................... 160,728,1 39 0.2 -0.9 PHYSICAL/OCCUPATIONAL THERAPY .............................................................................. 990,284,755 1.5 -1.3

1 2003 Allowed Charges

2 Percent change based upon percent change in total payment.



### Section 1848(d) and (f) of the Act requires the Secretary to set the physician fee schedule update under the sustainable growth rate (SGR) system. For 2004 and 2005, the statute requires the update to be no less than 1.5 percent. We believe it is highly likely that the statutory formula in section 1848(d)(4) will produce an update of less than 1.5 percent for 2005. Therefore, we estimate that the physician fee schedule update for 2005 will be 1.5 percent. We are currently forecasting payment reductions under the SGR system for 2006 and later years. As in the past, we will include a complete discussion of our methodology for calculating the SGR in the final rule.

Table 23 below shows the estimated change in average payments by specialty resulting from changes to the practice expense and malpractice RVUs and the 2005 physician fee schedule update. (Please note that the table does not include the specialties of Hematology/ Oncology, Urology, Rheumatology and Obstetrics/Gynecology. There are unique issues related to drug administration that will further affect these specialties that are presented in detail below).



### T ABLE 

### 23.

— I MPACT OF 

### P RACTICE 

### E XPENSE AND 

### M ALPRACTICE 

### RVU C HANGES AND 

### P HYSICIAN 

### F EE 

### S CHEDULE 

### U PDATE

ON 

### T OTAL 

### M EDICARE 

### A LLOWED 

### C HARGES BY 

### P HYSICIAN 

### , P RACTITIONER AND 

### S UPPLIER 

### S UBCATEGORY

Speciality Medicare allowed charges ($ in Millions) Practice expenses & malpractice RVU

changes (percent) Physician feeschedule update (percent) Total (percent)

Physicians: ALLERGY/IMMUNOLOGY ....................................................................... 161

¥ 2 1.5 0 ANESTHESIOLOGY ................................................................................. 1,416 0 1.5 2 CARDIAC SURGERY ............................................................................... 359 0 1.5 1 CARDIOLOGY .......................................................................................... 6,583 0 1.5 2 COLON AND RECTAL SURGERY .......................................................... 111 1 1.5 2 CRITICAL CARE ...................................................................................... 130 0 1.5 2 DERMATOLOGY ...................................................................................... 1,870 1 1.5 3 EMERGENCY MEDICINE ........................................................................ 1,672 0 1.5 2 ENDOCRINOLOGY .................................................................................. 280 0 1.5 2 FAMILY PRACTICE ................................................................................. 4,448 0 1.5 1 GASTROENTEROLOGY .......................................................................... 1,636 0 1.5 2 GENERAL PRACTICE ............................................................................. 998 0 1.5 1 GENERAL SURGERY .............................................................................. 2,258 1 1.5 2 GERIATRICS ............................................................................................ 117

¥ 1 1.5 1 HAND SURGERY ..................................................................................... 57 0 1.5 2 INFECTIOUS DISEASE ........................................................................... 401 0 1.5 2 INTERNAL MEDICINE ............................................................................. 8,846 0 1.5 1 INTERVENTIONAL RADIOLOGY ............................................................ 190 2 1.5 4 NEPHROLOGY ........................................................................................ 1,248 1 1.5 2 NEUROLOGY ........................................................................................... 1,200 0 1.5 2 NEUROSURGERY ................................................................................... 490

¥ 1 1.5 1 NUCLEAR MEDICINE .............................................................................. 85 0 1.5 1 OPHTHALMOLOGY ................................................................................. 4,583

¥ 1 1.5 0 ORTHOPEDIC SURGERY ....................................................................... 2,902 0 1.5 1 OTOLARNGOLOGY ................................................................................. 815 0 1.5 2 PATHOLOGY ........................................................................................... 869 2 1.5 4


## 47560 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 23.

— I MPACT OF 

### P RACTICE 

### E XPENSE AND 

### M ALPRACTICE 

### RVU C HANGES AND 

### P HYSICIAN 

### F EE 

### S CHEDULE 

### U PDATE

ON 

### T OTAL 

### M EDICARE 

### A LLOWED 

### C HARGES BY 

### P HYSICIAN 

### , P RACTITIONER AND 

### S UPPLIER 

### S UBCATEGORY



### — Continued

Speciality Medicare allowed charges ($ in Millions) Practice expenses & malpractice RVU

changes (percent) Physician feeschedule update (percent) Total (percent)

PEDIATRICS ............................................................................................ 59

¥ 1 1.5 1 PHYSICAL MEDICINE ............................................................................. 677 0 1.5 2 PLASTIC SURGERY ................................................................................ 281 1 1.5 2 PSYCHIATRY ........................................................................................... 1,093 0 1.5 2 PULMONARY DISEASE .......................................................................... 1,446 0 1.5 2 RADIATION ONCOLOGY ........................................................................ 1,164 0 1.5 1 RADIOLOGY ............................................................................................ 4,690 0 1.5 1 THORACIC SURGERY ............................................................................ 463 0 1.5 2 VASCULAR SURGERY ............................................................................ 487 3 1.5 4
Practitioners: AUDIOLOGIST ......................................................................................... 28

¥ 4 1.5

¥ 2 CHIROPRACTOR ..................................................................................... 656

¥ 1 1.5 1 CLINICAL PSYCHOLOGIST .................................................................... 490 0 1.5 1 CLINICAL SOCIAL WORKER .................................................................. 313 0 1.5 1 NURSE ANESTHETIST ........................................................................... 481 0 1.5 2 NURSE PRACTITIONER ......................................................................... 552

¥ 1 1.5 0 OPTOMETRY ........................................................................................... 664 0 1.5 1 ORAL/MAXILLOFACIAL SURGERY ........................................................ 36 4 1.5 5 PHYSICAL/OCCUPATIONAL THERAPY ................................................. 990

¥ 2 1.5

¥ 1 PHYSICIAN ASSISTANT ......................................................................... 410 0 1.5 1 PODIATRY ............................................................................................... 1,383

¥ 1 1.5 1 Suppliers: DIAGNOSTIC TESTING FACILITY .......................................................... 876 1 1.5 3 INDEPENDENT LABORATORY .............................................................. 530 6 1.5 8 PORTABLE X-RAY SUPPLIER ................................................................ 91 0 1.5 1 Other: ALL OTHER .............................................................................................. 93 2 1.5 3 ALL PHYSICIAN FEE SCHEDULE .......................................................... 66,395 0 1.5 2



### Table 24 shows the impact on payments for selected high-volume procedures of all of the changes previously discussed. We selected these procedures because they are the most commonly provided procedures by a broad spectrum of physician specialties, or they are of particular interest to the physician community (for example, the preventive office visit, G0XX2). This table shows the combined impact of the change in the practice expense and malpractice RVUs and the estimated physician fee schedule update on total payment for the procedure. There are separate columns that show the change in the facility rates and the nonfacility rates. For an explanation of facility and nonfacility practice expense refer to § 414.22(b)(5)(i). The table shows the estimated change in payment rates based on provisions of this proposed rule and the estimated physician fee schedule update. If we change any of the provisions following the consideration of public comments, these figures may change.



### T ABLE 

### 24.

— I MPACT OF 

### P ROPOSED 

### R ULE AND 

### P HYSICIAN 

### F EE 

### S CHEDULE 

### U PDATE ON 

### M EDICARE 

### P AYMENT FOR 

### S ELECTED 

### P ROCEDURES

CODE MOD Description Non-facility Facility

Old New Percent change Old New Percent change

11721 .......... .............. Debride nail, 6 or more .................... $ 38.08 $ 38.28 1 $ 29.87 $ 29.94 0 17000 .......... .............. Destroy benign/premlg lesion .......... 60.49 61.39 1 35.84 45.48 27 27130 .......... .............. Total hip arthroplasty ....................... N/A N/A N/A 1,370.28 1,382.50 1 27236 .......... .............. Treat thigh fracture ........................... N/A N/A N/A 1,088.01 1,103.20 1 27244 .......... .............. Treat thigh fracture ........................... N/A N/A N/A 1,115.27 1,133.51 2 27447 .......... .............. Total knee arthroplasty .................... N/A N/A N/A 1,475.95 1,492.02 1 33533 .......... .............. CABG, arterial, single ...................... N/A N/A N/A 1,882.18 1,905.49 1 35301 .......... .............. Rechanneling of artery ..................... N/A N/A N/A 1,114.89 1,122.90 1 43239 .......... .............. Upper GI endoscopy, biopsy ........... 321.85 336.15 4 159.43 162.58 2 45385 .......... .............. Lesion removal colonoscopy ............ 497.71 514.65 3 288.24 293.71 2 66821 .......... .............. After cataract laser surgery .............. 240.83 237.62

¥ 1 237.09 230.80

¥ 3 66984 .......... .............. Cataract surg w/iol, 1 stage ............. N/A N/A N/A 684.39 683.67 0 67210 .......... .............. Treatment of retinal lesion ............... 577.98 599.92 4 560.81 573.01 2 71010 .......... 26 Chest x-ray ....................................... 9.33 9.47 2 9.33 9.47 2 71020 .......... 26 Chest x-ray ....................................... 11.20 11.37 2 11.20 11.37 2 76091 .......... 26 Mammogram, both breasts .............. 96.33 97.40 1 N/A N/A N/A 76091 .......... .............. Mammogram, both breasts .............. 44.80 45.10 1 44.80 45.10 1


## 47561 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 24.

— I MPACT OF 

### P ROPOSED 

### R ULE AND 

### P HYSICIAN 

### F EE 

### S CHEDULE 

### U PDATE ON 

### M EDICARE 

### P AYMENT FOR 

### S ELECTED 

### P ROCEDURES



### — Continued

CODE MOD Description Non-facility Facility

Old New Percent change Old New Percent change

76092 .......... 26 Mammogram, screening .................. 84.76 85.27 1 N/A N/A N/A 76092 .......... .............. Mammogram, screening .................. 36.22 36.38 0 36.22 36.38 0 77427 .......... .............. Radiation tx management, x5 .......... 169.14 172.05 2 169.14 172.05 2 78465 .......... 26 Heart image (3d), multiple ............... 76.17 77.31 1 76.17 77.31 1 88305 .......... 26 Tissue exam by pathologist ............. 41.44 42.07 2 41.44 42.07 2 90801 .......... .............. Psy dx interview ............................... 150.84 153.48 2 142.26 144.39 1 90806 .......... .............. Psytx, off, 45

– 50 min ....................... 97.45 98.91 1 93.72 95.12 1 90807 .......... .............. Psytx, off, 45

– 50 min w/e&m ........... 103.80 104.98 1 101.18 102.32 1 90862 .......... .............. Medication management .................. 51.15 52.30 2 48.17 49.27 2 90935 .......... .............. Hemodialysis, one evaluation .......... N/A N/A N/A 72.06 73.14 1 92004 .......... .............. Eye exam, new patient .................... 126.57 129.61 2 89.24 90.58 2 92012 .......... .............. Eye exam established pat ................ 63.47 65.18 3 36.22 37.14 3 92014 .......... .............. Eye exam & treatment ..................... 93.34 96.26 3 58.99 60.64 3 92980 .......... .............. Insert intracoronary stent ................. N/A N/A N/A 812.09 829.58 2 92982 .......... .............. Coronary artery dilation .................... N/A N/A N/A 602.63 615.83 2 93000 .......... .............. Electrocardiogram, complete ........... 26.51 26.91 2 N/A N/A N/A 93010 .......... .............. Electrocardiogram report .................. 8.96 9.10 2 8.96 9.10 2 93015 .......... .............. Cardiovascular stress test ................ 106.78 108.01 1 N/A N/A N/A 93307 .......... 26 Echo exam of heart .......................... 49.29 49.27 0 49.29 49.27 0 93510 .......... 26 Left heart catheterization ................. 252.77 257.32 2 252.77 257.32 2 98941 .......... .............. Chiropractic manipulation ................. 36.22 36.76 1 31.74 31.83 0 99203 .......... .............. Office/outpatient visit, new ............... 95.96 97.40 2 71.69 72.38 1 99204 .......... .............. Office/outpatient visit, new ............... 135.53 137.57 2 105.66 107.25 2 99205 .......... .............. Office/outpatient visit, new ............... 172.13 174.71 1 140.39 142.49 1 99211 .......... .............. Office/outpatient visit, est ................. 21.28 21.98 3 8.96 9.10 2 99212 .......... .............. Office/outpatient visit, est ................. 37.71 38.66 3 23.52 24.25 3 99213 .......... .............. Office/outpatient visit, est ................. 52.65 53.06 1 35.47 35.24

¥ 1 99214 .......... .............. Office/outpatient visit, est ................. 82.14 83.00 1 57.87 58.74 2 99215 .......... .............. Office/outpatient visit, est ................. 119.11 121.27 2 93.34 95.12 2 99221 .......... .............. Initial hospital care ........................... N/A N/A N/A 66.83 68.22 2 99222 .......... .............. Initial hospital care ........................... N/A N/A N/A 111.27 112.93 1 99223 .......... .............. Initial hospital care ........................... N/A N/A N/A 154.95 157.27 1 99231 .......... .............. Subsequent hospital care ................ N/A N/A N/A 33.23 34.11 3 99232 .......... .............. Subsequent hospital care ................ N/A N/A N/A 54.89 56.09 2 99233 .......... .............. Subsequent hospital care ................ N/A N/A N/A 78.04 79.58 2 99236 .......... .............. Observ/hosp same date ................... N/A N/A N/A 226.26 223.60

¥ 1 99238 .......... .............. Hospital discharge day ..................... N/A N/A N/A 69.82 70.87 2 99239 .......... .............. Hospital discharge day ..................... N/A N/A N/A 95.21 91.71

¥ 4 99241 .......... .............. Office consultation ............................ 50.03 50.40 1 33.98 34.49 2 99242 .......... .............. Office consultation ............................ 91.48 92.47 1 69.45 70.11 1 99243 .......... .............. Office consultation ............................ 120.60 122.79 2 92.22 93.99 2 99244 .......... .............. Office consultation ............................ 170.63 172.81 1 136.65 138.70 2 99245 .......... .............. Office consultation ............................ 220.29 224.35 2 181.09 184.56 2 99251 .......... .............. Initial inpatient consult ...................... N/A N/A N/A 35.84 36.00 0 99252 .......... .............. Initial inpatient consult ...................... N/A N/A N/A 71.69 72.76 1 99253 .......... .............. Initial inpatient consult ...................... N/A N/A N/A 97.45 98.91 1 99254 .......... .............. Initial inpatient consult ...................... N/A N/A N/A 140.39 142.12 1 99255 .......... .............. Initial inpatient consult ...................... N/A N/A N/A 193.03 195.55 1 99261 .......... .............. Follow-up inpatient consult .............. N/A N/A N/A 22.40 22.36 0 99262 .......... .............. Follow-up inpatient consult .............. N/A N/A N/A 44.80 45.48 2 99263 .......... .............. Follow-up inpatient consult .............. N/A N/A N/A 66.09 67.46 2 99282 .......... .............. Emergency dept visit ........................ N/A N/A N/A 27.63 27.67 0 99283 .......... .............. Emergency dept visit ........................ N/A N/A N/A 61.61 62.15 1 99284 .......... .............. Emergency dept visit ........................ N/A N/A N/A 95.58 7.02 2 99285 .......... .............. Emergency dept visit ........................ N/A N/A N/A 149.72 151.97 2 99291 .......... .............. Critical care, first hour ...................... 242.69 257.32 6 203.12 207.68 2 99292 .......... .............. Critical care, add ’ l 30 min ................ 107.91 114.45 6 101.56 103.84 2 99301 .......... .............. Nursing facility care .......................... 71.69 66.32

¥ 7 61.61 66.32 8 99302 .......... .............. Nursing facility care .......................... 97.82 87.92

¥ 10 82.52 87.92 7 99303 .......... .............. Nursing facility care .......................... 120.97 108.39

¥ 10 102.68 108.39 6 99311 .......... .............. Nursing fac care, subseq ................. 40.70 34.49

¥ 15 30.62 34.49 13 99312 .......... .............. Nursing fac care, subseq ................. 63.10 56.85

¥ 10 51.53 56.85 10 99313 .......... .............. Nursing fac care, subseq ................. 86.25 79.96

¥ 7 72.43 79.96 10 99348 .......... .............. Home visit, est patient ..................... 75.42 72.01

¥ 5 N/A N/A N/A 99350 .......... .............. Home visit, est patient ..................... 169.89 165.23

¥ 3 N/A N/A N/A G0317 .......... .............. ESRDrelsvc 4+/mo;20+yr ................. 303.18 307.73 2 303.18 307.73 2 G0318 .......... .............. ESRDrelsvc 2

– 3/mo;20+yr ............... 252.40 256.19 2 252.40 256.19 2 G0319 .......... .............. ESRDrelsvc 1/mo;20+yr ................... 201.62 204.65 2 201.62 204.65 2


## 47562 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 24.

— I MPACT OF 

### P ROPOSED 

### R ULE AND 

### P HYSICIAN 

### F EE 

### S CHEDULE 

### U PDATE ON 

### M EDICARE 

### P AYMENT FOR 

### S ELECTED 

### P ROCEDURES



### — Continued

CODE MOD Description Non-facility Facility

Old New Percent change Old New Percent change

G0XX2 ......... .............. Preventive Office Visit ...................... N/A 124.30 N/A N/A 82.24 N/A



### Section 303(a)(1) of the MMA amended section 1848(c)(2) of the Act to require increased work and practice expense RVUs for drug administration services. Section 303(a)(4) of the MMA required an additional temporary increase in payment to specific drug administration services (procedure codes 90780 through 90788, 96400, 96408 through 96425, 96520, and 96530) of 32 percent for 2004 and 3 percent for 2005. Table 25 shows thepayment amounts for selected highvolume drug administration CPT codes from 2002 to 2006 including the effect of the transition adjustment of 32 percent required for 2004 and 3 percent for 2005 and 0 percent for 2006. The amounts shown in the table include the effect of the 1.5 percent update for 2004 and 2005. The 2006 payment amount shown in the table reflects the 2005 conversion factor because the 2006 physician fee schedule update is currently unknown.

With the exception of procedure code 96412 declining by 17 percent (which occurred because resource-based pricing replaced the use of charge-based RVUs when the services were removed from the nonphysician work pool), the MMA permanently increases payment for all of these services from a low of 17 percent for procedure code 90781 to 321 percent for procedure code 90782. The volume-weighted average permanent increase in payment among these drug administration services is approximately 105 percent (109 percent for oncologists and 94 percent for other physicians). Including the effect of the transition makes the volume-weighted increase in payment for these codes more than 170 percent from 2003 to 2004 and 110 percent from 2003 to 2005. The payment amount for procedure code 96400 in 2002 was $5.07. Payment for this code increased substantially to $37.52 in 2003 when, at the request of the American Urological Association (see 67 FR 79981 published on December 31, 2002), we removed this code from the nonphysician work pool. Including the effect of the additional changes required by MMA, we expect payment for this code to be $49.65 by 2006. Thus, the payment increase for procedure code 96400 between 2002 and 2006 is 879 percent. As indicated earlier, we are continuing to consider coding and RVU changes for drug administration services for 2005 based on the results of the CPT review and our consideration of public comments. If we change any of the RVUs for these codes as a result of CPT ’ s review or the consideration of public comments, these figures may change.



### T ABLE 

### 25.

— I MPACT OF 

### P ROPOSED 

### R ULE AND 

### P HYSICIAN 

### F EE 

### S CHEDULE 

### U PDATE ON 

### M EDICARE 

### P AYMENT FOR 

### S ELECTED 

### D RUG 

### A DMINISTRATION 

### S ERVICES

Code Description Non-facility payment

2002 Payment 2003 Payment 2004 Payment 2005 Payment * w/Current PE RVUs 2006 Payment * w/Current PE RVUs Percent change 2003 to

2006 Percent change 2002 to

2006

90780 IV infusion therapy, 1 hour ........... $40.54 $42.67 $117.79 $92.90 $90.20 111 122 90781 IV infusion, additional hour ........... 20.27 21.70 33.02 26.15 25.39 17 25 90782 Injection, sc/im .............................. 3.98 4.41 24.64 19.13 18.57 321 367 96400 Chemotherapy, sc/im .................... 5.07 37.52 64.07 51.14 49.65 32 879 96408 Chemotherapy, push technique .... 35.11 37.52 154.76 122.96 119.38 218 240 96410 Chemotherapy,infusion method .... 55.75 59.22 217.35 171.75 166.75 182 199 96412 Chemo, infuse method add-on ..... 41.63 44.14 48.30 37.86 36.76

– 17

– 12

* Payment amounts reflect the current practice expense RVUs and a 1.5 percent update for 2005. The 2006 update is currently unkn own. The payment amounts for 2006 were calculated using the 2005 conversion factor. If we were to make further revisions to the practice expense RVUs following the consideration of public comments and/or the CPT coding process, the payment amounts will be different.



### Table 26 below shows the impact of the drug and physician fee schedule changes for selected specialties that receive a significant portion of their total Medicare revenues from drugs. Table 27 shows the combined payment impact of the drug and physician fee schedule payment changes on combined Medicare revenues. The first column ( ‘‘ Estimated Medicare Drug Revenues ’’ ) shows estimated 2004 Medicare Drug Revenues using 2003 utilization adjusted for drug payment changes required in 2004 by the MMA. The next column ( ‘‘ % Change Medicare Drug
Revenues ’’ ) shows the payment impact of the adoption of the average sales price plus 6 percent (ASP+6) drug payment methodology in 2005 relative to 2004 on specialty drug payments. The payment impacts are based on ASP submissions from the 1st quarter of 2004. The ASP prices that will be used to determine payment in 2005 will begin with the 3rd quarter 2004 ASP submission and will be updated quarterly. To model the impact illustrated, we assumed an average increase in ASP prices of 3.39 percent (the national health expenditure prescription drug price growth factor) from the 1st quarter 2004 submission to the prices that will be used to determine 2005 payments. Table xxxxxxx follows table xxxxxx and shows the drug prices we used to determine the payment impact. The drug payment impacts are based on those high volume drugs where we have validated the ASP price submission that represent the following percentages of 2003 drug payments: 72 percent for Hematology/Oncology, 94


## 47563 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

percent for Urology, 97 percent for Rheumatology and 73 percent for Obstetrics/Gynecology. For drugs in which we did not complete our validation of the ASP submission before completing the proposed rule, we used the average payment change for other drugs provided by the specialty unless a special circumstance applied. (that is, for Hematology/Oncology and Obstetrics/Gynecology, we calculated the average reduction in payment for drugs excluding J9265, J2430, and J9390, three drugs having an unusually large reduction in payment as a result of coming off patent. We do not believe these reductions will be typical of other drugs furnished by oncologists and obstetrician/gynecologists).

Our estimates of changes in Medicare revenues for drugs and physician fee schedule services compare payment rates for 2005 with payment rates for 2004 using 2003 Medicare utilization for both years. We are using 2003 Medicare claims processed and paid through June 30, 2004 that we estimate are 96.7 complete and have adjusted the figures to reflect a full year of data. Thus, because we are using a single year of utilization, the estimated changes in revenues reflect payment changes only between 2004 and 2005. To the extent that there are year-to-year changes in the volume and mix of drugs and physician fee schedule services provided by physicians, the actual impact on total Medicare revenues will be different than those shown here.

Assuming no change in utilization, we estimate that Medicare drug revenues for oncologists would decline by less than 8 percent as a result of policies adopted in this proposed rule. Oncologists administer a number of drugs that are changing in payments by different amounts. For instance, oncologists ’ highest Medicare revenue drug, Q0136 (EPOGEN; PROCRIT), would decline in payment by 7 percent while its second highest revenue drug, J9310 (RITUXAN), would increase in payment by 7 percent. Three drugs supplied by oncologists, J9265 (ONXOL TAXOL), J2430 (PAMIDRONATE DISODIUM), and J9390 (NAVELBINE), are coming off patent and their price would decline respectively by 81 percent, 71 percent, and 12 percent. The 2004 Medicare payment amounts for these three drugs respectively were equal to 81, 85 and 81 percent of the April 1, 2003 average wholesale price levels that applied or did not decrease proportionally after the drugs came off patent. These three drugs are estimated to account for only 7 percent of oncologists adjusted 2004 Medicare drug revenues but contribute more than 5 percent of the approximate 8 percent total reduction in Medicare drug revenues that oncologists would experience as a result of adopting the ASP+6 payment methodology. While Medicare revenues to oncologists would decline from the reductions in payment for these three drugs, the cost to acquire these drugs has already declined. Thus, Medicare ’ s payment, as with all other drugs experiencing payment changes, will be much closer to the cost the physician pays to acquire the drug.

Adoption of ASP+6 prices would reduce Medicare drug revenues for urologists by approximately 36 percent. This large reduction can be attributed to a 35 percent reduction in payment for two drugs: J9202 (ZOLADEX) and J9217 (LUPRON DEPOT

– PED). While we estimate an even larger reduction in the ASP+6 price for J9217, our payment impact assumes that nearly all Medicare carriers are using the ‘‘ least costly alternative ’’ pricing and paying code J9217 at the J9202 price.

We estimate a 6 percent reduction in Medicare drug revenues for rheumatology. Nearly all of this reduction can be attributed to a 6 percent reduction in Medicare payment for J1745 (REMICADE).

We estimate less than an 18 percent decrease in Medicare drug revenues for obstetrics/gynecology. However, much of this revenue reduction can be attributed to an 81 percent reduction in payment for J9265 (ONXOL TAXOL) coming off patent. Even though this one drug is estimated to account for only 16 percent of obstetrics/gynecology adjusted 2004 Medicare drug revenues, it contributes 13 percent of the approximate 18 percent total reduction in Medicare drug revenues that obstetrics/gynecologists would experience as a result of adopting the ASP+6 payment methodology. As explained above, while Medicare revenues to obstetrics/gynecology would decline as a result of the price reduction for this code, Medicare ’ s payment will be much closer to the price physicians pay to acquire the drug. We are estimating an average approximate reduction of 6 percent across other drugs supplied by obstetrics/gynecology.

The remaining columns of Table 26 show the potential impact on physician fee schedule services of changes being contemplated for 2005 for the specialties shown. The column labeled

‘‘ Practice Expense and Malpractice RVU Changes ’’ show the combined impact of the changes previously illustrated for these specialties in Tables 21 and 22. The column labeled ‘‘ Drug Administration Payment Changes ’’ shows a range of potential physician fee schedule impacts for 2005. The left side of this column shows the impact of the changes required in payment by section 303(a)(4) of the MMA (that is, the change in the transition payment from 2004 to 2005) if we were to make no further changes to the payments or codes for drug administration services. However, because we are considering further changes to the payments or codes for drug administration once the
AMA ’ s CPT Panel review of this issue is complete, the right hand side of the column labeled ‘‘ Drug Administration Payment Changes ’’ reflects the amount that physician fee schedule payments would have to increase to make the net reduction across all Medicare revenues for these specialties equal to 2 percent. The next column shows the physician fee schedule update of 1.5 percent and the final column labeled ‘‘ Total Physician Fee Schedule ’’ Changes ’’ shows the combined effect of all of the changes previously described. The left hand side of the column shows the combined effect of (1) the practice expense and malpractice RVU changes, (2) the maximum reduction in payment that could occur if we made no further changes to payments for drug administration and (3) the physician fee schedule update. The right hand side of the column shows the combined effect of (1) the practice expense and malpractice RVU changes, (2) the amount physician fee schedule revenues would have to increase to make the reduction in total revenues equal to 2 percent and (3) the physician fee schedule update.

If we made no further changes to drug administration, physician fee schedule revenues would decline by 9 percent for oncology, be unchanged for urology and rheumatology, and increase by 1 percent for obstetrics/gynecology. Physician fee schedule revenues would have to increase by 12 percent for oncology, 19 percent for urology, 2 percent for rheumatology and 1 percent for obstetrics/gynecology for total revenues to these specialties to decline by 2 percent from adoption of the ASP+6 percent drug payment methodology.

Table 27 shows the combined impact of changes we are making to Medicare drug and physician fee schedule payments for the same specialties shown in table 26. The column labeled

‘‘ % of Total Medicare Revenues from Drugs ’’ shows the proportion of total Medicare revenues received from drugs, while the next column shows the payment impact from adoption of the ASP+6 drug payment methodology. The following columns show the proportion of total Medicare revenues received


## 47564 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

from physician fee schedule services and the payment impact from physician fee schedule changes. All of the payment impacts are the same as those shown in Table 26. We note that these impacts and percentages represent averages for each specialty or supplier. The percentages and impacts for any individual physician are dependent on the mix of drugs and physician fee schedule services they provide to Medicare beneficiaries. These tables are intended to illustrate, assuming constant utilization, the combined impact of payment changes from 2004 to 2005 across all of the services that these specialties perform using the most recent data available to us. Thus, the last 3 columns show combined Medicare revenues from all sources and the combined Medicare payment impact from the earlier described changes being proposed or considered for 2005.

For example, as indicated in the Table 27, we estimate that approximately 70 percent of total 2004 Medicare revenues for oncologists are attributed to drugs. We estimate that Medicare revenues from drugs will decline by approximately 8 percent for oncology as a result of policies adopted in this proposed rule. Physician fee schedule services account for approximately 28 percent of oncology ’ s 2004 Medicare revenues. If we made no other changes to the RVUs or codes for drug administration services and if there is no change in the utilization of services, we estimate that physician fee schedule payments to oncology would decline by approximately 9 percent from 2004 to 2005. In this scenario, combined Medicare payments to oncology would decline approximately 8 percent. However, if we were to make further changes to physician fee schedule payments so they increased by 12 percent, we estimate the combined revenue reduction to oncology would be 2 percent.

We estimate that urology receives approximately 37 percent of their 2004 total revenues from drugs and 60 percent from physician fee schedule services. Because urology and other physician specialties receive a smaller share of their total Medicare revenues from drug administration services than oncology, they are less affected than oncology by the reduction in the drug administration transition payment percentage from 32 to 3 percent from 2004 to 2005. If we made no other changes to the RVUs or codes for drug administration services, we estimate that physician fee schedule revenues for urologists would increase by approximately 1 percent from 2004 to 2005. (While the reduction in payment for drug administration alone would slightly reduce urologists ’ physician fee schedule revenues, we estimate that any reduction would be offset by the physician fee schedule update). In this scenario, combined Medicare payments to urologists would decline approximately 13 percent. However, if we were to make further changes to physician fee schedule payments so that they increased by 19 percent, we estimate the combined revenue reduction to urology would be 2 percent.

Rheumatology revenues from drugs are estimated to account for approximately 46 percent of their total revenues and would decline approximately 6 percent from adoption of the ASP+6 drug payment methodology. If we made no other changes to the RVUs or codes for drug administration services, we estimate that physician fee schedule revenues would be either unchanged or decline slightly in the aggregate and estimate a reduction in total Medicare revenues to rheumatology of approximately 3 percent. However, if we were to make further changes to physician fee schedule payments so they increased by 2 percent, we estimate the combined revenue reduction to rheumatologists would be 2 percent.

Medicare drug revenues represent 13 percent of total Medicare revenues for obstetrics/gynecology while physician fee schedule revenues account for 85 percent. We estimate that Medicare drug revenues for obstetrics/gynecology would decline by 18 percent and physician fee schedule revenues would increase 1 percent if we make no further changes to the RVUs or codes for drug administration services. In this scenario, obstetrics/gynecology ’ s combined Medicare revenues would decline by 2 percent. Any change to the drug administration codes that increases their payments would make the net revenue reduction equal to or less than 2 percent for obstetrics/gynecology.


## 47565 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed RulesTABLE26.—IMPACT OFDRUG ANDPHYSICIANFEESCHEDULEPAYMENTCHANGES ONTOTALMEDICAREALLOWEDCHARGES FORSELECTEDSPECIALTIESSpecialtyDrugs Physician fee scheduleEstimated medicare drug revenues ($ in millions)Percent changemedicare drugrevenuesMedicare allowedcharges ($ in mil-lions)Practice expense& malpracticeRVU changes(percent)Drug administra-tion paymentchangesPhysician feeschedule update(percent)Total physicianfee schedulechangesHEMATOLOGY/ONCOLOGY .......................... $4,363¥8 $1,753 0¥10 to 10 ........ 1.5¥9% to 12%UROLOGY ....................................................... 1,061¥36 1,699 0¥1% to 17% .... 1.5 0% to 19%RHEUMATOLOGY .......................................... 373¥6 413 0¥2% to 0% ...... 1.5 0% to 2%OBSTETRICS/GYNECOLOGY ....................... 88¥18 582 0¥1% to¥1% ... 1.5 1% to 1%The amounts shown on the left-hand side of the column labeled‘‘Drug Administration Payment Changes’’offset a part of the increase these specialties received in 2004 as shown in theJanuary 7, 2004**Federal Register**(69 FR 1100). We estimate the 2003–2005 increase in physician fee schedule payments to these specialties (before application of the physician feeschedule update) to be 28 percent for oncology, 2 percent for obstetrics/gynecology, 4 percent for rheumatology and 2 percent for urology. Urology received an additional 2 percent increasein total physician fee schedule payments (again, before application of the update) from 2002 to 2003 (see 67 FR 80035–80036 published on December 31, 2002) as a result of the large increase in payment for CPT code 96400 making the 2002–2005 payment increase exceed 4 percent.


## 47566 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 27.

— C OMBINED 

### P AYMENT 

### I MPACT 

### D RUG AND 

### P HYSICIAN 

### F EE 

### S CHEDULE 

### P AYMENT 

### C HANGES FOR 

### S ELECTED 

### S PECIALTIES

Specialty Drugs Physician fee schedule All revenues

Percent of totalmedicare revenues from drugs Percent change medicare drug

revenues Percent of totalmedicare revenues from fee

schedule Percent change physician feeschedule revenues Combined medicare revenues allsources ($ in millions) Combined percent change allmedicare revenues

HEMATOLOGY/ONCOLOGY. 70

¥ 8 28

¥ 9% to 12% .... $6,251

¥ 8% to

¥ 2%

UROLOGY ................. 37

¥ 36 60 0% to 19% ........ 2,842

¥ 13% to

¥ 2% RHEUMATOLOGY ..... 46

¥ 6 51 0% to 2% .......... 818

¥ 3% to

¥ 2%OBSTETRICS/GYNECOLOGY. 13

¥ 18 85 1% to 1% .......... 684

¥ 2% to

¥ 2%



### The above tables show those specialties that receive significant revenues from drugs and physician fee schedule services that could be further affected by the review of drug administration coding currently undertaken by the CPT Editorial Panel and any changes we may make after further consideration of this effort and public comments.

Although infectious disease physicians do receive significant revenues from drugs and drug administration, we are not showing them in this table because we have validated only drug payment data accounting for 27 percent of their allowed charges for drugs. Based on these data, we estimate an 11 percent reduction in their Medicare drug payments that account for approximately 6 percent of their total Medicare revenues. If total drug payment were to decline by 11 percent, we estimate that net revenues to infectious disease physicians will remain unchanged, absent any further changes in drug and drug administration coding. We are not showing DME and Other Medical Suppliers in the above table because they do not receive significant revenues for physician fee schedule services and will be unaffected by any further changes made to drug administration coding or RVUs because they do not bill for these services. However, they do receive a substantial portion of their total Medicare revenues from drugs that are affected by the change to ASP+6 pricing. For DME/Other Medical Suppliers, 40 and 60 percent of Medicare revenues respectively are received from drugs and DME fee schedule services. These suppliers would receive an approximate reduction of 70 percent in their Medicare drug revenues from the adoption of ASP+6 drug prices due to the large reduction in payment for two high volume inhalation drugs (J7619 and J7644). These impacts will be reduced somewhat by the dispensing fee we are proposing for inhalation drugs. We estimate the total reduction in payment across all of the services provided by DME suppliers as a result of provisions of this proposed rule would be approximately 28 percent.



### T ABLE 

### 28.

— D RUG 

### P RICING 

### T ABLE 

### U SED FOR 

### P AYMENT 

### I MPACTS

Code Short description Trade name CY 2004Pay allowance limit Estimated CY 2005 allowance limit 6%) Percent change

J0152 ......... Adenosine injection .................................. ADENOSCAN ........................................... $66.56 $ 69.78 5% J0585 ......... Botulinum toxin a per unit ........................ BOTOX ..................................................... 4.43 4.69 6 J0880 ......... Darbepoetin alfa injection ......................... ARANESP ................................................ 21.20 1 8.10

¥ 15 J1441 ......... Filgrastim 480 mcg injection .................... NEUPOGEN ............................................. 267.79 267.0 4 0 J1745 ......... Infliximab injection .................................... REMICADE ............................................... 58 .79 53.32

¥ 9 J2430 ......... Pamidronate disodium/30 MG .................. AREDIA, PAMIDRONATE DISODIUM, ... 237.88 67.27

¥ 72 J2505 ......... Injection, pegfilgrastim 6mg ..................... NEULASTA ............................................... 2,507.50 2,260.77

¥ 10 J2792 ......... Rho(D) immune globulin h, sd ................. WINRHO ................................................... 18.39 13.04

¥ 29 J3395 ......... Verteporfin injection .................................. VISUDYNE ............................................... 1,4 04.26 1,368.79

¥ 3 J3487 ......... Zoledronic acid ......................................... ZOMETA ................................................... 194.54 202.50 4 J7192 ......... Factor viii recombinant ............................. KOGENATE, HELIXATE, RECOMBINATE, REFACTO, BIOCLATE,. 1.29 0.92

¥ 29

J7317 ......... Sodium hyaluronate injection ................... HYALGAN, SUPARTZ, ORTHOVISC ...... 124.11 110.07

¥ 11 J7320 ......... Hylan G-F 20 injection ............................. SYNVISC .................................................. 204.0 3 188.88

¥ 7 J7507 ......... Tacrolimus oral per 1 MG ........................ PROGRAF ................................................ 3.13 3.19 2 J7517 ......... Mycophenolate mofetil oral ...................... CELLCEPT ............................................... 2.55 2.54 0 J7619 ......... Albuterol inh sol u d ................................. PROVENTIL, ALBUTEROL SULFATE, VENTOLIN. 0.39 0.04

¥ 89

J7626 ......... Budesonide inhalation sol ........................ PULMICORT ............................................ 4.04 3.91

¥ 3 J7644 ......... Ipratropium brom inh sol u d .................... IPRATROPIUM BROMIDE ....................... 2.82 0.30

¥ 89 J9045 ......... Carboplatin injection ................................. PARAPLATIN ........................................... 137.54 131.77

¥ 4 J9170 ......... Docetaxel .................................................. TAXOTERE .............................................. 301.40 287.59

¥ 5 J9201 ......... Gemcitabine HCl ...................................... GEMZAR .................................................. 111. 33 107.46

¥ 3 J9202 ......... Goserelin acetate implant ........................ ZOLADEX ................................................. 375.99 2 34.28

¥ 38 J9206 ......... Irinotecan injection ................................... CAMPTOSAR ........................................... 130.24 123.86

¥ 5 J9217* ........ Leuprolide acetate suspnsion .................. LUPRON DEPOT, ELIGARD, LUPRON DEPOT-PED. 500.58 234.28

¥ 53


## 47567 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 28.

— D RUG 

### P RICING 

### T ABLE 

### U SED FOR 

### P AYMENT 

### I MPACTS



### — Continued

Code Short description Trade name CY 2004Pay allowance limit Estimated CY 2005 allowance limit 6%) Percent change

J9219 ......... Leuprolide acetate implant ....................... VIADUR .................................................... 4,831. 40 2,190.71

¥ 55 J9265 ......... Paclitaxel injection .................................... TAXOL, ONXOL, NOV-ONXOL ............... 138.28 25.84

¥ 81 J9310 ......... Rituximab cancer treatment ..................... RITUXAN .................................................. 427.28 43 8.38 3 J9350 ......... Topotecan ................................................. HYCAMTIN ............................................... 706.17 731.46 4 J9355 ......... Trastuzumab ............................................. HERCEPTIN ............................................. 52. 01 50.84

¥ 2 J9390 ......... Vinorelbine tartrate/10 mg ........................ NAVELBINE ............................................. 76.19 64. 67

¥ 15 Q0136 ........ Non esrd epoetin alpha inj ....................... PROCRIT ................................................. 11.62 10. 37

¥ 11 **Unlisted ... ................................................................... ALOXI .......................................... ............. 307.80 202.51

¥ 34

*The figures here for J9217 reflect the ASP prices submitted by the drug manufacturer. However, we assumed that Medicare carrie rs are applying ‘‘ least costly alternative ’’ pricing and are using the J9202 price for J9217.

**Aloxi is the brand name for an antiemetic that is paid in 2004 at 95% of AWP using an unlisted code because the drug was appr oved by the FDA in the fall of 2003. Even though we do not have a code or volume for this drug from 2003 like we do for the other drugs sho wn in the table, we are showing it here because it is the highest growth injectable antiemetic drug currently on the market.



### B. Geographic Practice Cost Indices

As discussed in section II.B, in this rule, we are proposing changes to the work and practice expense GPCIs based on new census data. The resulting geographic redistributions would not result in an overall increase in the current geographic adjustment indices by more than 3.5 percent or a decrease by more than 1.6 percent for any given locality in 2005. These geographic redistributions would not result in an overall increase in the current geographic adjustment indices by more than 7 percent or a decrease by more than 3.5 percent for any given locality in 2006. Addenda E and F illustrate the locality specific overall impact of this proposal. The GAF, as displayed in addenda E and F is a weighted composite index of the individual proposed revisions to the work, practice expense, and malpractice expense GPCIs, respectively. The malpractice GPCI was updated as part of the November 7, 2003 final rule, and the MMA provisions were addressed in the final rule published on January 7, 2004.
C. Coding Issues

1. Revisions to Global Period

In section II.D.1, we are proposing a change in the global period for procedure code 77427, Radiation treatment management, five treatments from a global indicator of ‘‘ xxx ’’ (meaning that the global concept does not apply) to ‘‘ 090 ’’ (meaning that there is a 90-day global period). We are not changing any of the RVUs for procedure code 77427 because this service was valued to reflect a global period of 90 days. The implication of this change is that any visit services provided in the 90-day global period that are related to procedure code 77427 will no longer be paid separately. We reviewed Medicare data and found that physicians rarely bill for services during the 90-day period following the date-of-service for procedure code 77427. Therefore, we believe this proposal will have little effect on Medicare program expenditures and our payments to physicians.

2. Additions to the List of Medicare Telehealth Services

In section II.D.2, we are proposing to add end stage renal disease (ESRD) services, as represented by HCPCS codes G0308, G0309, G0311, G0312, G0314, G0315, G0317, G03178 to the list of telehealth services. We believe that this change will have little effect on Medicare expenditures.
3. National Pricing of G0238/G0239 (Respiratory Therapy Service Codes)

As discussed earlier in the preamble, we are proposing to use the nonphysician workpool to value two respiratory therapy service codes (G0238 and G0239) that are currently carrier priced. We believe that this proposed change will eliminate the uncertainty surrounding payment of these codes when performed in comprehensive outpatient rehabilitation facilities that are paid under the physician fee schedule through fiscal intermediaries. We do not anticipate that nationally pricing these services would have a significant impact on Medicare expenditures.

4. New HCPCS Code for Bone Marrow Aspiration

We are proposing a new HCPCS code for instances when a bone marrow aspiration and a bone marrow biopsy are performed on the same day through a single incision. Currently, we do not allow payment for both of these procedures on the same day. While this coding change will allow for a small additional payment for the second procedure performed through a single incision on the same day, we anticipate that the costs will be insignificant.

5. New HCPCS Code for Venous Mapping

As stated earlier in the preamble, we are proposing a new HCPCS code for venous mapping for hemodialysis access placement. The primary reason for this new code is to enable us to track the use of venous mapping for quality improvement purposes. Since pricing for this service is not changing, there will be no impact on Medicare expenditures.

D. MMA Provisions

1. Section 611

— Preventive Physical
Examination

As discussed earlier in this preamble, the MMA authorizes coverage of an initial preventive physical examination effective January 1, 2005, subject to certain eligibility and other limitations. We estimate that this new benefit will result in an increase in Medicare expenditures. These new payments will be made to physicians and other practitioners who provide these examinations and for any medically necessary follow-up tests, counseling, or treatment that may be required as a result of the coverage of these examinations. The impact of this provision is shown in the following table.


## 47568 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

TABLE 29.

— M EDICARE 

### C OST 

### E STIMATES FOR 

### MMA P ROVISION 

### 611

(in millions)

MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009

Sec. 611 ................................................................................................... 65 75 75 75 75



### 2. Section 613

— Diabetes Screening

Section 613 of the MMA adds subsection (yy) to section 1861 of the Social Security Act and mandates coverage of diabetes screening tests, effective on or after January 1, 2005. We estimate that this change in coverage for certain beneficiaries will result in an increase in Medicare payments. These payments will be made to physicians ’ office laboratories and other laboratory suppliers who perform these tests as a result of the increased frequency of coverage of these tests. The impact of this provision is shown in Table 30 that follows.

3. Section 612

— Cardiovascular Screening

Section 612 of the MMA provides for Medicare coverage for cholesterol and other lipid or triglyceride levels of cardiovascular screening blood tests for the early detection of abnormalities associated with an elevated risk for such diseases effective on or after January 1, 2005. We estimate that this change in coverage for certain beneficiaries will result in an increase in Medicare payments. These payments will be made to physician office laboratories and other laboratory suppliers who perform these tests as a result of the increased frequency of coverage of these tests. Increased Medicare program expenditures for this provision are shown in Table 30 below.



### TABLE 30.

— M EDICARE 

### C OST 

### E STIMATES FOR 

### MMA P ROVISIONS 

### 612 AND 

### 613

(in millions)

MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009

Sec. 612 Cholesterol and Blood Lipid ..................................................... 50 80 90 90 100 Sec. 613 Diabetes Screening. ................................................................. 20 40 50 60 80



### 4. Section 413

— Incentive Payment for Physician Scarcity
a. Physician Scarcity Areas

Section 413(a) of the MMA provides a new 5-percent incentive payment to physicians who furnish services in physician scarcity areas. The MMA provides for paying primary care physicians furnishing services in a primary care scarcity area, and specialty physicians furnishing services in a specialist care scarcity county, an additional amount equal to 5 percent of the amount paid for their professional services under the fee schedule from January 1, 2005 to December 31, 2007. We estimate that this new incentive payment for physician services will result in an increase in Medicare payments that are shown in Table 31.
b. Improvement to Medicare HPSA Incentive Payment Program

Section 413(b) of the MMA amended section 1833(m) of the Act to mandate that we automate payment of the 10 percent HPSA incentive payment to eligible physicians. Since the inception of the HPSA incentive payment program, physicians have been required to determine their eligibility and correctly code their Medicare claims using modifiers. We estimate that this change to the HPSA incentive payment program to provide for automation of payment will result in an increase in Medicare payments because many eligible physicians are not applying for bonuses due to the burden of verifying eligibility. The impact of this provision is shown in Table 31.



### TABLE 31.

— M EDICARE 

### C OST 

### E STIMATES FOR 

### MMA P ROVISIONS
(in millions)

MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009

Sec. 413(a) Physician Scarcity Areas ................................................... 30 50 50 20 0 Sec. 413(b) Improvement to HPSA ....................................................... 20 30 30 30 30



### 5. Sections 303

– 304

— Payment for Covered Outpatient Drugs and Biologicals and Section 305

— Payment for Inhalation Drugs

Sections 303 and 304 of the MMA make changes to Medicare payment for covered outpatient drugs and biologicals and changes to the administration of those drugs. Section 305 makes changes to payment for inhalation drugs. We implemented provisions of sections 303 through 305 changing payments in 2004 for drugs and their administration in the January 7, 2004 Federal Register (69 FR 1084). In this proposed rule, we are making further changes to Medicare ’ s payment for drugs and drug administration for 2005 required by sections 303 through 305 of the MMA. We estimate that adoption of the ASP+6 payment methodology will result in Medicare savings for FY 2005 of $180 million for section 303 of the MMA, $140 million for section 304 of the MMA, and $210 million for section 305 of the MMA. If we were to make no further changes to the coding or payment for drug administration services, we estimate Medicare savings of $90 million for section 303 of the MMA and $40 million for section 304 of the MMA. In addition, we are also proposing to pay a supplying fee of $10 per Medicare Part B oral drug prescription. We estimate this proposal will increase Medicare expenditures by $52 million from FY 2005 through FY 2009, assuming an average of two prescriptions per month. We are also


## 47569 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

proposing to pay a furnishing fee of $0.05 per unit off clotting factor. This proposal is estimated to cost $13 million from FY 2005 through FY 2009.

6. Section 952

— Reassignment

The reassignment provisions discussed in section III.F is currently estimated to have no significant impact on Medicare expenditures. 7. Section 623

— Payment for Renal Dialysis Services
a. Effects on the Medicare Program (Budgetary Effect)

Because the proposed basic case mix adjusted composite payment rate and the revised payment for ESRD drugs must be budget neutral in accordance with section 623(d)(1) of the MMA, except for the statutorily required 1.6 percent increase set forth in section 623(a), we estimate that there would be no budgetary impact for the Medicare program beyond this increase. The impact of this provision (net of beneficiary liability) is shown in the following table.



### TABLE 32.

— M EDICARE 

### C OST 

### E STIMATES FOR 

### MMA P ROVISION 

### 623

(in millions)

MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009

Section 623 .............................................................................................. 40 50 50 60 60



### b. Impact on ESRD Providers

In order to understand the impact of the proposed changes affecting payments to ESRD facilities that result from enactment of the MMA on different categories of ESRD facilities, it is necessary to compare estimated payments under the current payment system (current payments) to estimated payments under the proposed revisions to the composite rate payment system as set forth in this proposed rule (proposed payments). 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 proposed payments only for those ESRD facilities for which we are able to calculate both current payment and proposed payment.

Due to data limitations, we are unable estimate current and proposed payments for 592 facilities that bill for ESRD drugs. Of these 592 facilities, 174 are hospital based and 418 are independent. Therefore, 29 percent of hospital-based facilities and 11 percent of independent facilities are not shown in the impact table. 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 HCRIS. We also used the December 2003 update of CY 2003 Standard Analytical File (SAF) claims as a basis for Medicare dialysis treatments and separately billable drugs and biologicals. While the December 2003 update of the 2003 SAF file is not complete, we wanted to use the most recent data available, and plan to use an updated version of the 2003 SAF file for the final rule.



### T ABLE 

### 33.

— I MPACT OF 

### MMA S ECTION 

### 623 P AYMENTS TO 

### H OSPITAL 

### B ASED AND 

### I NDEPENDENT 

### ESRD F ACILITIES 

### (I NCLUDES 

### D RUG AND 

### C OMPOSITE 

### R ATE 

### P AYMENTS 

### )

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

Number of

facilities Number of dialysis treatments (in millions) Effect of changes in drug payments 1/ Effect of 1.6% composite rate update

on total payments 2/ Effect of case mix 3/ Overall effect 4/

All ............................................................. 3,671 29.2 0.0 1.0 0.0 1.0 Independent ............................................. 3,240 26.1

¥ 0.6 1.0

¥ 0.0 0.4 Hospital Based ......................................... 431 3.1 5.7 1.1 0.1 7.0
Size: ........................ ........................ ........................ ........................ ........................ .

....................... Small <5000 treatment per year ....... 1,313 4.0

¥ 0.6 1.0

¥ 0.1 0.3
Medium 5000

– 10000 treatments per

yr ................................................... 1,414 10.2

¥ 0.7 1.0

¥ 0.1 0.2 Large > 10000 treatments per year .. 944 15.0 0.6 1.0 0.0 1.7 Type of Ownership: ........................ ........................ ........................ ........................ ............

............ ........................ Not-for-profit ...................................... 697 5.2 2.9 1.1 0.0 4.1 For-profit ........................................... 2,710 21.9

¥ 0.6 1.0

¥ 0.0 0.4
Other ................................................. 264 2.1

¥ 0.1 1.0 0.0 1.0 Urban ................................................ 2,701 23.6 0.1 1.0 0.1 1.2
Rural ................................................. 970 5.6

¥ 0.5 1.0

¥ 0.5

¥ 0.0 Region: ........................ ........................ ........................ ........................ .......................

. ........................ New England .................................... 125 1.2 1.3 1.1 0.1 2.4
Middle Atlantic .................................. 475 4.0 0.5 1.0 0.9 2.4
East North Central ............................ 540 4.5 0.4 1.0

¥ 0.1 1.3
West North Central ........................... 255 1.7 1.4 1.1

¥ 0.5 2.0
South Atlantic .................................... 886 6.9

¥ 1.0 1.0 0.0 0.0
East South Central ........................... 309 2.2

¥ 1.0 1.0

¥ 0.7

¥ 0.7
West South Central .......................... 522 4.1

¥ 1.0 1.0

¥ 0.2

¥ 0.1
Mountain ........................................... 194 1.3 0.6 1.1

¥ 0.5 1.1
Pacific ............................................... 339 3.0 1.4 1.1

¥ 0.2 2.3


## 47570 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

T ABLE 

### 33.

— I MPACT OF 

### MMA S ECTION 

### 623 P AYMENTS TO 

### H OSPITAL 

### B ASED AND 

### I NDEPENDENT 

### ESRD F ACILITIES 

### (I NCLUDES 

### D RUG AND 

### C OMPOSITE 

### R ATE 

### P AYMENTS 

### )

— Continued

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

Number of

facilities Number of dialysis treatments (in millions) Effect of changes in drug payments 1/ Effect of 1.6% composite rate update

on total payments 2/ Effect of case mix 3/ Overall effect 4/

Puerto Rico ....................................... 26 0.4 0.8 1.0 1.4 3.3

1 This column shows the effect of the changes in drug payments to ESRD providers. These include changes in payment for separately billable drugs and the 11.3% drug add-on.

2 This column shows the effect of the 1.6% update to the composite rate on total payments to ESRD providers. Note that ESRD provi ders receive an average of 36% of their total revenues from separately billable drugs which results in an average net increase of 1.0%

.

3 This column shows impact of case-mix adjustments only.

4 This column shows percent change between the proposed and current payments to ESRD facilities. The proposed payments includes t he 1.6% increase, the 11.3% drug add-on, and the case-mix adjustments times treatments plus proposed payment for separately billab le drugs. The current payment to ESRD facilities includes the current composite rate times treatments plus current drug payments for separate ly billable drugs.



### Table 33 shows the impact of MMA Section 623 on hospital based and independent facilities. We have included both composite rate payments as well as payments for separately billable drugs and biologicals because both are effected by Section 623. The first column of Table 33 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 changes in drug payments to ESRD providers. The overall effect of changes in drug payments is budget-neutral as required by MMA. The drug add-on adjustment is designed to result in the same aggregate amount of expenditures as would have been made without the statutory policy change.

Current payments for drugs represent 2005 Medicare reimbursement using 95 percent of AWP prices for the top ten drugs. Medicare spending for drugs other than EPO is estimated using 2004 AWP prices updated by a 3 percent inflation factor times actual drug utilization from 2003 claims. EPO is priced $10 per 1000 units (EPO units are estimated using payments because the units field on bills represents the number of EPO administrations rather than the number EPO units). Spending under the proposed change is 2004 ASP minus 3 percent for the top ten drugs plus 3.39 percent inflation factor times actual drug utilization from 2003 claims.

Proposed payment for drugs under MMA also includes the 11.3 percent drug add-on to the composite rate. This amount is computed by multiplying the composite rate for each provider (with the 1.6 percent increase) times dialysis treatments from 2003 claims. Column 4 is computed by comparing spending under the proposed payment for drugs including the 11.3 percent drug add-on amount to spending under current payments for drugs. In order to make column 4 comparable with rest of Table 33, current composite rate payments to ESRD facilities were included in both current and proposed spending calculations.

Column 5 shows the effect of the 1.6 percent increase to the composite rate on total payments to ESRD providers. While all ESRD providers will get a 1.6 percent increase to their composite rate, this table shows the net effect of this increase on ESRD providers total Medicare revenues (both drug and composite rate payments combined), and therefore does not show a 1.6 percent increase.

On average, ESRD providers receive an average of 36 percent of their total revenues from separately billable drugs and 64 percent of their total revenues from composite rate payment. Since the 1.6 percent increase is applied to the 64 percent portion of their total Medicare revenues, the 1.6 percent composite rate increase is also arithmetically equal to a 1.0 percent increase in ESRD providers ’ total Medicare revenues. Column 5 is computed by combining proposed payment for drugs (including the 11.3 percent drug add-on amount) with: (1) Current composite rate times dialysis treatments from 2003 claims or (2) composite rate with 1.6 percent increase times dialysis treatments from 2003 claims. The difference between these two combinations is the net effect of the 1.6 percent increase on total payments to ESRD providers. In order to isolate the effect of the 1.6 percent increase, the computation in Column 5 assumes that drug payments to ESRD providers remain constant.

Column 6 shows the impact of the case-mix adjustments as described in section H.4.d of this proposed rule. Because MMA requires this adjustment be budget-neutral in the aggregate, there is no overall impact to the ESRDproviders as a whole. While the casemix adjustment will have an impact within the various provider types, Column 6 shows that the effect between provider groupings is minimal. Column 6 is computed as the difference between proposed payments to ESRD providers with the case-mix adjustments compared to payments to providers without the case-mix adjustments. As described in section H.4.f, we standardized the composite rate to meet the MMA requirement that payment be budget-neutral with respect to aggregate payments. Therefore, there is no change for ESRD providers in aggregate. We note that when applying the case-mix adjustments, we did so at the summary level as shown in Table 33.

Column 7 shows the overall effect of all changes in drug and composite rate payments to ESRD providers. The overall effect measured as the difference between proposed payment with all MMA changes as proposed in this rule and current payment. Proposed payment is computed by multiplying the composite rate for each provider (with both 1.6 percent increase and the 11.3 percent add-on) times dialysis treatments from 2003 claims times the appropriate case-mix adjustment by provider category. In addition, proposed payment includes payments for separately billable drugs under the revised pricing methodology as described in section III

– E

– Section 303

– Payment Reform for Outpatient Drugs and Biologicals, Subsection 1.d. Current payment is the current composite rate for each provider times dialysis treatments from 2003 claims plus current drug payments for separately billable drugs.

The overall impact to ESRD providers in aggregate is 1.0 percent. Among the three separately shown effects, the effect


## 47571 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

of changes in drug payments has the most variation among provider type and contributes most to the overall effect. Separately billable ESRD drugs are paid differently to hospital-based and independent ESRD providers. As discussed in section H.4.c, we are proposing a single drug add-on to the composite rates for both hospital based and independent facilities. The 7.0 percent increase in payments to hospital-based providers is largely due to the proposed single drug add-on to the composite rate. Many hospital based providers are not-for-profit, which may explain the larger than average increase in payments.

8. Section 731

— Coverage of Routine Costs for Category A Clinical Trials

The coverage of routine costs associated with certain Category A clinical trials as discussed in MMA section 731(b) has no significant impact on Medicare expenditures.

9. Section 629

— Part B Deductible

As explained earlier in the preamble, section 629 of the MMA provides for annual updates to the Medicare Part B deductible. The MMA stipulates that the Medicare Part B deductible will be $110 for calendar year 2005, and, for subsequent years, the deductible will be the previous year ’ s deductible increased by the annual percentage increase in the monthly actuarial rate under section 1839(a)(1) of the Act, ending with that subsequent year (rounded to the nearest dollar). We note that while this MMA provision results in a savings to the Medicare program, it also increases beneficiary costs by an equal amount.



### T ABLE 

### 34.

— E STIMATED 

### M EDICARE 

### S AVINGS FOR 

### MMA P ROVISION 

### 629

[in millions]

MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009

Sec. 629 ................................................................................................... 110 290 440 590 770



### 10. Section 512

— Hospice Consultation
Service

As explained in section III.K, effective January 1, 2005, section 512 of the MMA provides for payment to be made to a hospice for specified services furnished by a physician who is either the medical director of, or an employee of, a hospice agency. We estimate that this MMA provision will increase Medicare expenditures by $10 million per year beginning in 2005.

11. Section 302

— Clinical Conditions for Coverage of Durable Medical Equipment (DME)

As explained earlier in the preamble, to comply with the requirements of section 302 of the MMA and to enhance quality and reduce fraud, we are proposing to establish basic requirements that apply to all items of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). The impact to the Medicare program will be to improve quality of care because we are involving the physician early in the process when determining the medical necessity for items of DMEPOS. The physician community has stated that they are often asked to order an item of DMEPOS for their patient when they do not think the item is reasonable and necessary. We believe these requirements will result in no costs or savings to Medicare because if any additional spending from more physician visits occur it will be offset by savings from Medicare paying for less DMEPOS. However, we expect to continue evaluating this issue.

E. Other Issues
1. Outpatient Therapy Services Performed ‘‘ Incident to ’’ Physicians ’’ Services

As discussed in section IV.A, we are proposing to amend the regulations to include the statutory requirement that only individuals meeting the existing qualification and training standards for therapists (with the exception of licensure) consistent with § 484.4 qualify to provide therapy services incident to physicians ’ services. We believe that while this will have little impact on Medicare expenditures, it will assist in ensuring the quality of services provided to beneficiaries.
2. Supervision Requirements for Therapy Assistants in Private Practice

As discussed earlier in section IV.A.2, we are proposing to revise the regulations at § 410.59 and § 410.60 to replace a requirement to provide personal supervision and instead require direct supervision of physical therapist assistants and occupational therapy assistants when therapy services are provided by physical therapists or occupational therapists in private practice. This proposed policy change would provide beneficiaries access to medically necessary therapy services, under a physician-certified plan of care. We believe that this change would result in a 5 percent increase in therapy billing in therapy private practice settings with an estimated cost of $9 million for FY 2005. Projected costs for FY 2006 are $17 million while each subsequent year would only increase by $1 million each year, assuming the therapy caps are applied.

3. Low Osmolar Contrast Media

As discussed earlier in the preamble, we are proposing to revise the regulations at § 414.38 to eliminate the restrictive criteria for the payment of LOCM. This proposal will make payment for LOCM consistent across Medicare payment systems. By identifying contrast-enhanced procedures that most commonly use LOCM, the typical ranges of LOCM amounts used by modality, and the cost ranges for LOCM in the marketplace, we estimate program costs as shown in the following table:



### T ABLE 

### 35

Regulatory Provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009

LOCM ....................................................................................................... 20 30 30 30 30


## 47572 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

4. Payments for Physicians and Practitioners Managing Patients on Dialysis

We believe that the proposals with respect to ESRD-related services furnished to patients in observation settings and payment for outpatient ESRD-related services for partial month scenarios discussed earlier in section 1V. E. provide clarification of current policy surrounding these issues. We do not believe these proposals would have a significant impact on Medicare expenditures.
5. Supervision of Clinical Psychological Testing

We are proposing to change the supervision requirements regarding who can supervise diagnostic psychological testing services. As previously discussed, having ancillary staff supervised by clinical psychologists would enable these practitioners with a higher level of expertise to oversee psychological testing and potentially relieve burdens on physicians and healthcare facilities.

Additionally, in rural areas, we anticipate that permitting psychologists to supervise diagnostic psychological testing services would reduce delays in testing, diagnosis, and treatment that could result from the unavailability of physicians to supervise the tests. We believe that this proposal will have little impact on Medicare expenditures.
6. Care Plan Oversight

As discussed in section IV.G, we are proposing to revise § 414.39 to clarify that NPPs can perform home health care plan oversight even though they cannot certify a patient for home health services and sign the plan of care. We do not expect that this proposal would have an impact on Medicare expenditures, since it is only clarifying that an NPP or a physician can provide care plan oversight for home health

care. 7. Assignment of Medicare Claims

The proposed changes with respect to assignment of Medicare claims are currently estimated to have no significant impact on Medicare expenditures. However, as stated earlier in this preamble at section IV.H, we believe the proposed changes will reduce the paperwork burden on beneficiaries and suppliers.

F. Alternatives Considered

This proposed rule contains a range of policies, including proposals related to specific MMA provisions. The preamble provides descriptions of the statutory provisions that are addressed, identifies those policies when discretion has been exercised and presents rationale for our decisions and, when possible, alternatives that were considered.

The following is a discussion of additional points on the proposed changes required by section 302 of the MMA involving ordering items of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

In developing the proposed changes to implement section 302 of the MMA, we did consider establishing ‘‘ the faceto-face requirement, ’’ and ‘‘ the order prior to delivery ’’ requirement only for specific items of DMEPOS for which there has been an identified proliferation of use. However, we believe it is important that the physician or nonphysician practitioner determine the medical need for all items of DME. It is good clinical practice for beneficiaries to be seen by the physician for their medical condition and at that time the physician will decide whether an item of DME is appropriate. It is our intent to make Medicare more consistent with private payers in that beneficiaries be seen by their physician for their medical condition, who then makes a diagnosis and orders any supplies needed to address their needs. Since we expect beneficiaries to be seen by their doctor for a specific medical condition, we do not believe that this would place a burden on the physician, as it would be part of a necessary
examination.

We also note that in establishing these proposed requirements we do make exceptions for items of continued need, such as, glucose test strips or support surfaces. Once the physician has initially established the need, we do not require additional visits or additional documentation.
G. 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 will improve beneficiary access to services that are currently covered or will expand the Medicare benefit package to include new services. As explained in more detail below, the MMA or regulatory provisions may increase beneficiary liability in some cases. Any changes in aggregate beneficiary liability from a particular provision will be a function of the coinsurance (20 percent if applicable for the particular provision after the beneficiary has met the deductible) and the effect of the aggregate cost (savings) of the provision on the calculation of the Medicare Part B premium rate (generally 25 percent of the provision ’ s cost or savings). Taking into account the MMA and regulatory provisions of this proposed rule, we estimate beneficiary savings in FY 2005 of $270 million. This figure could be less if we make further changes to Medicare ’ s drug administration payments.

The MMA provisions that expand Medicare benefits include: section 611, adding a preventive office visit for newly eligible Medicare beneficiaries; section 612 providing coverage of cardiovascular screening blood tests; and section 613, providing coverage for diabetes screening tests for Medicare beneficiaries at risk for diabetes. While the preventive office visit for newly eligible Medicare beneficiaries is subject to deductible and coinsurance, we believe Medicare beneficiaries will continue to benefit from expanded coverage for this service. We believe many beneficiaries have supplemental insurance coverage or Medicaid that pays the Medicare deductible on their behalf and there will be no immediate additional out-of-pocket cost. Further, even if a beneficiary pays nearly all of the costs of this new benefit, the preventive office visit will substitute for another service a beneficiary may need to meet the annual deductible and the beneficiary will receive more covered benefits at little additional cost. There are no out-of-pocket costs to the beneficiary for the cardiovascular screening blood tests and diabetes screening tests.

Other proposals in this rule related to the MMA will also impact beneficiary liability, with the most significant related to indexing of the part B deductible (section 629 of the MMA) and the drug administration payment changes (sections 303 and 305 of the MMA). Indexing of the Part B deductible will result in an estimated cost to beneficiaries of $110 million in 2005. MMA provisions that improve administration of the 10 percent HPSA bonus and provide an additional 5 percent bonus payment to physicians in Medicare scarcity areas will have no impact on beneficiary liability because the bonus payments are applied to the amount Medicare pays the physician net of beneficiary liability. These provisions will also improve access for Medicare beneficiaries by increasing payments to physicians in areas that traditionally have had a low ratio of physicians to population.

The implementation of MMA provisions related to drugs and drug administration will reduce Medicare beneficiary liability for Medicare covered services. We estimate that implementation of sections 303 through 305 of the MMA will reduce Medicare


## 47573 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

beneficiary liability for drugs by $360 million in FY 2005. If we were to make no further changes to Medicare ’ s payments for drug administration, we estimate additional savings to Medicare beneficiaries of $120 million in FY 2005. Provisions of this proposed rule that increase the supplying fee for immunosuppressive drugs and the furnishing fee for the clotting factor are estimated to increase beneficiary liability by $36 million and $10 million respectively, from FY 2005 through FY

2009.

We do not believe that the drug and drug administration payment changes required by the MMA are intended to lessen beneficiary access to care. By reducing beneficiary liability, we believe it is likely that beneficiary access to care will be improved. As indicated earlier, without any further change in payment for drug administration, the MMA increased payment for drug administration by more than 105 percent from 2003 to 2005 while making payment for drugs at 6 percent more than their average sales price. Nevertheless, we acknowledge that there is a concern among physicians and others that the large changes in Medicare ’ s payments may affect their ability or willingness to continue making drugs and related services available.

As indicated above, we are considering making further changes to Medicare payment for drug administration based on the results of
CPT ’ s review of this issue or in response to public comment. Further, we are gathering Medicare utilization for drugs and drug administration beginning in 2002 and plan to analyze shifts or changes in utilization patterns as the information becomes available to us once the payment changes required by the MMA go into effect. While we do not believe the payment changes for drugs and drug administration will result in access problems, we plan to continue studying this issue. We also note that the MMA requires the Medicare Payment Advisory Commission (MedPAC) to study related issues. Specifically, section 303(a)(5) of the MMA requires MedPAC to study items and services furnished by oncologists and drug administration services furnished by other specialists. Similarly, section 305(b) requires the General Accounting Office to study the adequacy of Medicare payments for inhalation therapy.

We are also undertaking several changes using our administrative authority that will affect Medicare beneficiaries. Our proposal to remove restrictions that limit Medicare payment for use of low osmolar contrast material to specific indications would update Medicare ’ s payment policy to be consistent with the standard practice of medicine and will improve the quality of care for beneficiaries.

We believe early involvement of the physician in determining the medical necessity for items of DMEPOS will assist in improving the accuracy of Medicare program payments and the quality of care. In addition, it will also reduce out-of-pocket costs for unnecessary DMEPOS that may have otherwise been provided to Medicare beneficiaries.

In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget.
List of Subjects

42 CFR Part 405

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

42 CFR Part 410

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

42 CFR Part 411

Kidney diseases, Medicare, Reporting and recordkeeping requirements

42 CFR Part 414

Administrative practice and procedure, Health facilities, Health professions, Kidney diseases, Medicare, Reporting and recordkeeping requirements

42 CFR Part 418

Health facilities, Hospice care, Medicare, Reporting and recordkeeping requirements

42 CFR Part 424

Emergency medical services, Health facilities, Health professions, Medicare, Reporting and recordkeeping requirements

42 CFR Part 484

Health facilities, Health professions, Medicare, Reporting and recordkeeping requirements

42 CFR Part 486

Grant programs-health, Health facilities, Medicare, Reporting and recordkeeping requirements, X-rays

For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services proposes to amend 42 CFR chapter IV as follows:

**PART 405**

**— FEDERAL HEALTH**  **INSURANCE FOR THE AGED AND DISABLED** 

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

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



### 2. Section 405.207 is amended by revising paragraph (b) to read as follows:

**§ 405.207 Services related to a noncovered**  **device.**



### * * * * *

(b) When payment is made. Medicare payment may be made for

—

(1) Covered services to treat a condition or complication that arises due to the use of a noncovered device or a noncovered device-related service;

or (2) Routine care services related to experimental/investigational (Category A) devices as defined in § 405.201(b); and furnished in conjunction with an FDA-approved clinical trial. The trial must meet criteria established through the national coverage determination process; and if the trial is initiated before January 1, 2010, the device must be determined as intended for use in the diagnosis, monitoring or treatment of an immediate life-threatening disease or condition.

(3) Routine care services related to a non-experimental/investigational (Category B) device defined in § 405.201(b) that is furnished in conjunction with an FDA-approved clinical trial.

3. Section 405.517 is amended by adding a new paragraph (a)(3) to read as follows:

**§ 405.517 Payment for drugs and**  **biologicals that are not paid on a cost or prospective payment basis.** 



### (a) Applicability. *** (3) Payment for drugs and biologicals on or after January 1, 2005. Effective January 1, 2005, payment for drugs and biologicals that are not paid on a cost or prospective payment basis are paid in accordance with part 414, subpart K of this chapter.

**PART 410**

**— SUPPLEMENTARY**  **MEDICAL INSURANCE (SMI) BENEFITS** 

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


## 47574 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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



### 5. Section 410.10 is amended by adding new paragraph (y) to read as follows:

**§ 410.10 Medical and other health**  **services: Included services.**



### * * * * *

(y) Intravenous immune globulin administered in the home for the treatment of primary immune deficiency diseases.

6. Section 410.16 is added to read as follows:

**§ 410.16 Initial preventive physical**  **examination: Conditions for and limitations**
**on coverage.**



### (a) Definitions. As used in this section, the following definitions apply

—

Eligible beneficiary means individuals who receive their initial preventive physical examinations within 6 months after the effective date of their first Medicare Part B coverage period, but only if their first Part B coverage period begins on or after January 1, 2005.

Initial preventive physical
examination means all of the following services furnished to an individual by a physician or other qualified nonphysician practitioner with the goal of health promotion and disease detection:

(1) Review of the individual ’ s comprehensive medical and social history.

(2) Review of the individual ’ s potential (risk factors) for depression, including past experiences with depression or other mood disorders, based on the use of an appropriate screening instrument, which the physician or other qualified nonphysician practitioner may select unless the appropriate screening instrument is further defined through a national coverage determination.

(3) Review of the individual ’ s functional ability, and level of safety, based on the use of an appropriate screening instrument, which the physician or other qualified nonphysician practitioner may select unless the appropriate screening instrument is defined through a national coverage determination.

(4) An examination to include measurement of the individual ’ s height, weight, blood pressure, a visual acuity screen, and other factors as deemed appropriate, based on the individual ’ s medical and social history, and current clinical standards.

(5) Performance and interpretation of an electrocardiogram. (6) Education, counseling, and referral, as deemed appropriate by the physician or qualified nonphysician practitioner, based on the results of the review and evaluation services described in this section.

(7) Education, counseling, and referral, including a written plan provided to the individual for obtaining the appropriate screening and other preventive services for the individual that are covered as separate Medicare Part B benefits as described in section 1861(s)(10), section 1861(jj), section 1861(nn), section 1861(oo), section 1861(pp), section 1861(qq)(1), section 1861(rr), section 1861(uu), section 1861(vv), section 1861(xx)(1), and section 1861(yy) of the Social Security Act (the Act).

Medical history is defined to include, at a minimum, the following:

(1) Past medical and surgical history, including experiences with illnesses, hospital stays, operations, allergies, injuries and treatments.

(2) Current medications and supplements, including calcium and
vitamins.

(3) Family history, including a review of medical events in the patient ’ s family, including diseases that may be hereditary or place the individual at risk.

Physician for purposes of this provision means a doctor of medicine or osteopathy (as defined in section 1861(r)(1) of the Act).

Qualified nonphysician practitioner for purposes of this provision means a physician assistant, nurse practitioner, or clinical nurse specialist (as authorized under section 1861(s)(2)(K)(i) and section 1861(s)(2)(K)(ii) of the Act and defined in section 1861(aa)(5) of the Act, or in regulations at § 410.74, § 410.75, and § 410.76).

Review of the individual ’ s functional ability and level of safety. Review of the individual ’ s functional ability and level of safety must include, at a minimum, a review of the following areas:

(1) Hearing impairment. (2) Activities of daily living. (3) Falls risk. (4) Home safety. Social history is defined to include, at a minimum, the following:

(1) History of alcohol, tobacco, and illicit drug use.

(2) Work and travel history. (3) Diet. (4) Social activities. (5) Physical activities. (b) Condition for coverage of an initial preventive physical examination. Medicare Part B pays for an initial preventive physical examination provided to an eligible beneficiary, as described in paragraph (a) of this section, if it is furnished by a physician or other qualified nonphysician practitioner, as defined in paragraphs (a) of this section.

(c) Limitations on coverage of initial preventive physical examinations. Payment may not be made for an initial preventive physical preventive examination that is performed for an individual who is not an eligible beneficiary as described in paragraph (a) of this section.

7. A new § 410.17 is added to read as follows:

**§ 410.17 Cardiovascular disease screening** 
**tests.**



### (a) Definition. For purposes of this subpart, the following definition applies:

Cardiovascular screening blood test

means:

(1) A lipid panel consisting of a total cholesterol, HDL cholesterol, and triglyceride. The test is performed after a 12-hour fasting period.

(2) Other blood tests, previously recommended by the U.S. Preventive Services Task Force (USPSTF), as determined by the Secretary through a national coverage determination

process.

(3) Other non-invasive tests, for indications that have a blood test recommended by the USPSTF, as determined by the Secretary through a national coverage determination

process.

(b) General conditions of coverage. Medicare Part B covers cardiovascular disease screening tests when ordered by the physician who is treating the beneficiary (see § 410.32(a)) for the purpose of early detection of cardiovascular disease in individuals without apparent signs or symptoms of cardiovascular disease.

(c) Limitation on coverage of cardiovascular screening tests. Payment may be made for cardiovascular screening tests performed for an asymptomatic individual only if the individual has not had the screening tests paid for by Medicare during the preceding 59 months following the month in which the last cardiovascular screening tests were performed.

8. A new § 410.18 is added to read as follows:

**§ 410.18 Diabetes screening tests.** 



### (a) Definitions. For purposes of this section, the following definitions apply:

Diabetes means diabetes mellitus, a condition of abnormal glucose metabolism diagnosed using the following criteria: a fasting blood sugar


## 47575 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

greater than or equal to 126 mg/dL ontwo different occasions; a 2-hour postglucose challenge greater than or equal to 200 mg/dL on two different occasions; or a random glucose test over 200 mg/dL for a person with symptoms of uncontrolled diabetes.

Pre-diabetes means a condition of abnormal glucose metabolism diagnosed using the following criteria: a fasting glucose level of 100

– 125 mg/dL, or a 2- hour post-glucose challenge of 140

– 199 mg/dL. The term pre-diabetes includes the following conditions:

(1) Impaired fasting glucose. (2) Impaired glucose tolerance. (b) General conditions of coverage. Medicare Part B covers diabetes screening tests after a referral from a physician or qualified nonphysician practitioner to an individual at risk for diabetes for the purpose of early detection of diabetes.

(c) Types of tests covered. The following tests are covered if all other conditions of this subpart are met:

(1) Fasting plasma glucose test. (2) Post-glucose challenges including, but not limited to, an oral glucose tolerance test with a glucose challenge of 75 grams of glucose for non-pregnant adults, a 2-hour post glucose challenge test alone.

(3) Other tests as determined by the Secretary through a national coverage determination.

(d) Amount of testing covered. Medicare covers the following for individuals:

(1) Diagnosed with pre-diabetes Medicare, two screening tests per calendar year.

(2) Previously tested who were not diagnosed with pre-diabetes, or who have never been tested before, one screening test per year.

(e) Eligible risk factors. Individuals with the following risk factors are eligible to receive the benefit:

(1) Hypertension. (2) Dyslipidemia. (3) Obesity, defined as a body mass index greater than or equal to 30 kg/m2.

(4) Prior identification of impaired fasting glucose or glucose intolerance.

(5) Any two of the following characteristics:

(i) Overweight, defined as body mass index greater than 25, but less than 30, kg/m2.

(ii) A family history of diabetes. (iii) 65 years of age or older. (iv) A history of birthing a baby weighing more than 9 pounds.

(f) Individuals not covered. For individuals previously diagnosed as diabetic, no coverage.

9. Section 410.26 is amended by revising paragraph (c) to read as follows: **§ 410.26 Services and supplies incident to**  **a physician ’**  **s professional services: Conditions.** 



### * * * * *

(c) Limitations. (1) Drugs and biologicals are also subject to the limitations specified in § 410.29.

(2) Physical therapy, occupational therapy and speech-language pathology services provided incident to a physician ’ s professional services are subject to the provisions established in § 410.59(a)(3)(iii), § 410.60(a)(3)(iii), and § 410.62(a)(3)(ii).

10. Section 410.32 is amended by revising paragraph (b)(2)(iii) to read as follows:

**§ 410.32 Diagnostic x-ray tests, diagnostic**  **laboratory tests, and other diagnostic tests: Conditions.** 



### * * * * *

(b) * * * (2) * * * (iii) Diagnostic psychological testing services when

—

(A) Personally furnished by a clinical psychologist or an independently practicing psychologist as defined in program instructions; or

(B) Furnished under the general supervision of a physician or a clinical psychologist.

* * * * *

11. Section 410.36 is amended by

— A. Revising the section heading. B. Adding to paragraph (a), the paragraph heading ‘‘ Condition for coverage medical supplies, appliances, and devices. ’’

C. Revising paragraph (b). D. Adding new paragraphs (c) and (d). The additions and revisions read as follows:

**§ 410.36 Medical supplies, appliances, and**  **devices: Conditions for and limitations on**
**coverage.**



### (a) Conditions for coverage of medical supplies, appliances, and medical devices. ***

(b) Conditions for coverage. Medicare Part B pays for the medical supplies, appliances, and devices listed in paragraph (a) of this section when:

(1) The medical supplies, appliances, and devices are ordered by a physician, physician assistant, clinical nurse specialist, or nurse practitioner as defined in the Act.

(2) The physician or prescribing practitioner

—

(i) Conducts a face-to-face examination to determine the medical necessity for medical supplies, appliances, and devices.

(ii) Conducts the face-to-face examination only for the initial order and at the time of the prescription renewal for items of continued need, such as glucose testing supplies.

(iii) Is independent from the DME supplier and may not be an employee or contractor of the supplier.

(3) A written order is completed and signed before delivery of these medical supplies, appliances, and devices to the beneficiary.

(4) The physician ’ s or prescribing practitioner ’ s order is dated and signed within 30 days after the face-to-face examination and the beneficiary ’ s medical record includes verification of the face-to-face examination.

(5) The physician or prescribing practitioner documents in the beneficiary ’ s medical record the need for the medical supplies, appliances, and devices being ordered.

(6) CMS may determine other criteria, such as prescription renewal requirements, repairs, minor revisions and replacement, through contractor
instructions.

(c) Limitation. Medicare does not pay for a face-to-face examination for the sole purpose of the beneficiary ’ s obtaining the physician or prescribing practitioner ’ s order for the medical supplies, appliances, and devices.

(d) Clinical conditions for coverage. Clinical conditions for coverage, other than those set forth in paragraph (b) of this section, of medical supplies, appliances, and devices are determined through the national or local coverage determination process.

12. Section 410.38 is amended by

— A. Revising paragraph (g). B. Adding paragraphs (h) and (i). The revision and additions read as follows:

**§ 410.38 Durable medical equipment:**  **Scope and conditions.**



### * * * * *

(g) Conditions for coverage. (1) Medicare Part B pays for durable medical equipment ordered by a physician, physician assistant, clinical nurse specialist, or nurse practitioner, as defined in the Act.

(2) The physician or prescribing practitioner must

—

(i) Conduct a face-to-face examination to determine the medical necessity of each item of durable medical equipment.

(ii) Conduct the face-to-face examination for the initial order and at the time of the prescription renewal for items of continued need, such as infusion pumps or hospital beds.

(iii) Be independent from the DME supplier and cannot be an employee or contractor of the supplier.

(3) A written order must be completed and signed before delivery of any


## 47576 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

durable medical equipment to the beneficiary.

(4) The physician ’ s or prescribing practitioner ’ s order must be dated andsigned within 30 days after the face-toface examination and the beneficiary ’ s medical record must include verification of the face-to-face
examination.

(5) The physician or prescribing practitioner must document in the beneficiary ’ s medical record the need for the durable medical equipment being ordered.

(6) CMS may determine other additional payment criteria, such as prescription renewal requirements, repairs, minor revisions and replacement, through contractor
instructions.

(h) Limitation. Medicare does not pay for a face-to-face examination for the sole purpose of the beneficiary ’ s obtaining the physician ’ s or prescribing practitioner ’ s order for the durable medical equipment.

(i) Clinical conditions for coverage. Clinical conditions for coverage, not defined in paragraph (g) of this section, of durable medical equipment are determined through the national or local coverage determination process.

13. Section 410.59 is amended by

— A. Revising paragraph (a) introductory text and paragraph (a)(3)(ii).

B. Adding new paragraph (a)(3)(iii). C. Revising paragraph (b) heading. C. Revising paragraph (c)(2). D. Adding new paragraph (e)(1)(iii). The additions and revisions read as follows:

**§ 410.59 Outpatient occupational therapy**  **services: Conditions.**



### (a) Basic rule. Except as specified in paragraph (a)(3)(iii) of this section, Medicare Part B pays for outpatient occupational therapy services only if they are furnished by an individual meeting the qualifications in § 484.4 for an occupational therapist or by an appropriately supervised occupational therapy assistant who meets the following conditions: * * *

(3) * * * (ii) By, or under the direct supervision of, an occupational therapist in private practice as described in paragraph (c) of this section; or

(iii) By, or incident to the service of, a physician, physician assistant, clinical nurse specialist, or nurse practitioner when those professionals may perform occupational therapy services within the scope of their State practice. When an occupational therapy service is provided incident to the service of a physician, physician assistant, clinical nurse specialist, or nurse practitioner, the service and the person who furnishes the service must meet the standards and conditions that apply to occupational therapy and occupational therapists, except that a license to practice occupational therapy in the State is not required.

(b) Conditions for coverage of outpatient therapy services furnished to certain inpatients of a hospital or a CAH
or SNF. ***

* * * * *

(c) Special provisions for services furnished by occupational therapists in private practice. ***

(2) Supervision of occupational therapy services. Occupational therapy services are performed by, or under the direct supervision of, an occupational therapist in private practice. All services not performed personally by the therapist must be performed by employees of the practice, directly supervised by the therapist, and included in the fee for the therapist ’ s services.

* * * * *

(e) Annual limitation on incurred

expenses.

(1) * * * (iii) The limitation is not applied for services furnished from December 8, 2003 through December 31, 2005.

* * * * *

14. Section 410.60 is amended by

— A. Revising paragraph (a) introductory

text.

B. Revising paragraph (a)(3)(ii). C. Adding new paragraph (a)(3)(iii). D. Revising paragraph (b) heading. E. Revising paragraph (c)(2). F. Adding new paragraph (e)(1)(iii). The additions and revisions read as follows:

**§ 410.60 Outpatient physical therapy**  **services: Conditions.**



### (a) Basic rule. Except as specified in paragraph (a)(3)(iii) of this section, Medicare Part B pays for outpatient physical therapy services only if they are furnished by an individual meeting the qualifications in § 484.4 for a physical therapist or by an appropriately supervised physical therapist assistant who meets the following conditions:

* * * * *

(3) * * * (ii) By or under the direct supervision of a physical therapist in private practice as described in paragraph (c) of this section; or

(iii) By, or incident to, the service of a physician, physician assistant, clinical nurse specialist, or nurse practitioner when those professionals may perform physical therapy services within the scope of their State practice. When a physical therapy service is provided incident to the service of a physician, physician ’ s assistant, clinical nurse specialist, or nurse practitioner, the service and person who furnishes the service must meet the standards and conditions that apply to physical therapy and physical therapists, except that a license to practice physical therapy in the State is not required.

(b) Condition for coverage of outpatient physical therapy services furnished to certain inpatients of a hospital or a CAH or SNF. ***

(c) Special provisions for services furnished by physical therapists in private practice. * * *

(2) Supervision of physical therapy
services. Physical therapy services are performed by, or under the direct supervision of, a physical therapist in private practice. All services not performed personally by the therapist must be performed by employees of the practice, directly supervised by the therapist, and included in the fee for the therapist ’ s services.

* * * * *

(e) Annual limitation on incurred

expenses.

(1) * * * (iii) The limitation is not applied for services furnished from December 8, 2003 through December 31, 2005.

* * * * *

15. Section 410.62 is amended by

— A. Revising paragraph (a) introductory text and (a)(2)(i), (a)(2)(iii) and (a)(3).

B. Revising paragraphs (b) and (c). The revisions read as follows:

**§ 410.62 Outpatient speech-language**  **pathology services: Conditions and exclusions.** 



### (a) Basic rule. Except as specified in paragraph (a)(3)(ii) of this section, Medicare Part B pays for outpatient speech-language pathology services only if they are furnished by an individual who meets the qualifications for a speech-language pathologist in § 484.4 of this chapter if they meet the following conditions: * * *

(2) * * * (i) Is established by a physician or, effective January 1, 1982, by either a physician or the speech-language pathologist who provides the services to the particular individual;

(ii) * * * (iii) Meets the requirements of § 410.61.

(3) They are furnished

— (i) By a provider as defined in § 489.2 of this chapter, or by others under arrangements with, and under the supervision of, a provider; or

(ii) By, or incident to, the service of a physician, physician assistant, clinical


## 47577 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

nurse specialist, or nurse practitioner when those professionals may perform speech-language pathology services within the scope of their State practice. When a speech-language pathology service is provided incident to the services of a physician, physician ’ s assistant, clinical nurse specialist, or nurse practitioner, the service and the person who furnishes the service must meet the standards and conditions that apply to speech-language pathology and speech-language pathologists, exceptthat a license to practice speechlanguage pathology services in the State is not required.

(b) Condition for coverage of outpatient speech-language pathology services to certain inpatients of a hospital, CAH, or SNF. Medicare Part B pays for outpatient speech-language pathology services furnished to an inpatient of a hospital, CAH, or SNF who requires the services but has exhausted or is otherwise ineligible for benefit days under Medicare Part A.

(c) Excluded services. No service isincluded as an outpatient speechlanguage pathology service if it is not included as an inpatient hospital service if furnished to a hospital or CAH inpatient.

* * * * *

16. Section 410.63 is amended by

— A. Revising paragraph (b) section heading.

B. Adding a new paragraph (c). The revision and addition reads as follows:

**§ 410.63 Hepatitis vaccine and blood**  **clotting factors: Conditions.**



### (b) Blood clotting factors: Conditions.

***

(c) Blood clotting factors: Separate payment. Effective January 1, 2005, Medicare pays hemophilia treatment centers and homecare companies that furnish blood clotting factor a separate payment of $0.05 per unit for the items and services associated with the furnishing of the blood clotting factor. These items and services include the mixing and delivery of factors, including special inventory management and storage requirements, as well as ancillary supplies and patienttraining necessary for the selfadministration of these factors.

17. Section 410.78 is amended by

— A. Revising paragraph (a)(4). B. Revising paragraph (b) introductory

text.

The revisions read as follows:

**§ 410.78 Telehealth services.** 



### (a) * * * (4) Originating site means the location of an eligible Medicare beneficiary at the time the service being furnished via a telecommunications system occurs. For asynchronous store and forward telecommunications technologies, the only originating sites are Federal telemedicine demonstration programs conducted in Alaska or Hawaii.

(b) General rule. Medicare Part B pays for office and other outpatient visits, professional consultation, psychiatric diagnostic interview examination, individual psychotherapy, monthly end stage renal disease (ESRD) related evaluation and management services and pharmacologic management furnished by an interactive telecommunications system if the following conditions are met:

* * * * *

18. Section 410.160 is amended by revising paragraph (f) to read as follows:

**§ 410.160 Part B annual deductible.** 



### * * * * *

(f) Amount of the Part B annual deductible. (1) Beginning with expenses for services furnished during calendar year 2006, and for all succeeding years, the annual deductible is the previous

year ’ s deductible plus the annual percentage increase in the monthly actuarial rate for Medicare enrollees age 65 and over, rounded to the nearest dollar.

(2) For 2005, the deductible is $110. (3) From 1991 through 2004, the deductible was $100.

(4) From 1982 through 1990, the deductible was $75.

(5) From 1973 through 1981, the deductible was $60.

(6) From 1966 through 1972, the deductible was $50.

* * * * *

**PART 411**

**— EXCLUSIONS FROM**  **MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT** 

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

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



### 20. Section 411.15 is amended by

— A. Revising paragraph (a)(1). B. Adding paragraph (k)(11). The revision and addition 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, or initial preventive physical examinations that meet the criteria specified in paragraphs (k)(6) through (k)(11) of this section.

* * * * *

(k) * * * (11) In the case of initial preventive physical examinations, with the goal of health promotion and disease prevention, subject to the conditions and limitations specified in § 410.16 of this chapter.

* * * * *

21. Section 411.404 is amended by revising paragraph (b) to read as follows:

**§ 411.404 Criteria for determining that a**  **beneficiary knew that services were excluded from coverage as custodial care**  **or as not reasonable and necessary.**



### * * * * *

(b) Written notice. Written notice is given to the beneficiary, or to someone acting on his or her behalf, that the services were not covered because they did not meet Medicare coverage guidelines. A notice concerning similar or reasonably comparable services furnished on a previous occasion also meets this criterion. After a beneficiary is notified that there is no Medicare payment for a service that is not covered by Medicare, he or she is presumed to know that there is no Medicare payment for any form of subsequent treatment for the non-covered condition.

* * * * *

**PART 414**

**— PAYMENT FOR PART B**  **MEDICAL AND OTHER HEALTH SERVICES.** 

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

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

**§ 414.38 [Removed]** 



### 23. Section 414.38 is removed. 24. Section 414.39 is amended by

— A. Revising paragraph (a). B. Adding paragraph (c). The revision and addition read as follows:

**§ 414.39 Special rules for payment of care**  **plan oversight.**



### (a) General. Except as specified in paragraphs (b) and (c) of this section, payment for care plan oversight is included in the payment for visits and other services under the physician fee schedule. For purposes of this section a nonphysician practitioner (NPP) is a nurse practitioner, clinical nurse specialist or physician assistant.

* * * * *


## 47578 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

(c) Special rules for payment of care plan oversight provided by nonphysician practitioners for beneficiaries who receive HHA services covered by Medicare. (1) An NPP can perform physician care plan oversight without certifying a patient for home health services (only a physician can certify a patient for home health care) if the relationship with the physician who signs the plan of care meets one of the following conditions:

(i) The physician and NPP are part of the same group practice;

(ii) If the NPP is a nurse practitioner or clinical nurse specialist, the physician signing the plan of care also has a collaborative agreement with the NPP;

(iii) If the NPP is a physician assistant, the physician signing the plan of care is also the physician who provides general supervision of physician assistant services for the practice; or

(iv) The physician signing the plan of care provides regular ongoing care under the same plan of care as does the NPP billing for care plan oversight.

(2) Payment may be made for care plan oversight services furnished by an NPP when:

(i) The NPP providing the care plan oversight has seen and examined the patient;

(ii) The NPP providing care plan oversight is not functioning as a consultant whose participation is limited to a single medical condition rather than multi-disciplinary coordination of care; or

(iii) The NPP providing care plan oversight integrates his or her care with that of the physician who signed the plan of care.

25. 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, monthly end stage renal disease (ESRD) related evaluation and management services and pharmacologic management furnished via an interactive telecommunications system is equal to the current fee schedule amount applicable for the service of the physician or practitioner.

* * * * *

26. Section 414.66 is added to read as follows: **§ 414.66 Incentive payments for**  **physicians scarcity areas.**



### (a) Definition. As used in this section, the following definition applies

—

Primary care physician is defined as a general practitioner, family practice practitioner, general internist, obstetrician or gynecologist.

(b) Physicians ’ services furnished to a beneficiary in a Physician Scarcity Area (PSA) for primary or specialist care are eligible for a 5 percent incentive payment.

(c) Primary care physicians furnishing services in primary care PSAs are entitled to an additional 5 percent incentive payment above the amount paid under the physician fee schedule for their professional services furnished on or after January 1, 2005 and before January 1, 2008.

(d) Physicians (other than dentists, podiatrists, optometrists, chiropractors, and those identified in paragraph (a) of this section) furnishing services in specialist care PSAs are entitled to an additional 5 percent payment above the amount paid under the physician fee schedule for their professional services furnished on or after January 1, 2005 and before January 1, 2008.

27. Section 414.67 is added to read as follows:

**§ 414.67 Incentive payments for Health**  **Professional Shortage Areas.**



### (a) Physicians ’ services furnished to a beneficiary in a geographic-based Health Professional Shortage Area (HPSA) are eligible for a 10 percent incentive payment.

(b) Physicians furnishing services in a geographic-based primary medical care HPSA are entitled to a 10 percent incentive payment above the amount paid for their professional services under the physician fee schedule.

(c) Psychiatrists furnishing services in a mental health HPSA are entitled to a 10 percent incentive payment above the amount paid for their professional services under the physician fee schedule. (The only physicians eligible to receive the 10 percent incentive payment in mental health HPSAs that do not overlap with primary care HPSAs are psychiatrists.)

28. Part 414 is amended by adding a new subpart K to read as follows:

**Subpart K**

**— Payment for Drugs and**  **Biologicals in 2005**

Sec.
414.900 Basis. 414.902 Definitions. 414.904 Basis of Payment. 

### Subpart K

**— Payment for Drugs and**  **Biologicals in 2005**

**§ 414.900 Basis.** 



### (a) This subpart implements section 1842(o) of the Social Security Act by specifying the methodology for determining the payment allowance limit for drugs and biologicals covered under Medicare Part B that are not paid on a cost or prospective payment system basis.

(b) Examples of drugs that are subject to the requirements specified in this subpart are:

(1) Drugs furnished incident to a physician ’ s service; durable medical equipment (DME) drugs.

(2) Separately billable drugs at independent dialysis facilities not under the ESRD composite rate.

(3) Statutorily covered drugs, for example

—

(i) Influenza (ii) Pneumococcal and hepatitis
vaccines.

(iii) Antigens. (iv) Hemophilia blood clotting factor. (v) Immunosuppressive drugs. (vi) Certain oral anti-cancer drugs.

**§ 414.902 Definitions.** 



### As used in this subpart, unless the context indicates otherwise

—

Drug means both drugs and biologicals.

Manufacturer ’ s average sales price means the price calculated and reported by a manufacturer under part 414, subpart J of this chapter.

Multiple source drug means a drug described by section 1847A(c)(6)(C) of the Act.

Single source drug means a drug described by section 1847A(c)(6)(D) of the Act.

Unit is defined as in part 414, subpart J of this chapter. Wholesale acquisition cost (WAC) means the price described by section 1847A(c)(6)(B) of the Act.

**§ 414.904 Basis of payment.** 



### (a) Method of payment. Payment for a drug for calendar year 2005 is based on the lesser of

— (1) The actual charge on the claim for program benefits; or

(2) 106 percent of the average sales price, subject to the applicable limitations specified in paragraph (d) of this section or subject to the exceptions described in paragraph (e) of this
section.

(b) Multiple source drugs. (1) Average sales prices. The average sales price for all drug products included within the same multiple source drug billing and payment code is the volume-weighted


## 47579 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

average of the manufacturers ’ average sales prices for those drug products.

(2) Calculation of the average sales price. The average sales price is determined by

—

(i) Computing the sum of the products (for each National Drug Code assigned to the drug products) of the manufacturer ’ s average sales price and the total number of units sold; and

(ii) Dividing that sum by the sum of the total number of units sold for all NDCs assigned to the drug products.

(c) Single source drugs. (1) Average sales price. The average sales price is the volume-weighted average of the manufacturers ’ average sales prices for all National Drug Codes assigned to the drug or biological product.

(2) Calculation of the average sales price. The average sales price is determined by computing

—

(i) The sum of the products (for each National Drug Code assigned to the drug product) of the manufacturer ’ s average sales price and the total number of units sold; and

(ii) Dividing that sum by the sum of the total number of units sold for all NDCs assigned to the drug product.

(d) Limitations on the average sales price. (1) Wholesale acquisition cost for a single source drug. The payment limit for a single source drug product is the lesser of 106 percent of the average sales price for the product or 106 percent of the wholesale acquisition cost for the product.

(2) Payment limit for a drug furnished to an end-stage renal disease patient. The payment for a drug furnished to an end-stage renal disease patient that is separately billed by an end stage renal disease facility, including erythropoietin, cannot exceed 97 percent of the average sales price.

(3) Widely available market price and average manufacturer price. If the Inspector General finds that the average sales price exceeds the widely available market price or the average manufacturer price by 5 percent or more in calendar year 2005, the payment limit in the quarter following the transmittal of this information to the Secretary is the lesser of the widely available market price or 103 percent of the average manufacturer price.

(e) Exceptions to the average sales price. (1) Vaccines. The payment limits for hepatitis B vaccine furnished to individuals at high or intermediate risk of contracting hepatitis B (as determined by the Secretary), pneumococcal vaccine, and influenza vaccine and are calculated using 95 percent of the average wholesale price.

(2) Infusion drugs furnished through a covered item of durable medical equipment. The payment limit for an infusion drug furnished through a covered item of durable medical equipment is calculated using 95 percent of the average wholesale price in effect on October 1, 2003 and is not updated in 2005.

(3) Blood and blood products. In the case of blood and blood products (other than blood clotting factors), the payment limits are determined in the same manner as the payment limits were determined on October 1, 2003.

(4) Payment limit in a case where the average sales price during the first quarter of sales is unavailable. In the case of a drug during an initial period (not to exceed a full calendar quarter) in which data on the prices for sales of the drug are not sufficiently available from the manufacturer to compute an average sales price for the drug, the payment limit is based on the wholesale acquisition cost or the applicable Medicare Part B drug payment methodology in effect on November 1,

2003.

(f) Except as otherwise specified (see paragraph (e)(2)of this section) for infusion drugs, the payment limits are updated quarterly.

(g) The payment limit is computed without regard to any special packaging, labeling, or identifiers on the dosage form or product or package.

(h) The payment amount is subject to applicable deductible and coinsurance.

**PART 418**

**— HOSPICE CARE** 

29. 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).



### 30. Section 418.205 is added to read as follows:

**§ 418.205 Special requirements for**  **hospice pre-election evaluation and counseling services.** 



### (a) Definition. For purposes of this section, the following definition applies:

Terminal illness is defined as having a prognosis of 6 months or less if the disease or illness runs its normal course.

(b) Effective date for payment and requirements. Effective January 1, 2005, payment for hospice pre-election evaluation and counseling services as specified in § 418.304(d) may be made to a hospice agency on behalf of a Medicare beneficiary who is terminally ill if the requirements of this section are

met.

(1) The beneficiary: (i) Is certified as having a terminal illness.

(ii) Has not made a hospice election. (iii) Has not previously received hospice pre-election evaluation and consultation services specified under this section.

(2) Services provided. The hospice pre-election services include

— (i) An evaluation of an individual ’ s need for pain and symptom management;

(ii) Counseling regarding hospice and other care options; and

(iii) May include advising the individual regarding advanced care planning.

(3) Provider of pre-election hospice
services. (i) The physician furnishing these services must be an employee or medical director of the hospice billing for this service.

(ii) The services cannot be furnished by other hospice personnel, such as but not limited to nurse practitioners, nurses, or social workers, physicians under contractual arrangements with the hospice or by the beneficiary ’ s physician, if that physician is not an employee of the hospice.

(iii) If the beneficiary ’ s physician is also the medical director or a physician employee of the hospice, the attending physician is not required to request or provide this service because that physician already possesses theexpertise necessary to furnish end-oflife evaluation and management, and counseling services.

(4) Documentation. (i) If the individual ’ s physician initiates the request for services of the hospice medical director or physician, appropriate documentation is required.

(ii) The request or referral must be in writing, and the hospice medical director or physician employee is expected to provide a written note on the patient ’ s medical record.

(iii) The hospice agency employing the physician providing these services is required to maintain a written record of the services rendered.

(iv) If the services are initiated by the beneficiary, the hospice agency is required to maintain a record of the services and that communication between the hospice medical director or physician and the beneficiary ’ s physician occurs, with the beneficiary ’ s permission, to the extent necessary to ensure continuity of care.

31. Section 418.304 is amended by adding paragraph (d) to read as follows.

**§ 418.304 Payment for physician services.** 



### * * * * *

(d) Payment for hospice evaluation and counseling services

— pre-election. The intermediary makes payment for these services established in § 418.205 to the hospice. As directed by the statute, payment for this service is set at an amount established for an office or other outpatient visit for evaluation and


## 47580 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

management associated with presenting problems of moderate severity and requiring medical decision-making of low complexity under the physician fee schedule, other than the portion of such amount attributable to the practice expense component. Payment for this pre-election service is not calculated towards the hospice cap amount.

**PART 424**

**— CONDITIONS FOR**  **MEDICARE PAYMENT**

32. 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).



### 33. Section 424.55 is amended by adding new paragraph (c) to read as follows:

**§ 424.55 Payment to the supplier.** 



### * * * * *

(c) Exception. In situations when payment under the Act can only be made on an assignment-related basis or when payment is for services furnished by a participating physician or supplier, the beneficiary (or the person authorized to request payment on the beneficiary ’ s behalf) is not required to assign the claim to the supplier in order for an assignment to be effective.

34. Section 424.71 is amended as follows:

A. The definition of ‘‘ Health care delivery system or system ’’ is removed.

B. The definition of the term ‘‘ Entity ’’ is added in alphabetical order.

The addition reads as follows:

**§ 424.71 Definitions.** 



### * * * * *

Entity means a person, group, or facility that is enrolled in the Medicare

program.
* * * * *

35. Section 424.80 is amended by

— A. Revising paragraph (b)(2). B. Removing paragraph (b)(3). C. Redesignating paragraphs (b)(4) through (6) as paragraphs (b) (3) through (5), respectively.

D. Revising paragraph (c). E. Adding a new paragraph (d). The revisions and addition read as follows:

**§ 424.80 Prohibition of reassignment of**  **claims by suppliers.**



### * * * * *

(b) * * * (1) * * * (2) Payment to an entity under a contractual arrangement. Medicare may pay an entity enrolled in the Medicare program if there is a contractual arrangement between the entity and the supplier under which the entity bills for the supplier ’ s services, subject to the provisions of paragraph (d) of this
section.

* * * * *

(c) Rules applicable to an employer or entity. An employer or entity that may receive payment under paragraph (b)(1) or (b)(2) of this section is considered the supplier of those services for purposes of subparts C, D, and E of this part, subject to the provisions of paragraph (d) of this section.

(d) Reassignment to an entity under a contractual arrangement: Conditions and limitations. (1) Liability of the parties. An entity enrolled in the Medicare program that receives payment under a contractual arrangement under paragraph (b)(2) of this section and the supplier that otherwise receives payment are jointly and severally responsible for any Medicare overpayment to that entity.

(2) Access to records. The supplier furnishing the service has unrestricted access to claims submitted by an entity for services provided by that supplier.

**PART 484**

**– HOME HEALTH SERVICES** 

36. 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).

**§ 484.4 [Amended]** 



### 37. In § 484.4 in the definition of physical therapy assistant the term

‘‘ physical therapy assistant ’’ is removed and the term ‘‘ physical therapist
assistant ’’ is added in its place wherever it appears.

**PART 486**

**— CONDITIONS FOR**  **COVERAGE OF SPECIALIZED SERVICES FURNISHED BY**  **SUPPLIERS**

38. The authority citation for part 486 continues to read as follows:

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



### Subpart D [Removed and Reserved]

39. Part 486 subpart D, consisting of § 486.150 through § 486.163, is removed and reserved.

(Catalog of Federal Domestic Assistance Program No. 93.774, Medicare

— Supplementary Medical Insurance Program) Dated: July 13, 2004. Mark B. McClellan, Administrator, Centers for Medicare & Medicaid Services.

Approved: July 23, 2004. Tommy G. Thompson, Secretary.

Note: These addenda will not appear in the Code of Federal Regulations.

Addendum A—Explanation and Use of Addenda B

The addenda on the following pages provide various data pertaining to the Medicare fee schedule for physicians ’ services furnished in 2005. Addendum B contains the RVUs for work, non-facility practice expense, facility practice expense, and malpractice expense, and other information for all services included in the physician fee schedule.

In previous years, we have listed many services in Addendum B that are not paid under the physician fee schedule. To avoid publishing as many pages of codes for these services, we are not including clinical laboratory codes and most alpha-numeric codes (Healthcare Common Procedure Coding System (HCPCS) codes not included in CPT) in Addendum B.

Addendum B—2005 Relative Value Units and Related Information Used in Determining Medicare Payments for 2005

This addendum contains the following information for each CPT code and alphanumeric HCPCS code, except for alphanumeric codes beginning with B (enteral and parenteral therapy), E (durable medical equipment), K (temporary codes for nonphysicians ’ services or items), or L (orthotics), and codes for anesthesiology.

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: One for the global values (both professional and technical); one for modifier

– 26 (PC); and one for modifier TC. The global service is not designated by a modifier, and physicians must bill using the code without a modifier if the physician furnishes both the PC and the TC of the
service.

Modifier

– 53 is shown for a discontinued procedure. There will be RVUs for the code (CPT code 45378) with this modifier.

3. Status indicator. This indicator shows whether the CPT/HCPCS code is in the physician fee schedule and whether it is separately payable if the service is covered.

A = Active code. These codes are separately payable under the fee schedule 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 decision regarding the coverage of the service. Carriers remain responsible for coverage decisions in the absence of a national Medicare policy.


## 47581

B = Bundled code. Payment for covered services is always bundled into payment for other services not specified. If RVUs are shown, they are not used for Medicare payment. If these services are covered, payment for them is subsumed by the payment for the services to which they are incident. (An example is a telephone call from a hospital nurse regarding care of a patient.)

C = Carrier-priced code. Carriers will establish RVUs and payment amounts for these services, generally on a case-by-case basis following review of documentation, such as an operative report.

D = Deleted code. These codes are deleted effective with the beginning of the calendar

year.

E = Excluded from physician fee schedule by regulation. These codes are for items or services that we chose to exclude from the physician fee schedule payment by regulation. No RVUs are shown, and no payment may be made under the physician fee schedule for these codes. Payment for them, if they are covered, continues under reasonable charge or other payment procedures.

F = Deleted/discontinued codes. Code not subject to a 90-day grace period.

G = Code not valid for Medicare purposes. Medicare does not recognize codes assigned this status. Medicare uses another code for reporting of, and payment for, these services.

H = Deleted modifier. Either the TC or PC component shown for the code has been deleted, and the deleted component is shown in the data base with the H status indicator. (Code subject to a 90-day grace period.)

I = Not valid for Medicare purposes. Medicare uses another code for the reporting of, and the payment for these services. (Code NOT subject to a 90-day grace period.)

N = Noncovered service. These codes are noncovered services. Medicare payment may not be made for these codes. If RVUs are shown, they are not used for Medicare payment.

P = Bundled or excluded code. There are no RVUs for these services. No separate payment should be made for them under the physician fee schedule.

— If the item or service is covered as incident

to a physician ’ s service and is furnished on the same day as a physician ’ s service, payment for it is bundled into the payment for the physician ’ s service to which it is incident (an example is an elastic bandage furnished by a physician incident to a physician ’ s service).

— If the item or service is covered as other

than incident to a physician ’ s service, it is excluded from the physician fee schedule (for example, colostomy supplies) and is paid under the other payment provisions of the Act. R = Restricted coverage. Special coverage instructions apply. If the service is covered and no RVUs are shown, it is carrier-priced.

T = Injections. There are RVUs for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the service(s) for which payment is made.

X = Exclusion by law. These codes represent an item or service that is not within the definition of ‘‘ physicians ’ services ’’ for physician fee schedule payment purposes. No RVUs are shown for these codes, and no payment may be made under the physician fee schedule. (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 2005. Codes that are not used for Medicare payment are identified with a ‘‘ +. ’’

6. Facility practice expense RVUs. These are the fully implemented resource-based practice expense RVUs for facility settings.

7. Non-facility practice expense RVUs.These are the fully implemented resourcebased practice expense RVUs for non-facility settings.

8. Malpractice expense RVUs. These are the RVUs for the malpractice expense for the service for 2005.

9. Facility total. This is the sum of the work, fully implemented facility practice expense, and malpractice expense RVUs.

10. Non-facility total. This is the sum of the work, fully implemented non-facility practice expense, and malpractice expense RVUs.

11. Global period. This indicator shows the number of days in the global period for the code (0, 10, or 90 days). An explanation of the alpha codes follows:

MMM = The code describes a service furnished in uncomplicated maternity cases including antepartum care, delivery, and postpartum care. The usual global surgical concept does not apply. See the 1999 Physicians ’ Current Procedural Terminology for specific definitions.

XXX = The global concept does not apply. YYY = The global period is to be set by the carrier (for example, unlisted surgery codes).

ZZZ = Code related to another service that is always included in the global period of the other service. ( Note: Physician work and practice expense are associated with intra service time and in some instances the post service time.)

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

10021 ......... ............ A Fna w/o image ............................................. 1.27 2.16 0.54 0.11 3.54 1.92 XXX 10022 ......... ............ A Fna w/image ................................................ 1.27 2.55 0.42 0.08 3.90 1.77 XXX 10040 ......... ............ A Acne surgery ................................................ 1.18 1.01 0.79 0.10 2.29 2.07 010 10060 ......... ............ A Drainage of skin abscess ............................ 1.17 1.21 0.94 0.10 2.48 2.21 010 10061 ......... ............ A Drainage of skin abscess ............................ 2.40 1.82 1.50 0.21 4.43 4.11 010 10080 ......... ............ A Drainage of pilonidal cyst ............................ 1.17 3.12 1.12 0.11 4.40 2.40 010 10081 ......... ............ A Drainage of pilonidal cyst ............................ 2.45 4.10 1.51 0.26 6.81 4.22 010 10120 ......... ............ A Remove foreign body .................................. 1.22 2.19 0.99 0.11 3.52 2.32 010 10121 ......... ............ A Remove foreign body .................................. 2.69 3.53 1.79 0.30 6.52 4.78 010 10140 ......... ............ A Drainage of hematoma/fluid ........................ 1.53 1.77 1.29 0.15 3.45 2.97 010 10160 ......... ............ A Puncture drainage of lesion ......................... 1.20 1.61 1.09 0.12 2.93 2.41 010 10180 ......... ............ A Complex drainage, wound ........................... 2.25 3.00 1.98 0.32 5.57 4.55 010 11000 ......... ............ A Debride infected skin ................................... 0.60 0.58 0.21 0.05 1.23 0.86 000 11001 ......... ............ A Debride infected skin add-on ....................... 0.30 0.23 0.11 0.02 0.55 0.43 ZZZ 11010 ......... ............ A Debride skin, fx ............................................ 4.19 6.89 2.62 0.59 11.67 7.40 010 11011 ......... ............ A Debride skin/muscle, fx ............................... 4.94 8.19 2.33 0.69 13.82 7.96 000 11012 ......... ............ A Debride skin/muscle/bone, fx ...................... 6.87 12.09 3.83 1.11 20.07 11.81 000 11040 ......... ............ A Debride skin, partial ..................................... 0.50 0.52 0.21 0.04 1.06 0.75 000 11041 ......... ............ A Debride skin, full .......................................... 0.82 0.66 0.33 0.07 1.55 1.22 000 11042 ......... ............ A Debride skin/tissue ...................................... 1.12 0.97 0.44 0.11 2.20 1.67 000 11043 ......... ............ A Debride tissue/muscle ................................. 2.38 3.40 2.59 0.27 6.05 5.24 010 11044 ......... ............ A Debride tissue/muscle/bone ........................ 3.06 4.47 3.75 0.38 7.91 7.19 010
11055 ......... ............ R Trim skin lesion ............................................ 0.43 0.56 0.17 0.03 1.02 0.63 000 11056 ......... ............ R Trim skin lesions, 2 to 4 .............................. 0.61 0.63 0.23 0.05 1.29 0.89 000


## 47582

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

11057 ......... ............ R Trim skin lesions, over 4 ............................. 0.79 0.74 0.30 0.06 1.59 1.15 000 11100 ......... ............ A Biopsy, skin lesion ....................................... 0.81 1.25 0.36 0.07 2.13 1.24 000 11101 ......... ............ A Biopsy, skin add-on ..................................... 0.41 0.33 0.19 0.03 0.77 0.63 ZZZ 11200 ......... ............ A Removal of skin tags ................................... 0.77 1.05 0.76 0.07 1.89 1.60 010 11201 ......... ............ A Remove skin tags add-on ............................ 0.29 0.16 0.12 0.03 0.48 0.44 ZZZ 11300 ......... ............ A Shave skin lesion ......................................... 0.51 0.99 0.21 0.04 1.54 0.76 000 11301 ......... ............ A Shave skin lesion ......................................... 0.85 1.11 0.38 0.07 2.03 1.30 000 11302 ......... ............ A Shave skin lesion ......................................... 1.05 1.30 0.46 0.09 2.44 1.60 000 11303 ......... ............ A Shave skin lesion ......................................... 1.24 1.58 0.52 0.11 2.93 1.87 000 11305 ......... ............ A Shave skin lesion ......................................... 0.67 0.84 0.27 0.06 1.57 1.00 000 11306 ......... ............ A Shave skin lesion ......................................... 0.99 1.10 0.42 0.08 2.17 1.49 000 11307 ......... ............ A Shave skin lesion ......................................... 1.14 1.29 0.49 0.10 2.53 1.73 000 11308 ......... ............ A Shave skin lesion ......................................... 1.41 1.45 0.59 0.12 2.98 2.12 000 11310 ......... ............ A Shave skin lesion ......................................... 0.73 1.12 0.32 0.07 1.92 1.12 000 11311 ......... ............ A Shave skin lesion ......................................... 1.05 1.23 0.49 0.09 2.37 1.63 000 11312 ......... ............ A Shave skin lesion ......................................... 1.20 1.42 0.55 0.11 2.73 1.86 000 11313 ......... ............ A Shave skin lesion ......................................... 1.62 1.79 0.72 0.15 3.56 2.49 000 11400 ......... ............ A Exc tr-ext b9+marg 0.5 < cm ....................... 0.85 2.00 0.88 0.09 2.94 1.82 010 11401 ......... ............ A Exc tr-ext b9+marg 0.6-1 cm ....................... 1.23 2.06 1.02 0.13 3.42 2.38 010 11402 ......... ............ A Exc tr-ext b9+marg 1.1-2 cm ....................... 1.51 2.23 1.08 0.17 3.91 2.76 010 11403 ......... ............ A Exc tr-ext b9+marg 2.1-3 cm ....................... 1.79 2.40 1.32 0.21 4.40 3.32 010 11404 ......... ............ A Exc tr-ext b9+marg 3.1-4 cm ....................... 2.06 2.71 1.40 0.25 5.02 3.71 010 11406 ......... ............ A Exc tr-ext b9+marg > 4.0 cm ....................... 2.76 3.07 1.66 0.33 6.16 4.75 010 11420 ......... ............ A Exc h-f-nk-sp b9+marg 0.5 < ....................... 0.98 1.76 0.93 0.10 2.84 2.01 010 11421 ......... ............ A Exc h-f-nk-sp b9+marg 0.6-1 ....................... 1.42 2.06 1.11 0.15 3.63 2.68 010 11422 ......... ............ A Exc h-f-nk-sp b9+marg 1.1-2 ....................... 1.63 2.25 1.34 0.18 4.06 3.15 010 11423 ......... ............ A Exc h-f-nk-sp b9+marg 2.1-3 ....................... 2.01 2.58 1.45 0.23 4.82 3.69 010 11424 ......... ............ A Exc h-f-nk-sp b9+marg 3.1-4 ....................... 2.43 2.80 1.60 0.28 5.51 4.31 010 11426 ......... ............ A Exc h-f-nk-sp b9+marg > 4 cm .................... 3.77 3.49 2.10 0.44 7.70 6.31 010 11440 ......... ............ A Exc face-mm b9+marg 0.5 < cm ................. 1.06 2.21 1.31 0.10 3.37 2.47 010 11441 ......... ............ A Exc face-mm b9+marg 0.6-1 cm ................. 1.48 2.34 1.49 0.16 3.98 3.13 010 11442 ......... ............ A Exc face-mm b9+marg 1.1-2 cm ................. 1.72 2.54 1.57 0.20 4.46 3.49 010 11443 ......... ............ A Exc face-mm b9+marg 2.1-3 cm ................. 2.29 2.92 1.81 0.26 5.47 4.36 010 11444 ......... ............ A Exc face-mm b9+marg 3.1-4 cm ................. 3.14 3.47 2.17 0.35 6.96 5.66 010 11446 ......... ............ A Exc face-mm b9+marg > 4 cm .................... 4.48 4.04 2.76 0.47 8.99 7.71 010 11450 ......... ............ A Removal, sweat gland lesion ....................... 2.73 5.06 2.02 0.35 8.14 5.10 090 11451 ......... ............ A Removal, sweat gland lesion ....................... 3.94 6.64 2.54 0.52 11.10 7.00 090 11462 ......... ............ A Removal, sweat gland lesion ....................... 2.51 5.14 2.01 0.31 7.96 4.83 090 11463 ......... ............ A Removal, sweat gland lesion ....................... 3.94 6.85 2.68 0.51 11.30 7.13 090 11470 ......... ............ A Removal, sweat gland lesion ....................... 3.25 5.09 2.26 0.38 8.72 5.89 090 11471 ......... ............ A Removal, sweat gland lesion ....................... 4.40 6.74 2.76 0.54 11.68 7.70 090 11600 ......... ............ A Exc tr-ext mlg+marg 0.5 < cm ..................... 1.31 2.64 0.97 0.13 4.08 2.41 010 11601 ......... ............ A Exc tr-ext mlg+marg 0.6-1 cm ..................... 1.80 2.70 1.22 0.18 4.68 3.20 010 11602 ......... ............ A Exc tr-ext mlg+marg 1.1-2 cm ..................... 1.95 2.83 1.26 0.20 4.98 3.41 010 11603 ......... ............ A Exc tr-ext mlg+marg 2.1-3 cm ..................... 2.19 3.07 1.33 0.24 5.50 3.76 010 11604 ......... ............ A Exc tr-ext mlg+marg 3.1-4 cm ..................... 2.40 3.38 1.39 0.28 6.06 4.07 010 11606 ......... ............ A Exc tr-ext mlg+marg > 4 cm ........................ 3.42 4.06 1.73 0.40 7.88 5.55 010 11620 ......... ............ A Exc h-f-nk-sp mlg+marg 0.5 < ..................... 1.19 2.60 0.95 0.13 3.92 2.27 010 11621 ......... ............ A Exc h-f-nk-sp mlg+marg 0.6-1 ..................... 1.76 2.70 1.24 0.19 4.65 3.19 010 11622 ......... ............ A Exc h-f-nk-sp mlg+marg 1.1-2 ..................... 2.09 2.97 1.38 0.23 5.29 3.70 010 11623 ......... ............ A Exc h-f-nk-sp mlg+marg 2.1-3 ..................... 2.61 3.33 1.58 0.31 6.25 4.50 010 11624 ......... ............ A Exc h-f-nk-sp mlg+marg 3.1-4 ..................... 3.06 3.74 1.77 0.38 7.18 5.21 010 11626 ......... ............ A Exc h-f-nk-sp mlg+mar > 4 cm .................... 4.29 4.64 2.38 0.50 9.43 7.17 010 11640 ......... ............ A Exc face-mm malig+marg 0.5 < .................. 1.35 2.66 1.11 0.15 4.16 2.61 010 11641 ......... ............ A Exc face-mm malig+marg 0.6-1 .................. 2.16 3.02 1.52 0.24 5.42 3.92 010 11642 ......... ............ A Exc face-mm malig+marg 1.1-2 .................. 2.59 3.40 1.71 0.30 6.29 4.60 010 11643 ......... ............ A Exc face-mm malig+marg 2.1-3 .................. 3.10 3.80 1.95 0.37 7.27 5.42 010 11644 ......... ............ A Exc face-mm malig+marg 3.1-4 .................. 4.02 4.67 2.44 0.49 9.18 6.95 010 11646 ......... ............ A Exc face-mm mlg+marg > 4 cm .................. 5.94 5.74 3.46 0.67 12.35 10.07 010 11719 ......... ............ R Trim nail(s) ................................................... 0.17 0.25 0.07 0.01 0.43 0.25 000 11720 ......... ............ A Debride nail, 1-5 .......................................... 0.32 0.34 0.12 0.03 0.69 0.47 000 11721 ......... ............ A Debride nail, 6 or more ................................ 0.54 0.43 0.21 0.04 1.01 0.79 000 11730 ......... ............ A Removal of nail plate ................................... 1.13 1.03 0.43 0.09 2.25 1.65 000 11732 ......... ............ A Remove nail plate, add-on .......................... 0.57 0.44 0.22 0.05 1.06 0.84 ZZZ 11740 ......... ............ A Drain blood from under nail ......................... 0.37 0.56 0.36 0.03 0.96 0.76 000 11750 ......... ............ A Removal of nail bed ..................................... 1.86 2.16 1.75 0.15 4.17 3.76 010 11752 ......... ............ A Remove nail bed/finger tip ........................... 2.67 2.99 2.99 0.28 5.94 5.94 010 11755 ......... ............ A Biopsy, nail unit ........................................... 1.31 1.57 0.77 0.11 2.99 2.19 000 11760 ......... ............ A Repair of nail bed ........................................ 1.58 2.63 1.79 0.18 4.39 3.55 010 11762 ......... ............ A Reconstruction of nail bed ........................... 2.89 2.88 2.34 0.27 6.04 5.50 010 11765 ......... ............ A Excision of nail fold, toe .............................. 0.69 1.78 0.76 0.06 2.53 1.51 010 11770 ......... ............ A Removal of pilonidal lesion .......................... 2.61 3.50 1.50 0.32 6.43 4.43 010 11771 ......... ............ A Removal of pilonidal lesion .......................... 5.73 5.66 3.31 0.72 12.11 9.76 090 11772 ......... ............ A Removal of pilonidal lesion .......................... 6.97 7.54 5.08 0.88 15.39 12.93 090 11900 ......... ............ A Injection into skin lesions ............................. 0.52 0.65 0.21 0.04 1.21 0.77 000


## 47583

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

11901 ......... ............ A Added skin lesions injection ........................ 0.80 0.66 0.35 0.07 1.53 1.22 000 11920 ......... ............ R Correct skin color defects ............................ 1.61 3.69 1.09 0.22 5.52 2.92 000 11921 ......... ............ R Correct skin color defects ............................ 1.93 3.95 1.27 0.28 6.16 3.48 000 11922 ......... ............ R Correct skin color defects ............................ 0.49 1.13 0.25 0.07 1.69 0.81 ZZZ 11950 ......... ............ R Therapy for contour defects ........................ 0.84 1.14 0.39 0.09 2.07 1.32 000 11951 ......... ............ R Therapy for contour defects ........................ 1.19 1.49 0.51 0.15 2.83 1.85 000 11952 ......... ............ R Therapy for contour defects ........................ 1.69 1.85 0.68 0.24 3.78 2.61 000 11954 ......... ............ R Therapy for contour defects ........................ 1.85 2.43 0.90 0.17 4.45 2.92 000 11960 ......... ............ A Insert tissue expander(s) ............................. 9.07 NA 10.37 1.23 NA 20.67 090 11970 ......... ............ A Replace tissue expander ............................. 7.05 NA 6.12 1.04 NA 14.21 090 11971 ......... ............ A Remove tissue expander(s) ......................... 2.13 9.13 3.78 0.30 11.56 6.21 090 11976 ......... ............ R Removal of contraceptive cap ..................... 1.78 1.73 0.68 0.20 3.71 2.66 000 11980 ......... ............ A Implant hormone pellet(s) ............................ 1.48 1.08 0.54 0.13 2.69 2.15 000 11981 ......... ............ A Insert drug implant device ........................... 1.48 1.70 0.68 0.11 3.29 2.27 XXX 11982 ......... ............ A Remove drug implant device ....................... 1.78 1.94 0.83 0.18 3.90 2.79 XXX 11983 ......... ............ A Remove/insert drug implant ......................... 3.30 2.28 1.46 0.24 5.82 5.00 XXX 12001 ......... ............ A Repair superficial wound(s) ......................... 1.70 2.00 0.78 0.15 3.85 2.63 010 12002 ......... ............ A Repair superficial wound(s) ......................... 1.86 2.06 0.91 0.17 4.09 2.94 010 12004 ......... ............ A Repair superficial wound(s) ......................... 2.24 2.35 1.02 0.21 4.80 3.47 010 12005 ......... ............ A Repair superficial wound(s) ......................... 2.86 2.85 1.21 0.27 5.98 4.34 010 12006 ......... ............ A Repair superficial wound(s) ......................... 3.66 3.42 1.52 0.37 7.45 5.55 010 12007 ......... ............ A Repair superficial wound(s) ......................... 4.11 3.86 1.82 0.44 8.41 6.37 010 12011 ......... ............ A Repair superficial wound(s) ......................... 1.76 2.15 0.79 0.16 4.07 2.71 010 12013 ......... ............ A Repair superficial wound(s) ......................... 1.99 2.30 0.95 0.18 4.47 3.12 010 12014 ......... ............ A Repair superficial wound(s) ......................... 2.46 2.59 1.07 0.22 5.27 3.75 010 12015 ......... ............ A Repair superficial wound(s) ......................... 3.19 3.16 1.26 0.29 6.64 4.74 010 12016 ......... ............ A Repair superficial wound(s) ......................... 3.92 3.59 1.53 0.37 7.88 5.82 010 12017 ......... ............ A Repair superficial wound(s) ......................... 4.70 NA 1.89 0.48 NA 7.07 010 12018 ......... ............ A Repair superficial wound(s) ......................... 5.52 NA 2.25 0.58 NA 8.35 010 12020 ......... ............ A Closure of split wound ................................. 2.62 3.84 1.92 0.30 6.76 4.84 010 12021 ......... ............ A Closure of split wound ................................. 1.84 1.83 1.42 0.23 3.90 3.49 010 12031 ......... ............ A Layer closure of wound(s) ........................... 2.15 2.28 0.96 0.22 4.65 3.33 010 12032 ......... ............ A Layer closure of wound(s) ........................... 2.47 3.85 1.81 0.24 6.56 4.52 010 12034 ......... ............ A Layer closure of wound(s) ........................... 2.92 3.20 1.46 0.31 6.43 4.69 010 12035 ......... ............ A Layer closure of wound(s) ........................... 3.42 5.22 2.16 0.39 9.03 5.97 010 12036 ......... ............ A Layer closure of wound(s) ........................... 4.04 5.59 2.55 0.52 10.15 7.11 010 12037 ......... ............ A Layer closure of wound(s) ........................... 4.66 6.13 2.96 0.61 11.40 8.23 010 12041 ......... ............ A Layer closure of wound(s) ........................... 2.37 2.54 1.13 0.24 5.15 3.74 010 12042 ......... ............ A Layer closure of wound(s) ........................... 2.74 3.27 1.47 0.26 6.27 4.47 010 12044 ......... ............ A Layer closure of wound(s) ........................... 3.14 3.23 1.61 0.32 6.69 5.07 010 12045 ......... ............ A Layer closure of wound(s) ........................... 3.63 5.30 2.28 0.41 9.34 6.32 010 12046 ......... ............ A Layer closure of wound(s) ........................... 4.24 6.55 2.75 0.49 11.28 7.48 010 12047 ......... ............ A Layer closure of wound(s) ........................... 4.64 6.39 3.08 0.57 11.60 8.29 010 12051 ......... ............ A Layer closure of wound(s) ........................... 2.47 3.27 1.45 0.25 5.99 4.17 010 12052 ......... ............ A Layer closure of wound(s) ........................... 2.77 3.22 1.44 0.26 6.25 4.47 010 12053 ......... ............ A Layer closure of wound(s) ........................... 3.12 3.24 1.54 0.30 6.66 4.96 010 12054 ......... ............ A Layer closure of wound(s) ........................... 3.45 3.56 1.64 0.34 7.35 5.43 010 12055 ......... ............ A Layer closure of wound(s) ........................... 4.42 4.49 2.12 0.46 9.37 7.00 010 12056 ......... ............ A Layer closure of wound(s) ........................... 5.23 6.76 3.05 0.53 12.52 8.81 010 12057 ......... ............ A Layer closure of wound(s) ........................... 5.95 6.16 3.75 0.64 12.75 10.34 010 13100 ......... ............ A Repair of wound or lesion ........................... 3.12 4.05 2.30 0.33 7.50 5.75 010 13101 ......... ............ A Repair of wound or lesion ........................... 3.91 4.66 2.68 0.40 8.97 6.99 010 13102 ......... ............ A Repair wound/lesion add-on ........................ 1.24 1.17 0.57 0.15 2.56 1.96 ZZZ 13120 ......... ............ A Repair of wound or lesion ........................... 3.30 4.14 2.35 0.35 7.79 6.00 010 13121 ......... ............ A Repair of wound or lesion ........................... 4.32 4.85 2.79 0.43 9.60 7.54 010 13122 ......... ............ A Repair wound/lesion add-on ........................ 1.44 1.51 0.63 0.18 3.13 2.25 ZZZ 13131 ......... ............ A Repair of wound or lesion ........................... 3.78 4.36 2.68 0.39 8.53 6.85 010 13132 ......... ............ A Repair of wound or lesion ........................... 5.94 5.58 3.80 0.56 12.08 10.30 010 13133 ......... ............ A Repair wound/lesion add-on ........................ 2.19 1.66 1.03 0.24 4.09 3.46 ZZZ 13150 ......... ............ A Repair of wound or lesion ........................... 3.80 4.87 2.76 0.41 9.08 6.97 010 13151 ......... ............ A Repair of wound or lesion ........................... 4.44 4.80 3.14 0.45 9.69 8.03 010 13152 ......... ............ A Repair of wound or lesion ........................... 6.32 6.03 4.03 0.62 12.97 10.97 010 13153 ......... ............ A Repair wound/lesion add-on ........................ 2.38 1.93 1.14 0.28 4.59 3.80 ZZZ 13160 ......... ............ A Late closure of wound ................................. 10.46 NA 7.15 1.48 NA 19.09 090 14000 ......... ............ A Skin tissue rearrangement ........................... 5.88 7.82 5.43 0.70 14.40 12.01 090 14001 ......... ............ A Skin tissue rearrangement ........................... 8.46 9.39 7.03 1.00 18.85 16.49 090 14020 ......... ............ A Skin tissue rearrangement ........................... 6.58 8.58 6.48 0.77 15.93 13.83 090 14021 ......... ............ A Skin tissue rearrangement ........................... 10.04 9.96 8.23 1.10 21.10 19.37 090 14040 ......... ............ A Skin tissue rearrangement ........................... 7.86 8.78 7.16 0.83 17.47 15.85 090 14041 ......... ............ A Skin tissue rearrangement ........................... 11.47 10.58 8.64 1.13 23.18 21.24 090 14060 ......... ............ A Skin tissue rearrangement ........................... 8.49 8.78 7.41 0.88 18.15 16.78 090 14061 ......... ............ A Skin tissue rearrangement ........................... 12.27 11.59 9.46 1.20 25.06 22.93 090 14300 ......... ............ A Skin tissue rearrangement ........................... 11.74 11.11 9.13 1.40 24.25 22.27 090 14350 ......... ............ A Skin tissue rearrangement ........................... 9.60 NA 7.14 1.22 NA 17.96 090 15000 ......... ............ A Skin graft ...................................................... 3.99 3.79 2.18 0.47 8.25 6.64 000


## 47584

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

15001 ......... ............ A Skin graft add-on ......................................... 1.00 1.35 0.41 0.13 2.48 1.54 ZZZ 15050 ......... ............ A Skin pinch graft ............................................ 4.29 6.92 5.11 0.55 11.76 9.95 090 15100 ......... ............ A Skin split graft .............................................. 9.04 12.55 7.82 1.24 22.83 18.10 090 15101 ......... ............ A Skin split graft add-on .................................. 1.72 3.72 1.17 0.24 5.68 3.13 ZZZ 15120 ......... ............ A Skin split graft .............................................. 9.82 10.72 7.79 1.19 21.73 18.80 090 15121 ......... ............ A Skin split graft add-on .................................. 2.67 4.49 1.84 0.36 7.52 4.87 ZZZ 15200 ......... ............ A Skin full graft ................................................ 8.02 9.41 6.19 1.02 18.45 15.23 090 15201 ......... ............ A Skin full graft add-on ................................... 1.32 2.56 0.62 0.18 4.06 2.12 ZZZ 15220 ......... ............ A Skin full graft ................................................ 7.86 9.18 6.67 0.97 18.01 15.50 090 15221 ......... ............ A Skin full graft add-on ................................... 1.19 2.31 0.56 0.17 3.67 1.92 ZZZ 15240 ......... ............ A Skin full graft ................................................ 9.03 10.20 7.94 1.08 20.31 18.05 090 15241 ......... ............ A Skin full graft add-on ................................... 1.86 2.44 0.91 0.24 4.54 3.01 ZZZ 15260 ......... ............ A Skin full graft ................................................ 10.04 10.21 8.57 0.97 21.22 19.58 090 15261 ......... ............ A Skin full graft add-on ................................... 2.23 2.68 1.40 0.26 5.17 3.89 ZZZ 15342 ......... ............ A Cultured skin graft, 25 cm ........................... 1.00 1.86 0.55 0.10 2.96 1.65 010 15343 ......... ............ A Culture skn graft addl 25 cm ....................... 0.25 0.09 0.09 0.03 0.37 0.37 ZZZ 15350 ......... ............ A Skin homograft ............................................. 3.99 6.44 3.84 0.48 10.91 8.31 090 15351 ......... ............ A Skin homograft add-on ................................ 1.00 0.36 0.36 0.14 1.50 1.50 ZZZ 15400 ......... ............ A Skin heterograft ........................................... 3.99 4.01 4.01 0.39 8.39 8.39 090 15401 ......... ............ A Skin heterograft add-on ............................... 1.00 1.89 0.44 0.12 3.01 1.56 ZZZ 15570 ......... ............ A Form skin pedicle flap ................................. 9.20 11.30 6.75 1.30 21.80 17.25 090 15572 ......... ............ A Form skin pedicle flap ................................. 9.26 9.49 6.44 1.29 20.04 16.99 090 15574 ......... ............ A Form skin pedicle flap ................................. 9.87 10.67 7.77 1.22 21.76 18.86 090 15576 ......... ............ A Form skin pedicle flap ................................. 8.68 9.75 6.87 0.95 19.38 16.50 090 15600 ......... ............ A Skin graft ...................................................... 1.91 7.61 3.06 0.27 9.79 5.24 090 15610 ......... ............ A Skin graft ...................................................... 2.42 4.74 3.42 0.33 7.49 6.17 090 15620 ......... ............ A Skin graft ...................................................... 2.94 7.76 3.87 0.36 11.06 7.17 090 15630 ......... ............ A Skin graft ...................................................... 3.27 7.03 4.14 0.38 10.68 7.79 090 15650 ......... ............ A Transfer skin pedicle flap ............................ 3.96 7.14 4.20 0.49 11.59 8.65 090 15732 ......... ............ A Muscle-skin graft, head/neck ....................... 17.81 18.03 12.20 1.98 37.82 31.99 090 15734 ......... ............ A Muscle-skin graft, trunk ............................... 17.76 18.12 12.36 2.52 38.40 32.64 090 15736 ......... ............ A Muscle-skin graft, arm ................................. 16.25 18.14 11.20 2.38 36.77 29.83 090 15738 ......... ............ A Muscle-skin graft, leg ................................... 17.89 17.91 11.70 2.58 38.38 32.17 090 15740 ......... ............ A Island pedicle flap graft ............................... 10.23 10.14 8.25 1.01 21.38 19.49 090 15750 ......... ............ A Neurovascular pedicle graft ......................... 11.39 NA 9.02 1.51 NA 21.92 090 15756 ......... ............ A Free myo/skin flap microvasc ...................... 35.18 NA 20.52 4.51 NA 60.21 090 15757 ......... ............ A Free skin flap, microvasc ............................. 35.18 NA 21.55 4.05 NA 60.78 090 15758 ......... ............ A Free fascial flap, microvasc ......................... 35.05 NA 21.53 3.91 NA 60.49 090 15760 ......... ............ A Composite skin graft .................................... 8.73 10.02 7.25 0.94 19.69 16.92 090 15770 ......... ............ A Derma-fat-fascia graft .................................. 7.51 NA 6.67 1.01 NA 15.19 090 15775 ......... ............ R Hair transplant punch grafts ........................ 3.95 2.97 1.30 0.52 7.44 5.77 000 15776 ......... ............ R Hair transplant punch grafts ........................ 5.53 5.33 2.80 0.72 11.58 9.05 000 15780 ......... ............ A Abrasion treatment of skin ........................... 7.28 11.57 8.24 0.75 19.60 16.27 090 15781 ......... ............ A Abrasion treatment of skin ........................... 4.84 6.91 5.36 0.47 12.22 10.67 090 15782 ......... ............ A Abrasion treatment of skin ........................... 4.31 9.92 6.56 0.35 14.58 11.22 090 15783 ......... ............ A Abrasion treatment of skin ........................... 4.28 6.87 4.18 0.42 11.57 8.88 090 15786 ......... ............ A Abrasion, lesion, single ................................ 2.03 3.35 1.32 0.18 5.56 3.53 010 15787 ......... ............ A Abrasion, lesions, add-on ............................ 0.33 1.10 0.16 0.03 1.46 0.52 ZZZ 15788 ......... ............ R Chemical peel, face, epiderm ...................... 2.09 6.72 3.08 0.19 9.00 5.36 090 15789 ......... ............ R Chemical peel, face, dermal ........................ 4.91 8.09 4.82 0.43 13.43 10.16 090 15792 ......... ............ R Chemical peel, nonfacial ............................. 1.86 7.11 4.45 0.17 9.14 6.48 090 15793 ......... ............ A Chemical peel, nonfacial ............................. 3.73 6.29 4.39 0.32 10.34 8.44 090 15810 ......... ............ A Salabrasion .................................................. 4.73 NA 3.90 0.34 NA 8.97 090 15811 ......... ............ A Salabrasion .................................................. 5.38 5.47 4.76 0.80 11.65 10.94 090 15819 ......... ............ A Plastic surgery, neck ................................... 9.37 NA 7.17 0.91 NA 17.45 090 15820 ......... ............ A Revision of lower eyelid ............................... 5.14 6.93 5.52 0.48 12.55 11.14 090 15821 ......... ............ A Revision of lower eyelid ............................... 5.71 7.32 5.68 0.46 13.49 11.85 090 15822 ......... ............ A Revision of upper eyelid .............................. 4.44 5.82 4.47 0.39 10.65 9.30 090 15823 ......... ............ A Revision of upper eyelid .............................. 7.04 7.84 6.40 0.50 15.38 13.94 090 15831 ......... ............ A Excise excessive skin tissue ....................... 12.38 NA 8.15 1.69 NA 22.22 090 15832 ......... ............ A Excise excessive skin tissue ....................... 11.57 NA 8.33 1.63 NA 21.53 090 15833 ......... ............ A Excise excessive skin tissue ....................... 10.62 NA 8.20 1.48 NA 20.30 090 15834 ......... ............ A Excise excessive skin tissue ....................... 10.83 NA 7.68 1.60 NA 20.11 090
15835 ......... ............ A Excise excessive skin tissue ....................... 11.65 NA 7.53 1.63 NA 20.81 090
15836 ......... ............ A Excise excessive skin tissue ....................... 9.33 NA 6.77 1.31 NA 17.41 090
15837 ......... ............ A Excise excessive skin tissue ....................... 8.42 8.63 7.36 1.19 18.24 16.97 090
15838 ......... ............ A Excise excessive skin tissue ....................... 7.12 NA 6.05 0.63 NA 13.80 090
15839 ......... ............ A Excise excessive skin tissue ....................... 9.37 8.87 6.39 1.15 19.39 16.91 090 15840 ......... ............ A Graft for face nerve palsy ............................ 13.24 NA 9.96 1.39 NA 24.59 090 15841 ......... ............ A Graft for face nerve palsy ............................ 23.23 NA 14.98 2.79 NA 41.00 090 15842 ......... ............ A Flap for face nerve palsy ............................. 37.90 NA 22.88 2.91 NA 63.69 090 15845 ......... ............ A Skin and muscle repair, face ....................... 12.55 NA 9.29 0.86 NA 22.70 090 15850 ......... ............ B Removal of sutures ...................................... 0.78 1.57 0.29 0.05 2.40 1.12 XXX 15851 ......... ............ A Removal of sutures ...................................... 0.86 1.70 0.31 0.06 2.62 1.23 000 15852 ......... ............ A Dressing change not for burn ...................... 0.86 1.87 0.33 0.09 2.82 1.28 000


## 47585

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

15860 ......... ............ A Test for blood flow in graft ........................... 1.95 0.83 0.78 0.25 3.03 2.98 000 15920 ......... ............ A Removal of tail bone ulcer ........................... 7.94 NA 5.55 0.97 NA 14.46 090 15922 ......... ............ A Removal of tail bone ulcer ........................... 9.89 NA 7.20 1.41 NA 18.50 090 15931 ......... ............ A Remove sacrum pressure sore ................... 9.23 NA 5.68 1.23 NA 16.14 090 15933 ......... ............ A Remove sacrum pressure sore ................... 10.83 NA 7.84 1.48 NA 20.15 090 15934 ......... ............ A Remove sacrum pressure sore ................... 12.67 NA 8.03 1.76 NA 22.46 090 15935 ......... ............ A Remove sacrum pressure sore ................... 14.55 NA 10.31 2.06 NA 26.92 090 15936 ......... ............ A Remove sacrum pressure sore ................... 12.36 NA 8.21 1.74 NA 22.31 090 15937 ......... ............ A Remove sacrum pressure sore ................... 14.19 NA 9.80 2.01 NA 26.00 090 15940 ......... ............ A Remove hip pressure sore .......................... 9.33 NA 6.17 1.30 NA 16.80 090 15941 ......... ............ A Remove hip pressure sore .......................... 11.41 NA 9.43 1.63 NA 22.47 090 15944 ......... ............ A Remove hip pressure sore .......................... 11.44 NA 8.59 1.63 NA 21.66 090 15945 ......... ............ A Remove hip pressure sore .......................... 12.67 NA 9.63 1.80 NA 24.10 090 15946 ......... ............ A Remove hip pressure sore .......................... 21.54 NA 14.34 3.09 NA 38.97 090 15950 ......... ............ A Remove thigh pressure sore ....................... 7.53 NA 5.41 1.02 NA 13.96 090 15951 ......... ............ A Remove thigh pressure sore ....................... 10.70 NA 7.85 1.48 NA 20.03 090 15952 ......... ............ A Remove thigh pressure sore ....................... 11.37 NA 7.74 1.58 NA 20.69 090 15953 ......... ............ A Remove thigh pressure sore ....................... 12.61 NA 8.97 1.83 NA 23.41 090 15956 ......... ............ A Remove thigh pressure sore ....................... 15.50 NA 10.75 2.18 NA 28.43 090 15958 ......... ............ A Remove thigh pressure sore ....................... 15.46 NA 11.02 2.17 NA 28.65 090 16000 ......... ............ A Initial treatment of burn(s) ........................... 0.89 0.87 0.26 0.08 1.84 1.23 000 16010 ......... ............ A Treatment of burn(s) .................................... 0.87 0.66 0.63 0.08 1.61 1.58 000 16015 ......... ............ A Treatment of burn(s) .................................... 2.35 NA 1.15 0.30 NA 3.80 000 16020 ......... ............ A Treatment of burn(s) .................................... 0.80 1.31 0.59 0.08 2.19 1.47 000 16025 ......... ............ A Treatment of burn(s) .................................... 1.85 1.77 0.96 0.19 3.81 3.00 000 16030 ......... ............ A Treatment of burn(s) .................................... 2.08 2.18 1.12 0.22 4.48 3.42 000 16035 ......... ............ A Incision of burn scab, initi ............................ 3.74 NA 1.58 0.42 NA 5.74 090 16036 ......... ............ A Escharotomy; add-l incision ......................... 1.50 NA 0.60 0.20 NA 2.30 ZZZ 17000 ......... ............ A Destroy benign/premlg lesion ...................... 0.60 0.97 0.55 0.05 1.62 1.20 010 17003 ......... ............ A Destroy lesions, 2-14 ................................... 0.15 0.11 0.07 0.01 0.27 0.23 ZZZ 17004 ......... ............ A Destroy lesions, 15 or more ........................ 2.79 2.30 1.59 0.23 5.32 4.61 010 17106 ......... ............ A Destruction of skin lesions ........................... 4.58 4.58 3.33 0.44 9.60 8.35 090 17107 ......... ............ A Destruction of skin lesions ........................... 9.15 7.17 5.43 0.87 17.19 15.45 090 17108 ......... ............ A Destruction of skin lesions ........................... 13.18 9.25 7.64 1.33 23.76 22.15 090 17110 ......... ............ A Destruct lesion, 1-14 .................................... 0.65 1.63 0.71 0.05 2.33 1.41 010 17111 ......... ............ A Destruct lesion, 15 or more ......................... 0.92 1.68 0.81 0.08 2.68 1.81 010 17250 ......... ............ A Chemical cautery, tissue ............................. 0.50 1.22 0.34 0.05 1.77 0.89 000 17260 ......... ............ A Destruction of skin lesions ........................... 0.91 1.28 0.68 0.08 2.27 1.67 010 17261 ......... ............ A Destruction of skin lesions ........................... 1.17 1.61 0.83 0.10 2.88 2.10 010 17262 ......... ............ A Destruction of skin lesions ........................... 1.58 1.88 1.02 0.13 3.59 2.73 010 17263 ......... ............ A Destruction of skin lesions ........................... 1.79 2.05 1.09 0.15 3.99 3.03 010 17264 ......... ............ A Destruction of skin lesions ........................... 1.94 2.22 1.12 0.16 4.32 3.22 010 17266 ......... ............ A Destruction of skin lesions ........................... 2.34 2.50 1.22 0.20 5.04 3.76 010 17270 ......... ............ A Destruction of skin lesions ........................... 1.32 1.70 0.87 0.11 3.13 2.30 010 17271 ......... ............ A Destruction of skin lesions ........................... 1.49 1.77 0.98 0.13 3.39 2.60 010 17272 ......... ............ A Destruction of skin lesions ........................... 1.77 1.99 1.11 0.15 3.91 3.03 010 17273 ......... ............ A Destruction of skin lesions ........................... 2.05 2.20 1.21 0.17 4.42 3.43 010 17274 ......... ............ A Destruction of skin lesions ........................... 2.59 2.56 1.44 0.22 5.37 4.25 010 17276 ......... ............ A Destruction of skin lesions ........................... 3.20 2.94 1.68 0.29 6.43 5.17 010 17280 ......... ............ A Destruction of skin lesions ........................... 1.17 1.61 0.81 0.10 2.88 2.08 010 17281 ......... ............ A Destruction of skin lesions ........................... 1.72 1.90 1.09 0.15 3.77 2.96 010 17282 ......... ............ A Destruction of skin lesions ........................... 2.04 2.15 1.24 0.17 4.36 3.45 010 17283 ......... ............ A Destruction of skin lesions ........................... 2.64 2.54 1.49 0.22 5.40 4.35 010 17284 ......... ............ A Destruction of skin lesions ........................... 3.21 2.92 1.74 0.28 6.41 5.23 010 17286 ......... ............ A Destruction of skin lesions ........................... 4.43 3.67 2.43 0.41 8.51 7.27 010 17304 ......... ............ A 1 stage mohs, up to 5 spec ......................... 7.59 8.22 3.55 0.64 16.45 11.78 000 17305 ......... ............ A 2 stage mohs, up to 5 spec ......................... 2.85 3.88 1.34 0.24 6.97 4.43 000 17306 ......... ............ A 3 stage mohs, up to 5 spec ......................... 2.85 3.90 1.35 0.24 6.99 4.44 000 17307 ......... ............ A Mohs addl stage up to 5 spec ..................... 2.85 2.63 1.36 0.24 5.72 4.45 000 17310 ......... ............ A Mohs any stage > 5 spec each ................... 0.95 1.62 0.46 0.09 2.66 1.50 ZZZ 17340 ......... ............ A Cryotherapy of skin ...................................... 0.76 0.37 0.36 0.06 1.19 1.18 010 17360 ......... ............ A Skin peel therapy ......................................... 1.43 1.44 0.87 0.12 2.99 2.42 010 19000 ......... ............ A Drainage of breast lesion ............................ 0.84 1.98 0.31 0.08 2.90 1.23 000
19001 ......... ............ A Drain breast lesion add-on .......................... 0.42 0.25 0.14 0.04 0.71 0.60 ZZZ 19020 ......... ............ A Incision of breast lesion ............................... 3.56 6.36 2.68 0.45 10.37 6.69 090 19030 ......... ............ A Injection for breast x-ray .............................. 1.53 2.88 0.50 0.09 4.50 2.12 000 19100 ......... ............ A Bx breast percut w/o image ......................... 1.27 2.08 0.42 0.15 3.50 1.84 000 19101 ......... ............ A Biopsy of breast, open ................................. 3.18 4.51 1.91 0.36 8.05 5.45 010 19102 ......... ............ A Bx breast percut w/image ............................ 2.00 3.83 0.66 0.15 5.98 2.81 000 19103 ......... ............ A Bx breast percut w/device ........................... 3.69 11.53 1.23 0.30 15.52 5.22 000 19110 ......... ............ A Nipple exploration ........................................ 4.29 5.82 2.87 0.56 10.67 7.72 090 19112 ......... ............ A Excise breast duct fistula ............................. 3.66 6.11 2.69 0.48 10.25 6.83 090 19120 ......... ............ A Removal of breast lesion ............................. 5.55 4.55 3.06 0.72 10.82 9.33 090 19125 ......... ............ A Excision, breast lesion ................................. 6.05 4.79 3.28 0.79 11.63 10.12 090 19126 ......... ............ A Excision, addl breast lesion ......................... 2.93 NA 1.00 0.38 NA 4.31 ZZZ


## 47586

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

19140 ......... ............ A Removal of breast tissue ............................. 5.13 7.18 3.41 0.69 13.00 9.23 090 19160 ......... ............ A Removal of breast tissue ............................. 5.98 NA 3.43 0.78 NA 10.19 090 19162 ......... ............ A Remove breast tissue, nodes ...................... 13.51 NA 6.34 1.74 NA 21.59 090 19180 ......... ............ A Removal of breast ....................................... 8.79 NA 5.03 1.14 NA 14.96 090 19182 ......... ............ A Removal of breast ....................................... 7.72 NA 4.77 1.03 NA 13.52 090 19200 ......... ............ A Removal of breast ....................................... 15.47 NA 7.98 1.82 NA 25.27 090 19220 ......... ............ A Removal of breast ....................................... 15.70 NA 8.25 1.97 NA 25.92 090 19240 ......... ............ A Removal of breast ....................................... 15.98 NA 8.23 2.06 NA 26.27 090 19260 ......... ............ A Removal of chest wall lesion ....................... 15.42 NA 11.17 2.01 NA 28.60 090 19271 ......... ............ A Revision of chest wall .................................. 18.87 NA 17.99 2.51 NA 39.37 090 19272 ......... ............ A Extensive chest wall surgery ....................... 21.52 NA 18.97 3.01 NA 43.50 090 19290 ......... ............ A Place needle wire, breast ............................ 1.27 2.89 0.42 0.08 4.24 1.77 000 19291 ......... ............ A Place needle wire, breast ............................ 0.63 1.22 0.21 0.04 1.89 0.88 ZZZ 19295 ......... ............ A Place breast clip, percut .............................. 0.00 2.70 NA 0.01 2.71 NA ZZZ 19316 ......... ............ A Suspension of breast ................................... 10.67 NA 7.52 1.60 NA 19.79 090 19318 ......... ............ A Reduction of large breast ............................ 15.60 NA 11.12 2.79 NA 29.51 090 19324 ......... ............ A Enlarge breast ............................................. 5.84 NA 4.87 0.84 NA 11.55 090 19325 ......... ............ A Enlarge breast with implant ......................... 8.44 NA 6.53 1.28 NA 16.25 090 19328 ......... ............ A Removal of breast implant ........................... 5.67 NA 5.02 0.89 NA 11.58 090 19330 ......... ............ A Removal of implant material ........................ 7.58 NA 6.02 1.24 NA 14.84 090 19340 ......... ............ A Immediate breast prosthesis ....................... 6.32 NA 3.10 1.03 NA 10.45 ZZZ 19342 ......... ............ A Delayed breast prosthesis ........................... 11.18 NA 8.89 1.77 NA 21.84 090 19350 ......... ............ A Breast reconstruction ................................... 8.91 13.79 7.15 1.38 24.08 17.44 090 19355 ......... ............ A Correct inverted nipple(s) ............................ 7.56 10.25 4.70 1.07 18.88 13.33 090
19357 ......... ............ A Breast reconstruction ................................... 18.13 NA 13.76 2.79 NA 34.68 090 19361 ......... ............ A Breast reconstruction ................................... 19.23 NA 11.71 2.84 NA 33.78 090 19364 ......... ............ A Breast reconstruction ................................... 40.94 NA 23.49 5.85 NA 70.28 090 19366 ......... ............ A Breast reconstruction ................................... 21.25 NA 11.16 3.07 NA 35.48 090 19367 ......... ............ A Breast reconstruction ................................... 25.69 NA 16.45 3.84 NA 45.98 090 19368 ......... ............ A Breast reconstruction ................................... 32.37 NA 20.12 4.63 NA 57.12 090 19369 ......... ............ A Breast reconstruction ................................... 29.78 NA 19.66 4.29 NA 53.73 090 19370 ......... ............ A Surgery of breast capsule ........................... 8.04 NA 6.87 1.27 NA 16.18 090 19371 ......... ............ A Removal of breast capsule .......................... 9.34 NA 7.79 1.65 NA 18.78 090 19380 ......... ............ A Revise breast reconstruction ....................... 9.13 NA 7.67 1.42 NA 18.22 090 19396 ......... ............ A Design custom breast implant ..................... 2.17 1.08 0.99 0.26 3.51 3.42 000 20000 ......... ............ A Incision of abscess ...................................... 2.12 2.70 1.73 0.19 5.01 4.04 010 20005 ......... ............ A Incision of deep abscess ............................. 3.41 3.50 2.25 0.41 7.32 6.07 010 20100 ......... ............ A Explore wound, neck ................................... 10.06 NA 4.46 1.19 NA 15.71 010 20101 ......... ............ A Explore wound, chest .................................. 3.22 5.94 1.62 0.41 9.57 5.25 010 20102 ......... ............ A Explore wound, abdomen ............................ 3.93 7.50 1.91 0.50 11.93 6.34 010 20103 ......... ............ A Explore wound, extremity ............................ 5.29 8.60 3.39 0.70 14.59 9.38 010 20150 ......... ............ A Excise epiphyseal bar .................................. 13.67 NA 7.04 1.43 NA 22.14 090 20200 ......... ............ A Muscle biopsy .............................................. 1.46 3.05 0.75 0.22 4.73 2.43 000 20205 ......... ............ A Deep muscle biopsy .................................... 2.35 4.07 1.19 0.31 6.73 3.85 000 20206 ......... ............ A Needle biopsy, muscle ................................ 0.99 6.63 0.63 0.07 7.69 1.69 000 20220 ......... ............ A Bone biopsy, trocar/needle .......................... 1.27 4.89 0.80 0.09 6.25 2.16 000 20225 ......... ............ A Bone biopsy, trocar/needle .......................... 1.87 26.72 1.13 0.18 28.77 3.18 000 20240 ......... ............ A Bone biopsy, excisional ............................... 3.23 NA 2.56 0.41 NA 6.20 010 20245 ......... ............ A Bone biopsy, excisional ............................... 7.77 NA 6.59 1.19 NA 15.55 010 20250 ......... ............ A Open bone biopsy ....................................... 5.02 NA 3.50 0.91 NA 9.43 010 20251 ......... ............ A Open bone biopsy ....................................... 5.55 NA 4.15 1.05 NA 10.75 010 20500 ......... ............ A Injection of sinus tract .................................. 1.23 2.27 1.53 0.10 3.60 2.86 010 20501 ......... ............ A Inject sinus tract for x-ray ............................ 0.76 2.98 0.25 0.05 3.79 1.06 000 20520 ......... ............ A Removal of foreign body ............................. 1.85 2.93 1.77 0.20 4.98 3.82 010 20525 ......... ............ A Removal of foreign body ............................. 3.49 9.14 2.62 0.47 13.10 6.58 010 20526 ......... ............ A Ther injection, carp tunnel ........................... 0.94 0.97 0.51 0.10 2.01 1.55 000 20550 ......... ............ A Inj tendon sheath/ligament .......................... 0.75 0.71 0.23 0.08 1.54 1.06 000 20551 ......... ............ A Inj tendon origin/insertion ............................ 0.75 0.69 0.33 0.08 1.52 1.16 000 20552 ......... ............ A Inj trigger point, 1/2 muscl ........................... 0.66 0.72 0.20 0.07 1.45 0.93 000 20553 ......... ............ A Inject trigger points, =/> 3 ............................ 0.75 0.82 0.22 0.05 1.62 1.02 000 20600 ......... ............ A Drain/inject, joint/bursa ................................ 0.66 0.65 0.35 0.06 1.37 1.07 000 20605 ......... ............ A Drain/inject, joint/bursa ................................ 0.68 0.76 0.36 0.07 1.51 1.11 000 20610 ......... ............ A Drain/inject, joint/bursa ................................ 0.79 0.95 0.42 0.10 1.84 1.31 000 20612 ......... ............ A Aspirate/inj ganglion cyst ............................. 0.70 0.71 0.36 0.07 1.48 1.13 000 20615 ......... ............ A Treatment of bone cyst ................................ 2.28 3.53 1.84 0.19 6.00 4.31 010 20650 ......... ............ A Insert and remove bone pin ........................ 2.23 2.36 1.55 0.25 4.84 4.03 010 20660 ......... ............ A Apply, rem fixation device ........................... 2.51 3.05 1.61 0.54 6.10 4.66 000 20661 ......... ............ A Application of head brace ............................ 4.88 NA 5.06 1.11 NA 11.05 090 20662 ......... ............ A Application of pelvis brace ........................... 6.06 NA 5.58 0.53 NA 12.17 090 20663 ......... ............ A Application of thigh brace ............................ 5.42 NA 4.89 0.33 NA 10.64 090 20664 ......... ............ A Halo brace application ................................. 8.05 NA 7.15 1.68 NA 16.88 090 20665 ......... ............ A Removal of fixation device .......................... 1.31 2.21 1.35 0.19 3.71 2.85 010 20670 ......... ............ A Removal of support implant ......................... 1.74 11.52 2.09 0.26 13.52 4.09 010 20680 ......... ............ A Removal of support implant ......................... 3.34 8.77 3.71 0.52 12.63 7.57 090 20690 ......... ............ A Apply bone fixation device ........................... 3.51 NA 2.54 0.58 NA 6.63 090


## 47587

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

20692 ......... ............ A Apply bone fixation device ........................... 6.40 NA 3.77 0.99 NA 11.16 090 20693 ......... ............ A Adjust bone fixation device .......................... 5.85 NA 5.73 0.98 NA 12.56 090 20694 ......... ............ A Remove bone fixation device ...................... 4.15 7.13 4.04 0.69 11.97 8.88 090 20802 ......... ............ A Replantation, arm, complete ........................ 41.09 NA 21.49 4.51 NA 67.09 090 20805 ......... ............ A Replant forearm, complete .......................... 49.93 NA 35.25 4.64 NA 89.82 090 20808 ......... ............ A Replantation hand, complete ....................... 61.56 NA 43.10 5.37 NA 110.03 090 20816 ......... ............ A Replantation digit, complete ........................ 30.89 NA 38.46 4.37 NA 73.72 090 20822 ......... ............ A Replantation digit, complete ........................ 25.55 NA 35.14 3.46 NA 64.15 090 20824 ......... ............ A Replantation thumb, complete ..................... 30.89 NA 37.30 4.15 NA 72.34 090 20827 ......... ............ A Replantation thumb, complete ..................... 26.37 NA 37.15 3.73 NA 67.25 090 20838 ......... ............ A Replantation foot, complete ......................... 41.35 NA 22.78 10.71 NA 74.84 090 20900 ......... ............ A Removal of bone for graft ............................ 5.57 8.44 5.66 0.85 14.86 12.08 090 20902 ......... ............ A Removal of bone for graft ............................ 7.54 NA 7.06 1.21 NA 15.81 090 20910 ......... ............ A Remove cartilage for graft ........................... 5.33 NA 5.26 0.66 NA 11.25 090 20912 ......... ............ A Remove cartilage for graft ........................... 6.34 NA 6.15 0.70 NA 13.19 090 20920 ......... ............ A Removal of fascia for graft .......................... 5.30 NA 4.40 0.58 NA 10.28 090 20922 ......... ............ A Removal of fascia for graft .......................... 6.60 7.54 4.87 0.68 14.82 12.15 090 20924 ......... ............ A Removal of tendon for graft ......................... 6.47 NA 6.06 0.97 NA 13.50 090 20926 ......... ............ A Removal of tissue for graft .......................... 5.52 NA 4.99 0.81 NA 11.32 090 20931 ......... ............ A Spinal bone allograft .................................... 1.81 NA 0.93 0.42 NA 3.16 ZZZ 20937 ......... ............ A Spinal bone autograft .................................. 2.79 NA 1.45 0.49 NA 4.73 ZZZ 20938 ......... ............ A Spinal bone autograft .................................. 3.02 NA 1.55 0.57 NA 5.14 ZZZ 20950 ......... ............ A Fluid pressure, muscle ................................ 1.26 6.83 0.99 0.19 8.28 2.44 000 20955 ......... ............ A Fibula bone graft, microvasc ....................... 39.15 NA 25.19 4.72 NA 69.06 090 20956 ......... ............ A Iliac bone graft, microvasc ........................... 39.21 NA 25.05 7.16 NA 71.42 090 20957 ......... ............ A Mt bone graft, microvasc ............................. 40.59 NA 19.21 4.32 NA 64.12 090 20962 ......... ............ A Other bone graft, microvasc ........................ 39.21 NA 26.71 6.19 NA 72.11 090 20969 ......... ............ A Bone/skin graft, microvasc .......................... 43.85 NA 27.63 4.68 NA 76.16 090 20970 ......... ............ A Bone/skin graft, iliac crest ........................... 43.00 NA 25.97 6.77 NA 75.74 090 20972 ......... ............ A Bone/skin graft, metatarsal .......................... 42.93 NA 20.56 3.44 NA 66.93 090 20973 ......... ............ A Bone/skin graft, great toe ............................ 45.69 NA 25.46 5.61 NA 76.76 090
20974 ......... ............ A Electrical bone stimulation ........................... 0.62 0.69 0.54 0.10 1.41 1.26 000 20975 ......... ............ A Electrical bone stimulation ........................... 2.60 NA 1.71 0.46 NA 4.77 000 20979 ......... ............ A Us bone stimulation ..................................... 0.62 0.80 0.33 0.09 1.51 1.04 000 20982 ......... ............ A Ablate, bone tumor(s) perq .......................... 7.27 109.89 2.97 0.69 117.85 10.93 000 21010 ......... ............ A Incision of jaw joint ...................................... 10.12 NA 7.14 1.02 NA 18.28 090 21015 ......... ............ A Resection of facial tumor ............................. 5.28 NA 5.43 0.70 NA 11.41 090 21025 ......... ............ A Excision of bone, lower jaw ......................... 10.04 12.22 9.35 1.30 23.56 20.69 090 21026 ......... ............ A Excision of facial bone(s) ............................ 4.84 7.85 6.31 0.63 13.32 11.78 090 21029 ......... ............ A Contour of face bone lesion ........................ 7.70 9.34 6.99 0.90 17.94 15.59 090 21030 ......... ............ A Excise max/zygoma b9 tumor ..................... 4.49 6.32 5.03 0.86 11.67 10.38 090 21031 ......... ............ A Remove exostosis, mandible ....................... 3.24 5.16 3.62 0.47 8.87 7.33 090 21032 ......... ............ A Remove exostosis, maxilla .......................... 3.24 5.34 3.51 0.46 9.04 7.21 090 21034 ......... ............ A Excise max/zygoma mlg tumor ................... 16.15 15.88 12.63 1.74 33.77 30.52 090
21040 ......... ............ A Excise mandible lesion ................................ 4.49 6.38 4.72 0.57 11.44 9.78 090 21044 ......... ............ A Removal of jaw bone lesion ........................ 11.84 NA 9.37 1.10 NA 22.31 090 21045 ......... ............ A Extensive jaw surgery .................................. 16.15 NA 12.34 1.57 NA 30.06 090 21046 ......... ............ A Remove mandible cyst complex .................. 12.98 NA 11.86 0.88 NA 25.72 090 21047 ......... ............ A Excise lwr jaw cyst w/repair ........................ 18.72 NA 13.42 0.88 NA 33.02 090 21048 ......... ............ A Remove maxilla cyst complex ..................... 13.48 NA 12.08 0.88 NA 26.44 090 21049 ......... ............ A Excis uppr jaw cyst w/repair ........................ 17.97 NA 13.00 0.88 NA 31.85 090 21050 ......... ............ A Removal of jaw joint .................................... 10.75 NA 9.43 1.36 NA 21.54 090 21060 ......... ............ A Remove jaw joint cartilage .......................... 10.21 NA 8.60 1.51 NA 20.32 090 21070 ......... ............ A Remove coronoid process ........................... 8.19 NA 7.10 1.16 NA 16.45 090 21076 ......... ............ A Prepare face/oral prosthesis ........................ 13.40 12.34 9.99 1.91 27.65 25.30 010 21077 ......... ............ A Prepare face/oral prosthesis ........................ 33.70 31.27 25.96 5.03 70.00 64.69 090 21079 ......... ............ A Prepare face/oral prosthesis ........................ 22.31 21.46 17.12 3.09 46.86 42.52 090 21080 ......... ............ A Prepare face/oral prosthesis ........................ 25.06 24.45 19.33 3.68 53.19 48.07 090 21081 ......... ............ A Prepare face/oral prosthesis ........................ 22.85 22.26 17.45 3.10 48.21 43.40 090 21082 ......... ............ A Prepare face/oral prosthesis ........................ 20.84 19.30 15.69 2.95 43.09 39.48 090 21083 ......... ............ A Prepare face/oral prosthesis ........................ 19.27 18.76 14.41 2.55 40.58 36.23 090 21084 ......... ............ A Prepare face/oral prosthesis ........................ 22.48 22.40 17.67 2.28 47.16 42.43 090 21085 ......... ............ A Prepare face/oral prosthesis ........................ 8.99 8.27 6.77 1.17 18.43 16.93 010 21086 ......... ............ A Prepare face/oral prosthesis ........................ 24.88 23.73 19.39 3.19 51.80 47.46 090 21087 ......... ............ A Prepare face/oral prosthesis ........................ 24.88 23.23 19.14 3.58 51.69 47.60 090 21100 ......... ............ A Maxillofacial fixation ..................................... 4.21 11.59 4.76 0.35 16.15 9.32 090 21110 ......... ............ A Interdental fixation ....................................... 5.20 9.57 8.35 0.62 15.39 14.17 090 21116 ......... ............ A Injection, jaw joint x-ray ............................... 0.81 4.36 0.33 0.06 5.23 1.20 000 21120 ......... ............ A Reconstruction of chin ................................. 4.92 10.62 7.48 0.49 16.03 12.89 090 21121 ......... ............ A Reconstruction of chin ................................. 7.63 9.73 7.81 0.93 18.29 16.37 090 21122 ......... ............ A Reconstruction of chin ................................. 8.51 NA 8.62 0.98 NA 18.11 090 21123 ......... ............ A Reconstruction of chin ................................. 11.14 NA 10.78 0.91 NA 22.83 090 21125 ......... ............ A Augmentation, lower jaw bone .................... 10.60 55.70 8.31 0.76 67.06 19.67 090 21127 ......... ............ A Augmentation, lower jaw bone .................... 11.10 42.76 9.44 1.66 55.52 22.20 090 21137 ......... ............ A Reduction of forehead ................................. 9.81 NA 7.71 1.13 NA 18.65 090


## 47588

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

21138 ......... ............ A Reduction of forehead ................................. 12.17 NA 9.50 0.61 NA 22.28 090 21139 ......... ............ A Reduction of forehead ................................. 14.59 NA 11.04 1.68 NA 27.31 090 21141 ......... ............ A Reconstruct midface, lefort .......................... 18.07 NA 13.75 2.41 NA 34.23 090 21142 ......... ............ A Reconstruct midface, lefort .......................... 18.78 NA 12.94 2.26 NA 33.98 090 21143 ......... ............ A Reconstruct midface, lefort .......................... 19.55 NA 14.30 1.09 NA 34.94 090 21145 ......... ............ A Reconstruct midface, lefort .......................... 19.91 NA 14.02 2.58 NA 36.51 090 21146 ......... ............ A Reconstruct midface, lefort .......................... 20.68 NA 15.44 3.09 NA 39.21 090 21147 ......... ............ A Reconstruct midface, lefort .......................... 21.74 NA 15.13 1.83 NA 38.70 090 21150 ......... ............ A Reconstruct midface, lefort .......................... 25.20 NA 16.75 3.04 NA 44.99 090 21151 ......... ............ A Reconstruct midface, lefort .......................... 28.26 NA 22.88 4.22 NA 55.36 090 21154 ......... ............ A Reconstruct midface, lefort .......................... 30.47 NA 23.07 4.55 NA 58.09 090 21155 ......... ............ A Reconstruct midface, lefort .......................... 34.40 NA 23.85 6.61 NA 64.86 090 21159 ......... ............ A Reconstruct midface, lefort .......................... 42.32 NA 29.02 6.31 NA 77.65 090 21160 ......... ............ A Reconstruct midface, lefort .......................... 46.37 NA 27.46 4.91 NA 78.74 090 21172 ......... ............ A Reconstruct orbit/forehead .......................... 27.76 NA 14.01 2.83 NA 44.60 090 21175 ......... ............ A Reconstruct orbit/forehead .......................... 33.12 NA 18.18 3.43 NA 54.73 090 21179 ......... ............ A Reconstruct entire forehead ........................ 22.22 NA 14.72 3.24 NA 40.18 090 21180 ......... ............ A Reconstruct entire forehead ........................ 25.15 NA 15.92 3.08 NA 44.15 090 21181 ......... ............ A Contour cranial bone lesion ......................... 9.89 NA 7.78 1.37 NA 19.04 090
21182 ......... ............ A Reconstruct cranial bone ............................. 32.14 NA 19.47 3.42 NA 55.03 090 21183 ......... ............ A Reconstruct cranial bone ............................. 35.26 NA 21.18 3.51 NA 59.95 090 21184 ......... ............ A Reconstruct cranial bone ............................. 38.18 NA 22.37 6.84 NA 67.39 090 21188 ......... ............ A Reconstruction of midface ........................... 22.43 NA 18.83 2.97 NA 44.23 090 21193 ......... ............ A Reconst lwr jaw w/o graft ............................ 17.12 NA 12.84 2.10 NA 32.06 090 21194 ......... ............ A Reconst lwr jaw w/graft ............................... 19.81 NA 13.91 2.11 NA 35.83 090 21195 ......... ............ A Reconst lwr jaw w/o fixation ........................ 17.21 NA 14.79 1.22 NA 33.22 090 21196 ......... ............ A Reconst lwr jaw w/fixation ........................... 18.88 NA 15.66 2.03 NA 36.57 090 21198 ......... ............ A Reconstr lwr jaw segment ........................... 14.14 NA 12.69 1.41 NA 28.24 090 21199 ......... ............ A Reconstr lwr jaw w/advance ........................ 15.98 NA 9.15 1.39 NA 26.52 090 21206 ......... ............ A Reconstruct upper jaw bone ........................ 14.08 NA 12.62 1.78 NA 28.48 090 21208 ......... ............ A Augmentation of facial bones ...................... 10.21 22.32 9.56 1.11 33.64 20.88 090 21209 ......... ............ A Reduction of facial bones ............................ 6.71 10.78 8.06 0.90 18.39 15.67 090 21210 ......... ............ A Face bone graft ........................................... 10.21 24.84 9.33 1.37 36.42 20.91 090 21215 ......... ............ A Lower jaw bone graft ................................... 10.75 41.85 9.35 1.51 54.11 21.61 090 21230 ......... ............ A Rib cartilage graft ........................................ 10.75 NA 8.46 1.20 NA 20.41 090 21235 ......... ............ A Ear cartilage graft ........................................ 6.71 9.83 6.40 0.68 17.22 13.79 090 21240 ......... ............ A Reconstruction of jaw joint .......................... 14.03 NA 12.17 2.28 NA 28.48 090 21242 ......... ............ A Reconstruction of jaw joint .......................... 12.93 NA 11.66 2.29 NA 26.88 090 21243 ......... ............ A Reconstruction of jaw joint .......................... 20.76 NA 17.37 3.05 NA 41.18 090 21244 ......... ............ A Reconstruction of lower jaw ........................ 11.84 NA 12.07 1.24 NA 25.15 090 21245 ......... ............ A Reconstruction of jaw .................................. 11.84 14.35 9.83 1.12 27.31 22.79 090 21246 ......... ............ A Reconstruction of jaw .................................. 12.45 NA 9.03 1.24 NA 22.72 090 21247 ......... ............ A Reconstruct lower jaw bone ........................ 22.60 NA 17.43 3.23 NA 43.26 090 21248 ......... ............ A Reconstruction of jaw .................................. 11.46 12.11 9.38 1.67 25.24 22.51 090 21249 ......... ............ A Reconstruction of jaw .................................. 17.49 16.70 12.67 2.02 36.21 32.18 090 21255 ......... ............ A Reconstruct lower jaw bone ........................ 16.69 NA 16.15 2.57 NA 35.41 090 21256 ......... ............ A Reconstruction of orbit ................................. 16.17 NA 12.03 1.36 NA 29.56 090 21260 ......... ............ A Revise eye sockets ...................................... 16.50 NA 12.75 0.98 NA 30.23 090 21261 ......... ............ A Revise eye sockets ...................................... 31.44 NA 24.21 3.09 NA 58.74 090 21263 ......... ............ A Revise eye sockets ...................................... 28.38 NA 19.17 2.61 NA 50.16 090 21267 ......... ............ A Revise eye sockets ...................................... 18.87 NA 19.72 1.64 NA 40.23 090 21268 ......... ............ A Revise eye sockets ...................................... 24.44 NA 20.22 2.43 NA 47.09 090 21270 ......... ............ A Augmentation, cheek bone .......................... 10.21 11.66 7.24 1.04 22.91 18.49 090 21275 ......... ............ A Revision, orbitofacial bones ......................... 11.22 NA 8.63 1.29 NA 21.14 090 21280 ......... ............ A Revision of eyelid ........................................ 6.02 NA 5.95 0.46 NA 12.43 090 21282 ......... ............ A Revision of eyelid ........................................ 3.48 NA 4.58 0.27 NA 8.33 090 21295 ......... ............ A Revision of jaw muscle/bone ....................... 1.53 NA 2.54 0.15 NA 4.22 090 21296 ......... ............ A Revision of jaw muscle/bone ....................... 4.24 NA 4.90 0.35 NA 9.49 090 21300 ......... ............ A Treatment of skull fracture ........................... 0.72 2.39 0.26 0.11 3.22 1.09 000 21310 ......... ............ A Treatment of nose fracture .......................... 0.58 2.30 0.15 0.05 2.93 0.78 000 21315 ......... ............ A Treatment of nose fracture .......................... 1.51 4.23 1.88 0.14 5.88 3.53 010 21320 ......... ............ A Treatment of nose fracture .......................... 1.85 3.91 1.62 0.18 5.94 3.65 010 21325 ......... ............ A Treatment of nose fracture .......................... 3.76 NA 8.61 0.34 NA 12.71 090 21330 ......... ............ A Treatment of nose fracture .......................... 5.37 NA 9.64 0.61 NA 15.62 090 21335 ......... ............ A Treatment of nose fracture .......................... 8.60 NA 9.60 0.75 NA 18.95 090 21336 ......... ............ A Treat nasal septal fracture ........................... 5.71 NA 9.57 0.56 NA 15.84 090 21337 ......... ............ A Treat nasal septal fracture ........................... 2.70 6.49 3.56 0.27 9.46 6.53 090 21338 ......... ............ A Treat nasoethmoid fracture ......................... 6.45 NA 13.90 0.75 NA 21.10 090 21339 ......... ............ A Treat nasoethmoid fracture ......................... 8.08 NA 13.77 0.92 NA 22.77 090 21340 ......... ............ A Treatment of nose fracture .......................... 10.75 NA 8.59 0.97 NA 20.31 090 21343 ......... ............ A Treatment of sinus fracture ......................... 12.93 NA 15.39 1.67 NA 29.99 090 21344 ......... ............ A Treatment of sinus fracture ......................... 19.69 NA 16.42 2.45 NA 38.56 090 21345 ......... ............ A Treat nose/jaw fracture ................................ 8.15 9.84 7.16 1.11 19.10 16.42 090 21346 ......... ............ A Treat nose/jaw fracture ................................ 10.59 NA 12.18 1.22 NA 23.99 090 21347 ......... ............ A Treat nose/jaw fracture ................................ 12.67 NA 16.03 1.57 NA 30.27 090


## 47589

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

21348 ......... ............ A Treat nose/jaw fracture ................................ 16.66 NA 11.21 1.62 NA 29.49 090 21355 ......... ............ A Treat cheek bone fracture ........................... 3.76 6.24 3.49 0.28 10.28 7.53 010 21356 ......... ............ A Treat cheek bone fracture ........................... 4.14 7.10 4.53 0.47 11.71 9.14 010 21360 ......... ............ A Treat cheek bone fracture ........................... 6.45 NA 5.92 0.71 NA 13.08 090 21365 ......... ............ A Treat cheek bone fracture ........................... 14.93 NA 10.79 1.72 NA 27.44 090 21366 ......... ............ A Treat cheek bone fracture ........................... 17.74 NA 11.52 1.90 NA 31.16 090 21385 ......... ............ A Treat eye socket fracture ............................. 9.15 NA 8.27 0.83 NA 18.25 090 21386 ......... ............ A Treat eye socket fracture ............................. 9.15 NA 7.06 1.04 NA 17.25 090 21387 ......... ............ A Treat eye socket fracture ............................. 9.69 NA 8.93 0.96 NA 19.58 090 21390 ......... ............ A Treat eye socket fracture ............................. 10.11 NA 7.91 0.92 NA 18.94 090 21395 ......... ............ A Treat eye socket fracture ............................. 12.66 NA 9.21 1.60 NA 23.47 090 21400 ......... ............ A Treat eye socket fracture ............................. 1.40 2.64 1.90 0.14 4.18 3.44 090 21401 ......... ............ A Treat eye socket fracture ............................. 3.26 8.05 3.49 0.27 11.58 7.02 090 21406 ......... ............ A Treat eye socket fracture ............................. 7.00 NA 6.26 0.82 NA 14.08 090 21407 ......... ............ A Treat eye socket fracture ............................. 8.60 NA 7.05 0.94 NA 16.59 090 21408 ......... ............ A Treat eye socket fracture ............................. 12.36 NA 9.10 1.39 NA 22.85 090 21421 ......... ............ A Treat mouth roof fracture ............................. 5.13 9.33 8.31 0.61 15.07 14.05 090 21422 ......... ............ A Treat mouth roof fracture ............................. 8.31 NA 8.06 0.97 NA 17.34 090 21423 ......... ............ A Treat mouth roof fracture ............................. 10.38 NA 9.30 1.20 NA 20.88 090 21431 ......... ............ A Treat craniofacial fracture ............................ 7.04 NA 9.51 1.05 NA 17.60 090 21432 ......... ............ A Treat craniofacial fracture ............................ 8.60 NA 8.05 0.87 NA 17.52 090 21433 ......... ............ A Treat craniofacial fracture ............................ 25.31 NA 16.66 3.07 NA 45.04 090 21435 ......... ............ A Treat craniofacial fracture ............................ 17.22 NA 12.82 2.81 NA 32.85 090 21436 ......... ............ A Treat craniofacial fracture ............................ 28.00 NA 18.25 3.23 NA 49.48 090 21440 ......... ............ A Treat dental ridge fracture ........................... 2.70 7.10 6.16 0.35 10.15 9.21 090 21445 ......... ............ A Treat dental ridge fracture ........................... 5.37 9.73 8.36 0.68 15.78 14.41 090 21450 ......... ............ A Treat lower jaw fracture ............................... 2.97 7.38 6.92 0.37 10.72 10.26 090 21451 ......... ............ A Treat lower jaw fracture ............................... 4.86 9.34 8.40 0.65 14.85 13.91 090 21452 ......... ............ A Treat lower jaw fracture ............................... 1.98 13.11 4.61 0.20 15.29 6.79 090 21453 ......... ............ A Treat lower jaw fracture ............................... 5.53 10.73 10.71 0.71 16.97 16.95 090 21454 ......... ............ A Treat lower jaw fracture ............................... 6.45 NA 6.50 0.76 NA 13.71 090 21461 ......... ............ A Treat lower jaw fracture ............................... 8.08 24.43 12.64 0.95 33.46 21.67 090 21462 ......... ............ A Treat lower jaw fracture ............................... 9.78 27.59 12.69 0.94 38.31 23.41 090 21465 ......... ............ A Treat lower jaw fracture ............................... 11.89 NA 9.99 1.63 NA 23.51 090 21470 ......... ............ A Treat lower jaw fracture ............................... 15.32 NA 12.18 1.97 NA 29.47 090 21480 ......... ............ A Reset dislocated jaw .................................... 0.61 1.77 0.19 0.06 2.44 0.86 000 21485 ......... ............ A Reset dislocated jaw .................................... 3.98 8.22 7.67 0.49 12.69 12.14 090 21490 ......... ............ A Repair dislocated jaw .................................. 11.84 NA 9.84 1.79 NA 23.47 090 21493 ......... ............ A Treat hyoid bone fracture ............................ 1.27 NA 0.55 0.07 NA 1.89 090 21494 ......... ............ A Treat hyoid bone fracture ............................ 6.27 NA 3.53 0.53 NA 10.33 090 21495 ......... ............ A Treat hyoid bone fracture ............................ 5.68 NA 8.41 0.46 NA 14.55 090 21497 ......... ............ A Interdental wiring ......................................... 3.85 8.44 7.63 0.44 12.73 11.92 090 21501 ......... ............ A Drain neck/chest lesion ............................... 3.80 6.47 3.83 0.45 10.72 8.08 090
21502 ......... ............ A Drain chest lesion ........................................ 7.11 NA 5.67 0.93 NA 13.71 090 21510 ......... ............ A Drainage of bone lesion .............................. 5.73 NA 5.70 0.79 NA 12.22 090 21550 ......... ............ A Biopsy of neck/chest .................................... 2.06 3.59 1.72 0.19 5.84 3.97 010 21555 ......... ............ A Remove lesion, neck/chest .......................... 4.34 5.53 3.20 0.54 10.41 8.08 090 21556 ......... ............ A Remove lesion, neck/chest .......................... 5.56 NA 4.08 0.66 NA 10.30 090 21557 ......... ............ A Remove tumor, neck/chest .......................... 8.87 NA 5.41 1.09 NA 15.37 090 21600 ......... ............ A Partial removal of rib ................................... 6.88 NA 5.77 0.95 NA 13.60 090 21610 ......... ............ A Partial removal of rib ................................... 14.59 NA 9.11 2.49 NA 26.19 090 21615 ......... ............ A Removal of rib ............................................. 9.86 NA 6.70 1.39 NA 17.95 090 21616 ......... ............ A Removal of rib and nerves .......................... 12.02 NA 8.04 1.72 NA 21.78 090 21620 ......... ............ A Partial removal of sternum .......................... 6.78 NA 6.03 0.93 NA 13.74 090 21627 ......... ............ A Sternal debridement .................................... 6.80 NA 6.43 0.95 NA 14.18 090 21630 ......... ............ A Extensive sternum surgery .......................... 17.35 NA 11.89 2.45 NA 31.69 090 21632 ......... ............ A Extensive sternum surgery .......................... 18.11 NA 11.13 2.45 NA 31.69 090 21685 ......... ............ A Hyoid myotomy & suspension ..................... 12.98 NA 9.96 1.05 NA 23.99 090 21700 ......... ............ A Revision of neck muscle .............................. 6.18 NA 4.44 0.72 NA 11.34 090 21705 ......... ............ A Revision of neck muscle/rib ......................... 9.59 NA 5.60 1.21 NA 16.40 090 21720 ......... ............ A Revision of neck muscle .............................. 5.67 2.45 2.45 0.86 8.98 8.98 090 21725 ......... ............ A Revision of neck muscle .............................. 6.98 NA 5.63 0.78 NA 13.39 090 21740 ......... ............ A Reconstruction of sternum ........................... 16.48 NA 8.56 2.06 NA 27.10 090 21750 ......... ............ A Repair of sternum separation ...................... 10.75 NA 6.11 1.44 NA 18.30 090 21800 ......... ............ A Treatment of rib fracture .............................. 0.96 NA 1.37 0.09 NA 2.42 090 21805 ......... ............ A Treatment of rib fracture .............................. 2.75 NA 3.38 0.35 NA 6.48 090 21810 ......... ............ A Treatment of rib fracture(s) .......................... 6.85 NA 5.01 0.93 NA 12.79 090 21820 ......... ............ A Treat sternum fracture ................................. 1.28 1.84 1.79 0.15 3.27 3.22 090 21825 ......... ............ A Treat sternum fracture ................................. 7.40 NA 6.68 0.99 NA 15.07 090 21920 ......... ............ A Biopsy soft tissue of back ............................ 2.06 3.29 1.48 0.20 5.55 3.74 010 21925 ......... ............ A Biopsy soft tissue of back ............................ 4.48 5.20 3.24 0.59 10.27 8.31 090 21930 ......... ............ A Remove lesion, back or flank ...................... 4.99 5.73 3.40 0.63 11.35 9.02 090 21935 ......... ............ A Remove tumor, back ................................... 17.93 NA 10.24 2.46 NA 30.63 090 22100 ......... ............ A Remove part of neck vertebra ..................... 9.72 NA 7.73 1.68 NA 19.13 090 22101 ......... ............ A Remove part, thorax vertebra ...................... 9.80 NA 7.99 1.80 NA 19.59 090


## 47590

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

22102 ......... ............ A Remove part, lumbar vertebra ..................... 9.80 NA 8.25 1.57 NA 19.62 090 22103 ......... ............ A Remove extra spine segment ...................... 2.34 NA 1.21 0.39 NA 3.94 ZZZ 22110 ......... ............ A Remove part of neck vertebra ..................... 12.72 NA 9.38 2.24 NA 24.34 090 22112 ......... ............ A Remove part, thorax vertebra ...................... 12.79 NA 9.46 1.92 NA 24.17 090 22114 ......... ............ A Remove part, lumbar vertebra ..................... 12.79 NA 9.45 2.13 NA 24.37 090 22116 ......... ............ A Remove extra spine segment ...................... 2.32 NA 1.16 0.41 NA 3.89 ZZZ 22210 ......... ............ A Revision of neck spine ................................ 23.78 NA 15.63 4.60 NA 44.01 090 22212 ......... ............ A Revision of thorax spine .............................. 19.39 NA 13.45 3.12 NA 35.96 090 22214 ......... ............ A Revision of lumbar spine ............................. 19.42 NA 13.98 3.10 NA 36.50 090 22216 ......... ............ A Revise, extra spine segment ....................... 6.03 NA 3.12 1.05 NA 10.20 ZZZ 22220 ......... ............ A Revision of neck spine ................................ 21.34 NA 13.87 3.43 NA 38.64 090 22222 ......... ............ A Revision of thorax spine .............................. 21.49 NA 11.74 3.46 NA 36.69 090 22224 ......... ............ A Revision of lumbar spine ............................. 21.49 NA 14.40 3.63 NA 39.52 090 22226 ......... ............ A Revise, extra spine segment ....................... 6.03 NA 3.08 1.05 NA 10.16 ZZZ 22305 ......... ............ A Treat spine process fracture ........................ 2.05 2.31 1.92 0.33 4.69 4.30 090 22310 ......... ............ A Treat spine fracture ..................................... 2.61 2.79 2.34 0.42 5.82 5.37 090 22315 ......... ............ A Treat spine fracture ..................................... 8.83 9.68 7.32 1.60 20.11 17.75 090 22318 ......... ............ A Treat odontoid fx w/o graft .......................... 21.47 NA 13.56 4.70 NA 39.73 090 22319 ......... ............ A Treat odontoid fx w/graft .............................. 23.96 NA 14.97 5.38 NA 44.31 090 22325 ......... ............ A Treat spine fracture ..................................... 18.27 NA 12.26 3.18 NA 33.71 090 22326 ......... ............ A Treat neck spine fracture ............................. 19.56 NA 12.93 3.85 NA 36.34 090 22327 ......... ............ A Treat thorax spine fracture .......................... 19.17 NA 12.55 3.21 NA 34.93 090 22328 ......... ............ A Treat each add spine fx ............................... 4.60 NA 2.26 0.78 NA 7.64 ZZZ 22505 ......... ............ A Manipulation of spine ................................... 1.87 NA 0.94 0.30 NA 3.11 010 22520 ......... ............ A Percut vertebroplasty thor ........................... 8.90 99.93 5.09 1.43 110.26 15.42 010 22521 ......... ............ A Percut vertebroplasty lumb .......................... 8.33 90.95 4.94 1.34 100.62 14.61 010 22522 ......... ............ A Percut vertebroplasty add-l .......................... 4.30 NA 1.67 0.69 NA 6.66 ZZZ 22532 ......... ............ A Lat thorax spine fusion ................................ 23.96 NA 14.84 3.78 NA 42.58 090 22533 ......... ............ A Lat lumbar spine fusion ............................... 23.09 NA 13.60 2.80 NA 39.49 090 22534 ......... ............ A Lat thor/lumb, add-l seg ............................... 5.99 NA 3.03 1.04 NA 10.06 ZZZ 22548 ......... ............ A Neck spine fusion ........................................ 25.78 NA 15.79 5.15 NA 46.72 090 22554 ......... ............ A Neck spine fusion ........................................ 18.59 NA 12.33 3.73 NA 34.65 090 22556 ......... ............ A Thorax spine fusion ..................................... 23.42 NA 14.72 3.78 NA 41.92 090 22558 ......... ............ A Lumbar spine fusion .................................... 22.25 NA 13.28 2.80 NA 38.33 090 22585 ......... ............ A Additional spinal fusion ................................ 5.52 NA 2.79 1.04 NA 9.35 ZZZ 22590 ......... ............ A Spine & skull spinal fusion .......................... 20.48 NA 13.31 4.31 NA 38.10 090 22595 ......... ............ A Neck spinal fusion ....................................... 19.36 NA 12.82 3.88 NA 36.06 090 22600 ......... ............ A Neck spine fusion ........................................ 16.12 NA 11.18 3.24 NA 30.54 090 22610 ......... ............ A Thorax spine fusion ..................................... 16.00 NA 11.40 2.95 NA 30.35 090 22612 ......... ............ A Lumbar spine fusion .................................... 20.97 NA 14.18 3.55 NA 38.70 090 22614 ......... ............ A Spine fusion, extra segment ........................ 6.43 NA 3.35 1.14 NA 10.92 ZZZ 22630 ......... ............ A Lumbar spine fusion .................................... 20.81 NA 13.59 3.86 NA 38.26 090 22632 ......... ............ A Spine fusion, extra segment ........................ 5.22 NA 2.66 0.98 NA 8.86 ZZZ 22800 ......... ............ A Fusion of spine ............................................ 18.22 NA 12.74 3.04 NA 34.00 090 22802 ......... ............ A Fusion of spine ............................................ 30.83 NA 19.55 5.01 NA 55.39 090 22804 ......... ............ A Fusion of spine ............................................ 36.22 NA 22.65 5.68 NA 64.55 090 22808 ......... ............ A Fusion of spine ............................................ 26.23 NA 16.28 4.55 NA 47.06 090 22810 ......... ............ A Fusion of spine ............................................ 30.22 NA 18.33 4.43 NA 52.98 090 22812 ......... ............ A Fusion of spine ............................................ 32.65 NA 20.03 4.55 NA 57.23 090 22818 ......... ............ A Kyphectomy, 1-2 segments ......................... 31.78 NA 18.85 6.00 NA 56.63 090 22819 ......... ............ A Kyphectomy, 3 or more ............................... 36.39 NA 20.03 5.64 NA 62.06 090 22830 ......... ............ A Exploration of spinal fusion ......................... 10.83 NA 7.95 1.89 NA 20.67 090 22840 ......... ............ A Insert spine fixation device .......................... 12.52 NA 6.48 2.19 NA 21.19 ZZZ 22842 ......... ............ A Insert spine fixation device .......................... 12.56 NA 6.49 2.21 NA 21.26 ZZZ 22843 ......... ............ A Insert spine fixation device .......................... 13.44 NA 6.59 2.37 NA 22.40 ZZZ 22844 ......... ............ A Insert spine fixation device .......................... 16.42 NA 8.73 2.63 NA 27.78 ZZZ 22845 ......... ............ A Insert spine fixation device .......................... 11.94 NA 6.06 2.39 NA 20.39 ZZZ 22846 ......... ............ A Insert spine fixation device .......................... 12.40 NA 6.32 2.47 NA 21.19 ZZZ 22847 ......... ............ A Insert spine fixation device .......................... 13.78 NA 7.01 2.37 NA 23.16 ZZZ 22848 ......... ............ A Insert pelv fixation device ............................ 5.99 NA 3.18 0.96 NA 10.13 ZZZ 22849 ......... ............ A Reinsert spinal fixation ................................ 18.48 NA 11.86 3.14 NA 33.48 090 22850 ......... ............ A Remove spine fixation device ...................... 9.51 NA 7.11 1.61 NA 18.23 090 22851 ......... ............ A Apply spine prosth device ........................... 6.70 NA 3.35 1.23 NA 11.28 ZZZ 22852 ......... ............ A Remove spine fixation device ...................... 9.00 NA 6.90 1.52 NA 17.42 090 22855 ......... ............ A Remove spine fixation device ...................... 15.11 NA 9.79 2.90 NA 27.80 090
22900 ......... ............ A Remove abdominal wall lesion .................... 5.79 NA 3.25 0.74 NA 9.78 090 23000 ......... ............ A Removal of calcium deposits ....................... 4.35 8.62 4.42 0.59 13.56 9.36 090 23020 ......... ............ A Release shoulder joint ................................. 8.92 NA 7.79 1.43 NA 18.14 090
23030 ......... ............ A Drain shoulder lesion ................................... 3.42 7.42 2.90 0.53 11.37 6.85 010
23031 ......... ............ A Drain shoulder bursa ................................... 2.74 7.91 2.72 0.44 11.09 5.90 010
23035 ......... ............ A Drain shoulder bone lesion .......................... 8.60 NA 8.72 1.38 NA 18.70 090 23040 ......... ............ A Exploratory shoulder surgery ....................... 9.19 NA 8.09 1.50 NA 18.78 090 23044 ......... ............ A Exploratory shoulder surgery ....................... 7.11 NA 6.71 1.19 NA 15.01 090 23065 ......... ............ A Biopsy shoulder tissues ............................... 2.27 2.48 1.62 0.24 4.99 4.13 010 23066 ......... ............ A Biopsy shoulder tissues ............................... 4.15 7.70 3.98 0.62 12.47 8.75 090


## 47591

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

23075 ......... ............ A Removal of shoulder lesion ......................... 2.39 3.68 1.78 0.33 6.40 4.50 010 23076 ......... ............ A Removal of shoulder lesion ......................... 7.62 NA 5.86 1.11 NA 14.59 090 23077 ......... ............ A Remove tumor of shoulder .......................... 16.07 NA 10.90 2.27 NA 29.24 090 23100 ......... ............ A Biopsy of shoulder joint ............................... 6.02 NA 5.89 0.96 NA 12.87 090 23101 ......... ............ A Shoulder joint surgery .................................. 5.57 NA 5.58 0.91 NA 12.06 090 23105 ......... ............ A Remove shoulder joint lining ....................... 8.22 NA 7.39 1.32 NA 16.93 090 23106 ......... ............ A Incision of collarbone joint ........................... 5.95 NA 5.94 0.83 NA 12.72 090 23107 ......... ............ A Explore treat shoulder joint .......................... 8.61 NA 7.60 1.40 NA 17.61 090 23120 ......... ............ A Partial removal, collar bone ......................... 7.10 NA 6.69 1.13 NA 14.92 090 23125 ......... ............ A Removal of collar bone ................................ 9.38 NA 7.81 1.45 NA 18.64 090 23130 ......... ............ A Remove shoulder bone, part ....................... 7.54 NA 7.33 1.27 NA 16.14 090 23140 ......... ............ A Removal of bone lesion ............................... 6.88 NA 5.50 0.99 NA 13.37 090 23145 ......... ............ A Removal of bone lesion ............................... 9.08 NA 7.79 1.42 NA 18.29 090 23146 ......... ............ A Removal of bone lesion ............................... 7.82 NA 7.38 1.13 NA 16.33 090 23150 ......... ............ A Removal of humerus lesion ......................... 8.47 NA 7.15 1.24 NA 16.86 090 23155 ......... ............ A Removal of humerus lesion ......................... 10.33 NA 8.68 1.48 NA 20.49 090 23156 ......... ............ A Removal of humerus lesion ......................... 8.67 NA 7.60 1.36 NA 17.63 090 23170 ......... ............ A Remove collar bone lesion .......................... 6.85 NA 6.54 1.10 NA 14.49 090 23172 ......... ............ A Remove shoulder blade lesion .................... 6.89 NA 6.63 0.95 NA 14.47 090 23174 ......... ............ A Remove humerus lesion .............................. 9.50 NA 8.63 1.56 NA 19.69 090 23180 ......... ............ A Remove collar bone lesion .......................... 8.52 NA 9.43 1.47 NA 19.42 090 23182 ......... ............ A Remove shoulder blade lesion .................... 8.14 NA 9.09 1.26 NA 18.49 090 23184 ......... ............ A Remove humerus lesion .............................. 9.37 NA 9.78 1.50 NA 20.65 090 23190 ......... ............ A Partial removal of scapula ........................... 7.23 NA 6.38 1.18 NA 14.79 090 23195 ......... ............ A Removal of head of humerus ...................... 9.80 NA 7.95 1.18 NA 18.93 090 23200 ......... ............ A Removal of collar bone ................................ 12.06 NA 9.14 1.69 NA 22.89 090 23210 ......... ............ A Removal of shoulder blade .......................... 12.47 NA 9.49 2.01 NA 23.97 090 23220 ......... ............ A Partial removal of humerus ......................... 14.54 NA 11.12 2.50 NA 28.16 090 23221 ......... ............ A Partial removal of humerus ......................... 17.71 NA 12.01 2.33 NA 32.05 090 23222 ......... ............ A Partial removal of humerus ......................... 23.88 NA 16.10 3.90 NA 43.88 090 23330 ......... ............ A Remove shoulder foreign body ................... 1.85 3.75 1.88 0.24 5.84 3.97 010 23331 ......... ............ A Remove shoulder foreign body ................... 7.37 NA 7.01 1.14 NA 15.52 090 23332 ......... ............ A Remove shoulder foreign body ................... 11.60 NA 9.53 1.85 NA 22.98 090 23350 ......... ............ A Injection for shoulder x-ray .......................... 1.00 3.52 0.33 0.06 4.58 1.39 000 23395 ......... ............ A Muscle transfer,shoulder/arm ...................... 16.82 NA 12.97 2.56 NA 32.35 090 23397 ......... ............ A Muscle transfers .......................................... 16.11 NA 11.57 2.62 NA 30.30 090 23400 ......... ............ A Fixation of shoulder blade ........................... 13.52 NA 10.38 2.07 NA 25.97 090 23405 ......... ............ A Incision of tendon & muscle ........................ 8.36 NA 7.15 1.29 NA 16.80 090 23406 ......... ............ A Incise tendon(s) & muscle(s) ....................... 10.77 NA 8.60 1.72 NA 21.09 090 23410 ......... ............ A Repair rotator cuff, acute ............................. 12.43 NA 9.61 1.95 NA 23.99 090 23412 ......... ............ A Repair rotator cuff, chronic .......................... 13.29 NA 10.10 2.08 NA 25.47 090 23415 ......... ............ A Release of shoulder ligament ...................... 9.96 NA 8.15 1.70 NA 19.81 090 23420 ......... ............ A Repair of shoulder ....................................... 13.28 NA 11.06 2.10 NA 26.44 090 23430 ......... ............ A Repair biceps tendon ................................... 9.97 NA 8.32 1.57 NA 19.86 090 23440 ......... ............ A Remove/transplant tendon ........................... 10.46 NA 8.49 1.63 NA 20.58 090 23450 ......... ............ A Repair shoulder capsule .............................. 13.38 NA 10.06 2.12 NA 25.56 090 23455 ......... ............ A Repair shoulder capsule .............................. 14.35 NA 10.65 2.26 NA 27.26 090 23460 ......... ............ A Repair shoulder capsule .............................. 15.35 NA 11.58 2.43 NA 29.36 090 23462 ......... ............ A Repair shoulder capsule .............................. 15.28 NA 10.97 2.42 NA 28.67 090 23465 ......... ............ A Repair shoulder capsule .............................. 15.83 NA 11.52 2.51 NA 29.86 090 23466 ......... ............ A Repair shoulder capsule .............................. 14.20 NA 11.53 2.25 NA 27.98 090 23470 ......... ............ A Reconstruct shoulder joint ........................... 17.12 NA 12.23 2.70 NA 32.05 090 23472 ......... ............ A Reconstruct shoulder joint ........................... 21.07 NA 14.38 3.29 NA 38.74 090 23480 ......... ............ A Revision of collar bone ................................ 11.16 NA 8.98 1.89 NA 22.03 090 23485 ......... ............ A Revision of collar bone ................................ 13.41 NA 10.10 2.12 NA 25.63 090 23490 ......... ............ A Reinforce clavicle ......................................... 11.84 NA 9.04 1.44 NA 22.32 090 23491 ......... ............ A Reinforce shoulder bones ............................ 14.19 NA 10.91 2.29 NA 27.39 090 23500 ......... ............ A Treat clavicle fracture .................................. 2.08 2.87 2.54 0.29 5.24 4.91 090 23505 ......... ............ A Treat clavicle fracture .................................. 3.68 4.41 3.85 0.58 8.67 8.11 090 23515 ......... ............ A Treat clavicle fracture .................................. 7.40 NA 6.70 1.16 NA 15.26 090 23520 ......... ............ A Treat clavicle dislocation ............................. 2.16 2.86 2.75 0.32 5.34 5.23 090 23525 ......... ............ A Treat clavicle dislocation ............................. 3.59 4.57 3.96 0.42 8.58 7.97 090 23530 ......... ............ A Treat clavicle dislocation ............................. 7.30 NA 6.12 1.21 NA 14.63 090
23532 ......... ............ A Treat clavicle dislocation ............................. 8.00 NA 7.11 1.17 NA 16.28 090
23540 ......... ............ A Treat clavicle dislocation ............................. 2.23 2.87 2.41 0.27 5.37 4.91 090
23545 ......... ............ A Treat clavicle dislocation ............................. 3.25 4.20 3.39 0.42 7.87 7.06 090
23550 ......... ............ A Treat clavicle dislocation ............................. 7.23 NA 6.55 1.14 NA 14.92 090
23552 ......... ............ A Treat clavicle dislocation ............................. 8.44 NA 7.46 1.27 NA 17.17 090 23570 ......... ............ A Treat shoulder blade fx ................................ 2.23 3.01 2.90 0.35 5.59 5.48 090 23575 ......... ............ A Treat shoulder blade fx ................................ 4.05 4.88 4.32 0.66 9.59 9.03 090 23585 ......... ............ A Treat scapula fracture .................................. 8.95 NA 7.80 1.44 NA 18.19 090 23600 ......... ............ A Treat humerus fracture ................................ 2.93 4.54 3.57 0.46 7.93 6.96 090 23605 ......... ............ A Treat humerus fracture ................................ 4.86 6.14 5.11 0.81 11.81 10.78 090 23615 ......... ............ A Treat humerus fracture ................................ 9.34 NA 8.97 1.51 NA 19.82 090 23616 ......... ............ A Treat humerus fracture ................................ 21.24 NA 14.28 3.37 NA 38.89 090


## 47592

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

23620 ......... ............ A Treat humerus fracture ................................ 2.40 3.61 3.00 0.38 6.39 5.78 090 23625 ......... ............ A Treat humerus fracture ................................ 3.92 4.93 4.28 0.64 9.49 8.84 090 23630 ......... ............ A Treat humerus fracture ................................ 7.34 NA 6.77 1.18 NA 15.29 090 23650 ......... ............ A Treat shoulder dislocation ........................... 3.38 3.80 2.81 0.30 7.48 6.49 090 23655 ......... ............ A Treat shoulder dislocation ........................... 4.56 NA 4.24 0.62 NA 9.42 090 23660 ......... ............ A Treat shoulder dislocation ........................... 7.48 NA 6.53 1.22 NA 15.23 090 23665 ......... ............ A Treat dislocation/fracture ............................. 4.46 5.33 4.72 0.70 10.49 9.88 090 23670 ......... ............ A Treat dislocation/fracture ............................. 7.89 NA 7.00 1.25 NA 16.14 090 23675 ......... ............ A Treat dislocation/fracture ............................. 6.04 6.83 5.82 0.97 13.84 12.83 090 23680 ......... ............ A Treat dislocation/fracture ............................. 10.04 NA 8.27 1.61 NA 19.92 090 23700 ......... ............ A Fixation of shoulder ..................................... 2.52 NA 2.17 0.43 NA 5.12 010 23800 ......... ............ A Fusion of shoulder joint ............................... 14.14 NA 10.68 2.34 NA 27.16 090 23802 ......... ............ A Fusion of shoulder joint ............................... 16.58 NA 10.41 2.45 NA 29.44 090 23900 ......... ............ A Amputation of arm & girdle .......................... 19.69 NA 12.03 3.04 NA 34.76 090 23920 ......... ............ A Amputation at shoulder joint ........................ 14.59 NA 10.26 2.21 NA 27.06 090 23921 ......... ............ A Amputation follow-up surgery ...................... 5.48 NA 5.09 0.90 NA 11.47 090 23930 ......... ............ A Drainage of arm lesion ................................ 2.94 6.36 2.31 0.41 9.71 5.66 010 23931 ......... ............ A Drainage of arm bursa ................................. 1.79 5.93 2.17 0.26 7.98 4.22 010 23935 ......... ............ A Drain arm/elbow bone lesion ....................... 6.08 NA 6.43 0.98 NA 13.49 090 24000 ......... ............ A Exploratory elbow surgery ........................... 5.81 NA 5.50 0.93 NA 12.24 090 24006 ......... ............ A Release elbow joint ..................................... 9.30 NA 7.85 1.48 NA 18.63 090 24065 ......... ............ A Biopsy arm/elbow soft tissue ....................... 2.08 3.22 1.75 0.22 5.52 4.05 010 24066 ......... ............ A Biopsy arm/elbow soft tissue ....................... 5.20 8.95 4.14 0.77 14.92 10.11 090 24075 ......... ............ A Remove arm/elbow lesion ........................... 3.91 7.37 3.41 0.54 11.82 7.86 090 24076 ......... ............ A Remove arm/elbow lesion ........................... 6.29 NA 5.17 0.91 NA 12.37 090 24077 ......... ............ A Remove tumor of arm/elbow ....................... 11.74 NA 8.85 1.67 NA 22.26 090 24100 ......... ............ A Biopsy elbow joint lining .............................. 4.92 NA 4.64 0.78 NA 10.34 090 24101 ......... ............ A Explore/treat elbow joint .............................. 6.12 NA 6.02 1.01 NA 13.15 090 24102 ......... ............ A Remove elbow joint lining ............................ 8.02 NA 6.97 1.27 NA 16.26 090 24105 ......... ............ A Removal of elbow bursa .............................. 3.60 NA 4.50 0.60 NA 8.70 090 24110 ......... ............ A Remove humerus lesion .............................. 7.38 NA 6.93 1.21 NA 15.52 090 24115 ......... ............ A Remove/graft bone lesion ............................ 9.62 NA 7.54 1.36 NA 18.52 090 24116 ......... ............ A Remove/graft bone lesion ............................ 11.79 NA 9.31 2.05 NA 23.15 090
24120 ......... ............ A Remove elbow lesion .................................. 6.64 NA 6.02 1.07 NA 13.73 090 24125 ......... ............ A Remove/graft bone lesion ............................ 7.88 NA 6.27 0.73 NA 14.88 090 24126 ......... ............ A Remove/graft bone lesion ............................ 8.30 NA 7.10 1.13 NA 16.53 090 24130 ......... ............ A Removal of head of radius .......................... 6.24 NA 6.11 1.03 NA 13.38 090 24134 ......... ............ A Removal of arm bone lesion ....................... 9.72 NA 9.38 1.52 NA 20.62 090 24136 ......... ............ A Remove radius bone lesion ......................... 7.98 NA 7.41 1.29 NA 16.68 090 24138 ......... ............ A Remove elbow bone lesion ......................... 8.04 NA 7.86 1.29 NA 17.19 090 24140 ......... ............ A Partial removal of arm bone ........................ 9.17 NA 9.76 1.45 NA 20.38 090 24145 ......... ............ A Partial removal of radius .............................. 7.57 NA 8.27 1.22 NA 17.06 090 24147 ......... ............ A Partial removal of elbow .............................. 7.53 NA 8.80 1.26 NA 17.59 090 24149 ......... ............ A Radical resection of elbow .......................... 14.18 NA 11.65 2.23 NA 28.06 090 24150 ......... ............ A Extensive humerus surgery ......................... 13.25 NA 10.35 2.15 NA 25.75 090 24151 ......... ............ A Extensive humerus surgery ......................... 15.56 NA 11.94 1.27 NA 28.77 090 24152 ......... ............ A Extensive radius surgery ............................. 10.04 NA 7.99 1.01 NA 19.04 090 24153 ......... ............ A Extensive radius surgery ............................. 11.52 NA 5.74 0.70 NA 17.96 090 24155 ......... ............ A Removal of elbow joint ................................ 11.71 NA 8.51 1.82 NA 22.04 090 24160 ......... ............ A Remove elbow joint implant ........................ 7.82 NA 6.88 1.26 NA 15.96 090 24164 ......... ............ A Remove radius head implant ....................... 6.22 NA 5.76 1.01 NA 12.99 090 24200 ......... ............ A Removal of arm foreign body ...................... 1.76 3.45 1.63 0.19 5.40 3.58 010 24201 ......... ............ A Removal of arm foreign body ...................... 4.55 9.85 4.23 0.68 15.08 9.46 090 24220 ......... ............ A Injection for elbow x-ray .............................. 1.31 3.71 0.44 0.08 5.10 1.83 000 24300 ......... ............ A Manipulate elbow w/anesth ......................... 3.74 NA 5.62 0.63 NA 9.99 090 24301 ......... ............ A Muscle/tendon transfer ................................ 10.18 NA 8.32 1.64 NA 20.14 090 24305 ......... ............ A Arm tendon lengthening .............................. 7.44 NA 6.83 1.13 NA 15.40 090 24310 ......... ............ A Revision of arm tendon ............................... 5.97 NA 5.91 0.91 NA 12.79 090 24320 ......... ............ A Repair of arm tendon ................................... 10.54 NA 7.93 1.72 NA 20.19 090 24330 ......... ............ A Revision of arm muscles ............................. 9.59 NA 8.02 1.51 NA 19.12 090 24331 ......... ............ A Revision of arm muscles ............................. 10.63 NA 8.75 1.33 NA 20.71 090 24332 ......... ............ A Tenolysis, triceps ......................................... 7.44 NA 6.70 1.19 NA 15.33 090 24340 ......... ............ A Repair of biceps tendon .............................. 7.88 NA 7.07 1.27 NA 16.22 090 24341 ......... ............ A Repair arm tendon/muscle .......................... 7.89 NA 7.97 1.26 NA 17.12 090 24342 ......... ............ A Repair of ruptured tendon ........................... 10.60 NA 8.61 1.69 NA 20.90 090 24343 ......... ............ A Repr elbow lat ligmnt w/tiss ......................... 8.64 NA 8.07 1.39 NA 18.10 090 24344 ......... ............ A Reconstruct elbow lat ligmnt ....................... 13.98 NA 11.43 2.25 NA 27.66 090 24345 ......... ............ A Repr elbw med ligmnt w/tissu ..................... 8.64 NA 7.95 1.40 NA 17.99 090 24346 ......... ............ A Reconstruct elbow med ligmnt .................... 13.98 NA 11.25 2.04 NA 27.27 090 24350 ......... ............ A Repair of tennis elbow ................................. 5.24 NA 5.68 0.86 NA 11.78 090 24351 ......... ............ A Repair of tennis elbow ................................. 5.90 NA 6.02 0.98 NA 12.90 090 24352 ......... ............ A Repair of tennis elbow ................................. 6.42 NA 6.28 1.09 NA 13.79 090 24354 ......... ............ A Repair of tennis elbow ................................. 6.47 NA 6.24 1.11 NA 13.82 090 24356 ......... ............ A Revision of tennis elbow .............................. 6.67 NA 6.42 1.08 NA 14.17 090 24360 ......... ............ A Reconstruct elbow joint ............................... 12.32 NA 9.46 1.92 NA 23.70 090


## 47593

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

24361 ......... ............ A Reconstruct elbow joint ............................... 14.06 NA 10.56 2.10 NA 26.72 090 24362 ......... ............ A Reconstruct elbow joint ............................... 14.97 NA 10.04 2.30 NA 27.31 090 24363 ......... ............ A Replace elbow joint ..................................... 18.46 NA 13.69 2.84 NA 34.99 090 24365 ......... ............ A Reconstruct head of radius ......................... 8.38 NA 7.19 1.39 NA 16.96 090 24366 ......... ............ A Reconstruct head of radius ......................... 9.12 NA 7.53 1.47 NA 18.12 090 24400 ......... ............ A Revision of humerus .................................... 11.04 NA 9.14 1.82 NA 22.00 090 24410 ......... ............ A Revision of humerus .................................... 14.80 NA 10.60 2.57 NA 27.97 090 24420 ......... ............ A Revision of humerus .................................... 13.42 NA 10.90 2.07 NA 26.39 090 24430 ......... ............ A Repair of humerus ....................................... 12.79 NA 9.97 2.04 NA 24.80 090 24435 ......... ............ A Repair humerus with graft ........................... 13.15 NA 11.12 2.10 NA 26.37 090 24470 ......... ............ A Revision of elbow joint ................................. 8.73 NA 7.80 0.77 NA 17.30 090 24495 ......... ............ A Decompression of forearm .......................... 8.11 NA 8.94 1.18 NA 18.23 090 24498 ......... ............ A Reinforce humerus ...................................... 11.90 NA 9.50 1.93 NA 23.33 090 24500 ......... ............ A Treat humerus fracture ................................ 3.21 4.86 3.71 0.48 8.55 7.40 090 24505 ......... ............ A Treat humerus fracture ................................ 5.16 6.59 5.39 0.86 12.61 11.41 090 24515 ......... ............ A Treat humerus fracture ................................ 11.63 NA 9.55 1.88 NA 23.06 090 24516 ......... ............ A Treat humerus fracture ................................ 11.63 NA 9.31 1.88 NA 22.82 090 24530 ......... ............ A Treat humerus fracture ................................ 3.49 5.20 4.05 0.55 9.24 8.09 090 24535 ......... ............ A Treat humerus fracture ................................ 6.86 7.83 6.62 1.16 15.85 14.64 090 24538 ......... ............ A Treat humerus fracture ................................ 9.42 NA 8.89 1.51 NA 19.82 090 24545 ......... ............ A Treat humerus fracture ................................ 10.44 NA 8.60 1.70 NA 20.74 090 24546 ......... ............ A Treat humerus fracture ................................ 15.67 NA 11.50 2.52 NA 29.69 090 24560 ......... ............ A Treat humerus fracture ................................ 2.80 4.49 3.22 0.39 7.68 6.41 090 24565 ......... ............ A Treat humerus fracture ................................ 5.55 6.62 5.52 0.94 13.11 12.01 090 24566 ......... ............ A Treat humerus fracture ................................ 7.78 NA 8.34 1.33 NA 17.45 090 24575 ......... ............ A Treat humerus fracture ................................ 10.64 NA 8.44 1.70 NA 20.78 090 24576 ......... ............ A Treat humerus fracture ................................ 2.86 4.77 3.73 0.42 8.05 7.01 090 24577 ......... ............ A Treat humerus fracture ................................ 5.78 6.92 5.83 0.97 13.67 12.58 090 24579 ......... ............ A Treat humerus fracture ................................ 11.58 NA 9.02 1.89 NA 22.49 090 24582 ......... ............ A Treat humerus fracture ................................ 8.54 NA 9.26 1.48 NA 19.28 090 24586 ......... ............ A Treat elbow fracture ..................................... 15.19 NA 11.26 2.45 NA 28.90 090 24587 ......... ............ A Treat elbow fracture ..................................... 15.14 NA 11.05 2.23 NA 28.42 090 24600 ......... ............ A Treat elbow dislocation ................................ 4.22 4.86 3.53 0.47 9.55 8.22 090 24605 ......... ............ A Treat elbow dislocation ................................ 5.41 NA 5.41 0.87 NA 11.69 090 24615 ......... ............ A Treat elbow dislocation ................................ 9.41 NA 7.87 1.53 NA 18.81 090 24620 ......... ............ A Treat elbow fracture ..................................... 6.97 NA 6.27 1.07 NA 14.31 090 24635 ......... ............ A Treat elbow fracture ..................................... 13.17 NA 14.21 2.17 NA 29.55 090 24640 ......... ............ A Treat elbow dislocation ................................ 1.20 1.85 0.81 0.13 3.18 2.14 010 24650 ......... ............ A Treat radius fracture .................................... 2.16 3.79 2.78 0.33 6.28 5.27 090 24655 ......... ............ A Treat radius fracture .................................... 4.39 5.95 4.80 0.70 11.04 9.89 090 24665 ......... ............ A Treat radius fracture .................................... 8.13 NA 7.69 1.35 NA 17.17 090 24666 ......... ............ A Treat radius fracture .................................... 9.48 NA 8.25 1.55 NA 19.28 090 24670 ......... ............ A Treat ulnar fracture ...................................... 2.54 4.11 3.09 0.38 7.03 6.01 090 24675 ......... ............ A Treat ulnar fracture ...................................... 4.71 6.00 4.97 0.77 11.48 10.45 090 24685 ......... ............ A Treat ulnar fracture ...................................... 8.79 NA 7.72 1.43 NA 17.94 090 24800 ......... ............ A Fusion of elbow joint .................................... 11.18 NA 8.87 1.63 NA 21.68 090 24802 ......... ............ A Fusion/graft of elbow joint ........................... 13.67 NA 10.49 2.16 NA 26.32 090 24900 ......... ............ A Amputation of upper arm ............................. 9.59 NA 7.49 1.44 NA 18.52 090 24920 ......... ............ A Amputation of upper arm ............................. 9.53 NA 7.71 1.48 NA 18.72 090 24925 ......... ............ A Amputation follow-up surgery ...................... 7.06 NA 6.44 1.12 NA 14.62 090 24930 ......... ............ A Amputation follow-up surgery ...................... 10.23 NA 7.66 1.53 NA 19.42 090 24931 ......... ............ A Amputate upper arm & implant ................... 12.70 NA 6.10 1.88 NA 20.68 090 24935 ......... ............ A Revision of amputation ................................ 15.54 NA 8.40 2.05 NA 25.99 090 25000 ......... ............ A Incision of tendon sheath ............................ 3.37 NA 6.96 0.53 NA 10.86 090 25001 ......... ............ A Incise flexor carpi radialis ............................ 3.37 NA 4.16 0.52 NA 8.05 090 25020 ......... ............ A Decompress forearm 1 space ..................... 5.91 NA 9.84 0.95 NA 16.70 090 25023 ......... ............ A Decompress forearm 1 space ..................... 12.94 NA 15.33 1.91 NA 30.18 090 25024 ......... ............ A Decompress forearm 2 spaces ................... 9.49 NA 7.51 1.10 NA 18.10 090 25025 ......... ............ A Decompress forearm 2 spaces ................... 16.52 NA 9.99 1.79 NA 28.30 090 25028 ......... ............ A Drainage of forearm lesion .......................... 5.24 NA 8.40 0.78 NA 14.42 090 25031 ......... ............ A Drainage of forearm bursa .......................... 4.13 NA 8.21 0.63 NA 12.97 090 25035 ......... ............ A Treat forearm bone lesion ........................... 7.35 NA 13.88 1.21 NA 22.44 090 25040 ......... ............ A Explore/treat wrist joint ................................ 7.17 NA 7.40 1.15 NA 15.72 090 25065 ......... ............ A Biopsy forearm soft tissues ......................... 1.99 3.23 1.90 0.20 5.42 4.09 010 25066 ......... ............ A Biopsy forearm soft tissues ......................... 4.12 NA 7.18 0.62 NA 11.92 090 25075 ......... ............ A Removel forearm lesion subcu .................... 3.73 NA 6.06 0.52 NA 10.31 090 25076 ......... ............ A Removel forearm lesion deep ..................... 4.91 NA 9.83 0.74 NA 15.48 090 25077 ......... ............ A Remove tumor, forearm/wrist ...................... 9.75 NA 12.53 1.38 NA 23.66 090 25085 ......... ............ A Incision of wrist capsule .............................. 5.49 NA 7.40 0.84 NA 13.73 090 25100 ......... ............ A Biopsy of wrist joint ...................................... 3.89 NA 5.49 0.58 NA 9.96 090 25101 ......... ............ A Explore/treat wrist joint ................................ 4.68 NA 6.06 0.51 NA 11.25 090 25105 ......... ............ A Remove wrist joint lining .............................. 5.84 NA 7.58 0.91 NA 14.33 090 25107 ......... ............ A Remove wrist joint cartilage ........................ 6.42 NA 8.54 0.97 NA 15.93 090
25110 ......... ............ A Remove wrist tendon lesion ........................ 3.91 NA 7.20 0.60 NA 11.71 090
25111 ......... ............ A Remove wrist tendon lesion ........................ 3.38 NA 4.89 0.52 NA 8.79 090


## 47594

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

25112 ......... ............ A Reremove wrist tendon lesion ..................... 4.52 NA 5.49 0.70 NA 10.71 090 25115 ......... ............ A Remove wrist/forearm lesion ....................... 8.81 NA 14.32 1.31 NA 24.44 090 25116 ......... ............ A Remove wrist/forearm lesion ....................... 7.10 NA 13.40 1.08 NA 21.58 090
25118 ......... ............ A Excise wrist tendon sheath .......................... 4.36 NA 5.97 0.68 NA 11.01 090 25119 ......... ............ A Partial removal of ulna ................................. 6.03 NA 7.86 0.90 NA 14.79 090 25120 ......... ............ A Removal of forearm lesion .......................... 6.09 NA 12.28 0.99 NA 19.36 090 25125 ......... ............ A Remove/graft forearm lesion ....................... 7.47 NA 13.08 1.14 NA 21.69 090 25126 ......... ............ A Remove/graft forearm lesion ....................... 7.54 NA 13.15 1.16 NA 21.85 090 25130 ......... ............ A Removal of wrist lesion ............................... 5.25 NA 6.61 0.81 NA 12.67 090 25135 ......... ............ A Remove & graft wrist lesion ........................ 6.88 NA 7.64 0.93 NA 15.45 090 25136 ......... ............ A Remove & graft wrist lesion ........................ 5.96 NA 6.77 0.89 NA 13.62 090 25145 ......... ............ A Remove forearm bone lesion ...................... 6.36 NA 12.33 0.91 NA 19.60 090 25150 ......... ............ A Partial removal of ulna ................................. 7.08 NA 8.50 1.11 NA 16.69 090 25151 ......... ............ A Partial removal of radius .............................. 7.38 NA 12.93 1.12 NA 21.43 090 25170 ......... ............ A Extensive forearm surgery ........................... 11.07 NA 15.29 1.69 NA 28.05 090 25210 ......... ............ A Removal of wrist bone ................................. 5.94 NA 7.00 0.87 NA 13.81 090 25215 ......... ............ A Removal of wrist bones ............................... 7.88 NA 9.00 1.20 NA 18.08 090 25230 ......... ............ A Partial removal of radius .............................. 5.22 NA 6.31 0.78 NA 12.31 090 25240 ......... ............ A Partial removal of ulna ................................. 5.16 NA 7.18 0.80 NA 13.14 090 25246 ......... ............ A Injection for wrist x-ray ................................ 1.45 3.48 0.48 0.09 5.02 2.02 000 25248 ......... ............ A Remove forearm foreign body ..................... 5.13 NA 8.64 0.70 NA 14.47 090 25250 ......... ............ A Removal of wrist prosthesis ........................ 6.59 NA 6.09 0.95 NA 13.63 090 25251 ......... ............ A Removal of wrist prosthesis ........................ 9.56 NA 7.91 1.27 NA 18.74 090 25259 ......... ............ A Manipulate wrist w/anesthes ....................... 3.74 NA 5.62 0.62 NA 9.98 090 25260 ......... ............ A Repair forearm tendon/muscle .................... 7.79 NA 13.77 1.17 NA 22.73 090 25263 ......... ............ A Repair forearm tendon/muscle .................... 7.81 NA 13.67 1.11 NA 22.59 090 25265 ......... ............ A Repair forearm tendon/muscle .................... 9.87 NA 14.56 1.36 NA 25.79 090 25270 ......... ............ A Repair forearm tendon/muscle .................... 5.99 NA 12.45 0.92 NA 19.36 090 25272 ......... ............ A Repair forearm tendon/muscle .................... 7.03 NA 13.15 1.10 NA 21.28 090 25274 ......... ............ A Repair forearm tendon/muscle .................... 8.74 NA 13.88 1.28 NA 23.90 090 25275 ......... ............ A Repair forearm tendon sheath ..................... 8.49 NA 7.49 1.19 NA 17.17 090 25280 ......... ............ A Revise wrist/forearm tendon ........................ 7.21 NA 12.88 1.07 NA 21.16 090 25290 ......... ............ A Incise wrist/forearm tendon ......................... 5.28 NA 15.12 0.81 NA 21.21 090 25295 ......... ............ A Release wrist/forearm tendon ...................... 6.54 NA 12.45 0.95 NA 19.94 090 25300 ......... ............ A Fusion of tendons at wrist ........................... 8.79 NA 8.61 1.15 NA 18.55 090 25301 ......... ............ A Fusion of tendons at wrist ........................... 8.39 NA 8.26 1.24 NA 17.89 090 25310 ......... ............ A Transplant forearm tendon .......................... 8.13 NA 13.29 1.17 NA 22.59 090 25312 ......... ............ A Transplant forearm tendon .......................... 9.56 NA 14.17 1.37 NA 25.10 090 25315 ......... ............ A Revise palsy hand tendon(s) ....................... 10.18 NA 14.74 1.52 NA 26.44 090 25316 ......... ............ A Revise palsy hand tendon(s) ....................... 12.31 NA 16.51 2.07 NA 30.89 090 25320 ......... ............ A Repair/revise wrist joint ............................... 10.75 NA 11.40 1.58 NA 23.73 090 25332 ......... ............ A Revise wrist joint .......................................... 11.39 NA 9.15 1.72 NA 22.26 090 25335 ......... ............ A Realignment of hand ................................... 12.86 NA 11.80 2.00 NA 26.66 090 25337 ......... ............ A Reconstruct ulna/radioulnar ......................... 10.15 NA 11.24 1.57 NA 22.96 090 25350 ......... ............ A Revision of radius ........................................ 8.77 NA 14.12 1.36 NA 24.25 090 25355 ......... ............ A Revision of radius ........................................ 10.15 NA 14.74 1.39 NA 26.28 090 25360 ......... ............ A Revision of ulna ........................................... 8.42 NA 14.01 1.36 NA 23.79 090 25365 ......... ............ A Revise radius & ulna ................................... 12.38 NA 15.77 2.03 NA 30.18 090 25370 ......... ............ A Revise radius or ulna ................................... 13.34 NA 16.19 2.27 NA 31.80 090 25375 ......... ............ A Revise radius & ulna ................................... 13.02 NA 16.55 2.22 NA 31.79 090 25390 ......... ............ A Shorten radius or ulna ................................. 10.38 NA 14.74 1.55 NA 26.67 090 25391 ......... ............ A Lengthen radius or ulna ............................... 13.63 NA 16.70 2.17 NA 32.50 090 25392 ......... ............ A Shorten radius & ulna .................................. 13.93 NA 16.09 2.15 NA 32.17 090 25393 ......... ............ A Lengthen radius & ulna ............................... 15.85 NA 17.71 2.76 NA 36.32 090 25394 ......... ............ A Repair carpal bone, shorten ........................ 10.38 NA 8.05 1.31 NA 19.74 090 25400 ......... ............ A Repair radius or ulna ................................... 10.90 NA 15.32 1.73 NA 27.95 090 25405 ......... ............ A Repair/graft radius or ulna ........................... 14.36 NA 17.42 2.27 NA 34.05 090 25415 ......... ............ A Repair radius & ulna .................................... 13.33 NA 16.64 2.07 NA 32.04 090 25420 ......... ............ A Repair/graft radius & ulna ............................ 16.31 NA 18.41 2.58 NA 37.30 090 25425 ......... ............ A Repair/graft radius or ulna ........................... 13.19 NA 21.64 1.91 NA 36.74 090 25426 ......... ............ A Repair/graft radius & ulna ............................ 15.80 NA 16.70 1.39 NA 33.89 090 25430 ......... ............ A Vasc graft into carpal bone ......................... 9.24 NA 7.21 1.25 NA 17.70 090 25431 ......... ............ A Repair nonunion carpal bone ...................... 10.42 NA 8.33 1.69 NA 20.44 090 25440 ......... ............ A Repair/graft wrist bone ................................ 10.42 NA 9.51 1.50 NA 21.43 090 25441 ......... ............ A Reconstruct wrist joint ................................. 12.88 NA 9.98 2.06 NA 24.92 090 25442 ......... ............ A Reconstruct wrist joint ................................. 10.83 NA 8.86 1.51 NA 21.20 090 25443 ......... ............ A Reconstruct wrist joint ................................. 10.37 NA 8.75 1.66 NA 20.78 090 25444 ......... ............ A Reconstruct wrist joint ................................. 11.13 NA 9.01 1.53 NA 21.67 090 25445 ......... ............ A Reconstruct wrist joint ................................. 9.68 NA 7.97 1.52 NA 19.17 090 25446 ......... ............ A Wrist replacement ........................................ 16.53 NA 11.90 2.43 NA 30.86 090 25447 ......... ............ A Repair wrist joint(s) ...................................... 10.35 NA 8.63 1.53 NA 20.51 090 25449 ......... ............ A Remove wrist joint implant .......................... 14.47 NA 10.64 2.08 NA 27.19 090 25450 ......... ............ A Revision of wrist joint ................................... 7.86 NA 10.31 1.22 NA 19.39 090 25455 ......... ............ A Revision of wrist joint ................................... 9.48 NA 11.25 1.21 NA 21.94 090 25490 ......... ............ A Reinforce radius ........................................... 9.53 NA 13.89 1.38 NA 24.80 090


## 47595

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

25491 ......... ............ A Reinforce ulna .............................................. 9.95 NA 14.66 1.52 NA 26.13 090 25492 ......... ............ A Reinforce radius and ulna ........................... 12.31 NA 15.43 2.14 NA 29.88 090 25500 ......... ............ A Treat fracture of radius ................................ 2.45 3.59 2.74 0.33 6.37 5.52 090 25505 ......... ............ A Treat fracture of radius ................................ 5.20 6.54 5.43 0.82 12.56 11.45 090 25515 ......... ............ A Treat fracture of radius ................................ 9.17 NA 7.65 1.47 NA 18.29 090 25520 ......... ............ A Treat fracture of radius ................................ 6.25 6.86 6.06 1.02 14.13 13.33 090 25525 ......... ............ A Treat fracture of radius ................................ 12.22 NA 10.16 1.97 NA 24.35 090 25526 ......... ............ A Treat fracture of radius ................................ 12.96 NA 13.63 2.04 NA 28.63 090 25530 ......... ............ A Treat fracture of ulna ................................... 2.09 3.77 2.88 0.32 6.18 5.29 090 25535 ......... ............ A Treat fracture of ulna ................................... 5.13 6.02 5.29 0.83 11.98 11.25 090 25545 ......... ............ A Treat fracture of ulna ................................... 8.89 NA 7.85 1.43 NA 18.17 090 25560 ......... ............ A Treat fracture radius & ulna ......................... 2.44 3.71 2.64 0.33 6.48 5.41 090 25565 ......... ............ A Treat fracture radius & ulna ......................... 5.62 6.70 5.43 0.90 13.22 11.95 090 25574 ......... ............ A Treat fracture radius & ulna ......................... 7.00 NA 7.37 1.14 NA 15.51 090 25575 ......... ............ A Treat fracture radius/ulna ............................ 10.43 NA 9.66 1.67 NA 21.76 090 25600 ......... ............ A Treat fracture radius/ulna ............................ 2.63 4.09 2.99 0.39 7.11 6.01 090 25605 ......... ............ A Treat fracture radius/ulna ............................ 5.80 7.22 6.21 0.96 13.98 12.97 090 25611 ......... ............ A Treat fracture radius/ulna ............................ 7.76 NA 9.11 1.32 NA 18.19 090 25620 ......... ............ A Treat fracture radius/ulna ............................ 8.54 NA 7.47 1.35 NA 17.36 090 25622 ......... ............ A Treat wrist bone fracture ............................. 2.61 4.27 3.13 0.39 7.27 6.13 090 25624 ......... ............ A Treat wrist bone fracture ............................. 4.52 6.30 5.08 0.72 11.54 10.32 090 25628 ......... ............ A Treat wrist bone fracture ............................. 8.42 NA 8.04 1.30 NA 17.76 090 25630 ......... ............ A Treat wrist bone fracture ............................. 2.88 4.19 2.97 0.43 7.50 6.28 090 25635 ......... ............ A Treat wrist bone fracture ............................. 4.38 5.94 3.93 0.65 10.97 8.96 090 25645 ......... ............ A Treat wrist bone fracture ............................. 7.24 NA 6.99 1.12 NA 15.35 090 25650 ......... ............ A Treat wrist bone fracture ............................. 3.05 4.31 3.21 0.41 7.77 6.67 090 25651 ......... ............ A Pin ulnar styloid fracture .............................. 5.35 NA 5.42 0.73 NA 11.50 090 25652 ......... ............ A Treat fracture ulnar styloid ........................... 7.59 NA 6.94 1.19 NA 15.72 090 25660 ......... ............ A Treat wrist dislocation .................................. 4.75 NA 4.76 0.64 NA 10.15 090 25670 ......... ............ A Treat wrist dislocation .................................. 7.91 NA 7.27 1.23 NA 16.41 090 25671 ......... ............ A Pin radioulnar dislocation ............................ 5.99 NA 6.07 0.93 NA 12.99 090 25675 ......... ............ A Treat wrist dislocation .................................. 4.66 5.67 4.67 0.61 10.94 9.94 090 25676 ......... ............ A Treat wrist dislocation .................................. 8.03 NA 7.53 1.34 NA 16.90 090 25680 ......... ............ A Treat wrist fracture ....................................... 5.98 NA 4.85 0.73 NA 11.56 090 25685 ......... ............ A Treat wrist fracture ....................................... 9.77 NA 8.05 1.53 NA 19.35 090 25690 ......... ............ A Treat wrist dislocation .................................. 5.49 NA 5.57 0.89 NA 11.95 090 25695 ......... ............ A Treat wrist dislocation .................................. 8.33 NA 7.38 1.32 NA 17.03 090 25800 ......... ............ A Fusion of wrist joint ...................................... 9.75 NA 9.20 1.31 NA 20.26 090 25805 ......... ............ A Fusion/graft of wrist joint ............................. 11.26 NA 10.35 1.79 NA 23.40 090 25810 ......... ............ A Fusion/graft of wrist joint ............................. 10.55 NA 10.01 1.60 NA 22.16 090 25820 ......... ............ A Fusion of hand bones .................................. 7.44 NA 7.99 1.11 NA 16.54 090 25825 ......... ............ A Fuse hand bones with graft ......................... 9.26 NA 9.34 1.34 NA 19.94 090 25830 ......... ............ A Fusion, radioulnar jnt/ulna ........................... 10.04 NA 14.57 1.39 NA 26.00 090 25900 ......... ............ A Amputation of forearm ................................. 9.00 NA 12.73 1.36 NA 23.09 090 25905 ......... ............ A Amputation of forearm ................................. 9.11 NA 12.65 1.28 NA 23.04 090 25907 ......... ............ A Amputation follow-up surgery ...................... 7.79 NA 12.07 1.20 NA 21.06 090 25909 ......... ............ A Amputation follow-up surgery ...................... 8.95 NA 12.60 1.21 NA 22.76 090 25915 ......... ............ A Amputation of forearm ................................. 17.05 NA 19.33 1.13 NA 37.51 090 25920 ......... ............ A Amputate hand at wrist ................................ 8.67 NA 8.07 1.33 NA 18.07 090 25922 ......... ............ A Amputate hand at wrist ................................ 7.41 NA 7.30 1.29 NA 16.00 090 25924 ......... ............ A Amputation follow-up surgery ...................... 8.45 NA 8.31 1.47 NA 18.23 090 25927 ......... ............ A Amputation of hand ..................................... 8.79 NA 12.00 1.34 NA 22.13 090 25929 ......... ............ A Amputation follow-up surgery ...................... 7.58 NA 6.15 1.27 NA 15.00 090 25931 ......... ............ A Amputation follow-up surgery ...................... 7.80 NA 11.93 1.04 NA 20.77 090 26010 ......... ............ A Drainage of finger abscess .......................... 1.54 5.60 1.64 0.17 7.31 3.35 010 26011 ......... ............ A Drainage of finger abscess .......................... 2.19 8.81 2.32 0.32 11.32 4.83 010 26020 ......... ............ A Drain hand tendon sheath ........................... 4.66 NA 5.73 0.72 NA 11.11 090 26025 ......... ............ A Drainage of palm bursa ............................... 4.81 NA 5.52 0.74 NA 11.07 090 26030 ......... ............ A Drainage of palm bursa(s) ........................... 5.92 NA 6.16 0.92 NA 13.00 090
26034 ......... ............ A Treat hand bone lesion ................................ 6.22 NA 6.34 0.97 NA 13.53 090 26035 ......... ............ A Decompress fingers/hand ............................ 9.50 NA 8.28 1.40 NA 19.18 090 26037 ......... ............ A Decompress fingers/hand ............................ 7.24 NA 6.74 1.09 NA 15.07 090 26040 ......... ............ A Release palm contracture ............................ 3.33 NA 4.04 0.54 NA 7.91 090 26045 ......... ............ A Release palm contracture ............................ 5.55 NA 5.63 0.93 NA 12.11 090 26055 ......... ............ A Incise finger tendon sheath ......................... 2.69 14.17 3.93 0.43 17.29 7.05 090 26060 ......... ............ A Incision of finger tendon .............................. 2.81 NA 3.50 0.44 NA 6.75 090 26070 ......... ............ A Explore/treat hand joint ................................ 3.68 NA 3.38 0.47 NA 7.53 090 26075 ......... ............ A Explore/treat finger joint ............................... 3.78 NA 3.79 0.52 NA 8.09 090 26080 ......... ............ A Explore/treat finger joint ............................... 4.23 NA 4.85 0.65 NA 9.73 090 26100 ......... ............ A Biopsy hand joint lining ................................ 3.66 NA 4.13 0.54 NA 8.33 090 26105 ......... ............ A Biopsy finger joint lining ............................... 3.70 NA 4.22 0.58 NA 8.50 090 26110 ......... ............ A Biopsy finger joint lining ............................... 3.52 NA 4.03 0.53 NA 8.08 090
26115 ......... ............ A Removel hand lesion subcut ....................... 3.85 13.01 4.76 0.59 17.45 9.20 090 26116 ......... ............ A Removel hand lesion, deep ......................... 5.52 NA 5.99 0.82 NA 12.33 090 26117 ......... ............ A Remove tumor, hand/finger ......................... 8.54 NA 7.05 1.24 NA 16.83 090


## 47596

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

26121 ......... ............ A Release palm contracture ............................ 7.53 NA 6.95 1.17 NA 15.65 090 26123 ......... ............ A Release palm contracture ............................ 9.28 NA 8.85 1.42 NA 19.55 090 26125 ......... ............ A Release palm contracture ............................ 4.60 NA 2.44 0.70 NA 7.74 ZZZ 26130 ......... ............ A Remove wrist joint lining .............................. 5.41 NA 5.33 0.97 NA 11.71 090 26135 ......... ............ A Revise finger joint, each .............................. 6.95 NA 6.45 1.01 NA 14.41 090 26140 ......... ............ A Revise finger joint, each .............................. 6.16 NA 6.03 0.92 NA 13.11 090 26145 ......... ............ A Tendon excision, palm/finger ....................... 6.31 NA 6.04 0.98 NA 13.33 090
26160 ......... ............ A Remove tendon sheath lesion ..................... 3.15 12.36 4.12 0.48 15.99 7.75 090 26170 ......... ............ A Removal of palm tendon, each ................... 4.76 NA 4.93 0.71 NA 10.40 090 26180 ......... ............ A Removal of finger tendon ............................ 5.17 NA 5.40 0.81 NA 11.38 090 26185 ......... ............ A Remove finger bone .................................... 5.24 NA 6.02 0.72 NA 11.98 090 26200 ......... ............ A Remove hand bone lesion ........................... 5.50 NA 5.35 0.87 NA 11.72 090 26205 ......... ............ A Remove/graft bone lesion ............................ 7.69 NA 6.88 1.20 NA 15.77 090 26210 ......... ............ A Removal of finger lesion .............................. 5.14 NA 5.41 0.79 NA 11.34 090 26215 ......... ............ A Remove/graft finger lesion ........................... 7.09 NA 6.30 1.10 NA 14.49 090 26230 ......... ............ A Partial removal of hand bone ...................... 6.32 NA 5.90 0.95 NA 13.17 090 26235 ......... ............ A Partial removal, finger bone ........................ 6.18 NA 5.80 0.93 NA 12.91 090 26236 ......... ............ A Partial removal, finger bone ........................ 5.31 NA 5.32 0.80 NA 11.43 090 26250 ......... ............ A Extensive hand surgery ............................... 7.54 NA 6.42 1.21 NA 15.17 090 26255 ......... ............ A Extensive hand surgery ............................... 12.41 NA 9.38 1.47 NA 23.26 090 26260 ......... ............ A Extensive finger surgery .............................. 7.02 NA 6.17 1.05 NA 14.24 090 26261 ......... ............ A Extensive finger surgery .............................. 9.08 NA 6.20 1.29 NA 16.57 090 26262 ......... ............ A Partial removal of finger .............................. 5.66 NA 5.32 0.85 NA 11.83 090 26320 ......... ............ A Removal of implant from hand .................... 3.97 NA 4.31 0.59 NA 8.87 090 26340 ......... ............ A Manipulate finger w/anesth .......................... 2.50 NA 4.87 0.39 NA 7.76 090 26350 ......... ............ A Repair finger/hand tendon ........................... 5.98 NA 15.28 0.85 NA 22.11 090 26352 ......... ............ A Repair/graft hand tendon ............................. 7.67 NA 15.84 1.19 NA 24.70 090 26356 ......... ............ A Repair finger/hand tendon ........................... 8.06 NA 18.75 1.22 NA 28.03 090 26357 ......... ............ A Repair finger/hand tendon ........................... 8.57 NA 16.30 1.33 NA 26.20 090 26358 ......... ............ A Repair/graft hand tendon ............................. 9.13 NA 17.19 1.34 NA 27.66 090 26370 ......... ............ A Repair finger/hand tendon ........................... 7.10 NA 15.70 1.09 NA 23.89 090 26372 ......... ............ A Repair/graft hand tendon ............................. 8.75 NA 17.07 1.27 NA 27.09 090 26373 ......... ............ A Repair finger/hand tendon ........................... 8.15 NA 16.64 1.30 NA 26.09 090 26390 ......... ............ A Revise hand/finger tendon ........................... 9.18 NA 13.77 1.35 NA 24.30 090 26392 ......... ............ A Repair/graft hand tendon ............................. 10.24 NA 17.43 1.49 NA 29.16 090 26410 ......... ............ A Repair hand tendon ..................................... 4.62 NA 12.40 0.72 NA 17.74 090 26412 ......... ............ A Repair/graft hand tendon ............................. 6.30 NA 13.72 0.98 NA 21.00 090 26415 ......... ............ A Excision, hand/finger tendon ....................... 8.33 NA 12.22 1.06 NA 21.61 090 26416 ......... ............ A Graft hand or finger tendon ......................... 9.36 NA 15.03 1.18 NA 25.57 090 26418 ......... ............ A Repair finger tendon .................................... 4.24 NA 12.78 0.65 NA 17.67 090 26420 ......... ............ A Repair/graft finger tendon ............................ 6.76 NA 14.05 1.05 NA 21.86 090 26426 ......... ............ A Repair finger/hand tendon ........................... 6.14 NA 13.57 0.96 NA 20.67 090 26428 ......... ............ A Repair/graft finger tendon ............................ 7.20 NA 14.32 1.10 NA 22.62 090 26432 ......... ............ A Repair finger tendon .................................... 4.01 NA 10.55 0.62 NA 15.18 090 26433 ......... ............ A Repair finger tendon .................................... 4.55 NA 11.22 0.70 NA 16.47 090 26434 ......... ............ A Repair/graft finger tendon ............................ 6.08 NA 11.92 0.88 NA 18.88 090 26437 ......... ............ A Realignment of tendons ............................... 5.81 NA 11.84 0.89 NA 18.54 090 26440 ......... ............ A Release palm/finger tendon ......................... 5.01 NA 13.94 0.76 NA 19.71 090 26442 ......... ............ A Release palm & finger tendon ..................... 8.15 NA 16.43 1.16 NA 25.74 090 26445 ......... ............ A Release hand/finger tendon ........................ 4.30 NA 13.70 0.66 NA 18.66 090 26449 ......... ............ A Release forearm/hand tendon ..................... 6.99 NA 16.21 1.03 NA 24.23 090 26450 ......... ............ A Incision of palm tendon ............................... 3.66 NA 7.53 0.58 NA 11.77 090 26455 ......... ............ A Incision of finger tendon .............................. 3.63 NA 7.46 0.55 NA 11.64 090 26460 ......... ............ A Incise hand/finger tendon ............................ 3.45 NA 7.28 0.51 NA 11.24 090 26471 ......... ............ A Fusion of finger tendons .............................. 5.72 NA 11.52 0.88 NA 18.12 090 26474 ......... ............ A Fusion of finger tendons .............................. 5.31 NA 11.69 0.74 NA 17.74 090 26476 ......... ............ A Tendon lengthening ..................................... 5.17 NA 11.23 0.79 NA 17.19 090 26477 ......... ............ A Tendon shortening ....................................... 5.14 NA 11.40 0.77 NA 17.31 090 26478 ......... ............ A Lengthening of hand tendon ........................ 5.79 NA 12.09 0.94 NA 18.82 090 26479 ......... ............ A Shortening of hand tendon .......................... 5.73 NA 11.94 0.90 NA 18.57 090 26480 ......... ............ A Transplant hand tendon ............................... 6.68 NA 15.43 1.00 NA 23.11 090 26483 ......... ............ A Transplant/graft hand tendon ...................... 8.28 NA 15.89 1.22 NA 25.39 090 26485 ......... ............ A Transplant palm tendon ............................... 7.69 NA 15.77 1.09 NA 24.55 090 26489 ......... ............ A Transplant/graft palm tendon ....................... 9.54 NA 12.39 1.18 NA 23.11 090
26490 ......... ............ A Revise thumb tendon ................................... 8.40 NA 13.04 1.17 NA 22.61 090 26492 ......... ............ A Tendon transfer with graft ........................... 9.61 NA 13.84 1.39 NA 24.84 090 26494 ......... ............ A Hand tendon/muscle transfer ...................... 8.46 NA 13.47 1.21 NA 23.14 090
26496 ......... ............ A Revise thumb tendon ................................... 9.58 NA 13.47 1.38 NA 24.43 090 26497 ......... ............ A Finger tendon transfer ................................. 9.56 NA 13.82 1.46 NA 24.84 090 26498 ......... ............ A Finger tendon transfer ................................. 13.98 NA 16.40 1.95 NA 32.33 090 26499 ......... ............ A Revision of finger ......................................... 8.97 NA 13.40 1.30 NA 23.67 090
26500 ......... ............ A Hand tendon reconstruction ........................ 5.95 NA 11.98 0.89 NA 18.82 090
26502 ......... ............ A Hand tendon reconstruction ........................ 7.13 NA 12.45 1.03 NA 20.61 090
26504 ......... ............ A Hand tendon reconstruction ........................ 7.46 NA 12.85 1.18 NA 21.49 090
26508 ......... ............ A Release thumb contracture ......................... 6.00 NA 11.97 0.94 NA 18.91 090


## 47597

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

26510 ......... ............ A Thumb tendon transfer ................................ 5.42 NA 11.65 0.77 NA 17.84 090 26516 ......... ............ A Fusion of knuckle joint ................................. 7.14 NA 12.50 1.04 NA 20.68 090 26517 ......... ............ A Fusion of knuckle joints ............................... 8.82 NA 13.82 1.49 NA 24.13 090 26518 ......... ............ A Fusion of knuckle joints ............................... 9.01 NA 13.63 1.52 NA 24.16 090 26520 ......... ............ A Release knuckle contracture ....................... 5.29 NA 14.38 0.80 NA 20.47 090 26525 ......... ............ A Release finger contracture .......................... 5.32 NA 14.49 0.81 NA 20.62 090 26530 ......... ............ A Revise knuckle joint ..................................... 6.68 NA 6.13 1.03 NA 13.84 090 26531 ......... ............ A Revise knuckle with implant ........................ 7.90 NA 7.10 1.15 NA 16.15 090 26535 ......... ............ A Revise finger joint ........................................ 5.23 NA 3.74 0.58 NA 9.55 090 26536 ......... ............ A Revise/implant finger joint ........................... 6.36 NA 9.63 0.89 NA 16.88 090 26540 ......... ............ A Repair hand joint ......................................... 6.42 NA 12.22 0.97 NA 19.61 090 26541 ......... ............ A Repair hand joint with graft ......................... 8.61 NA 13.69 1.23 NA 23.53 090 26542 ......... ............ A Repair hand joint with graft ......................... 6.77 NA 12.25 0.98 NA 20.00 090 26545 ......... ............ A Reconstruct finger joint ................................ 6.91 NA 12.66 1.01 NA 20.58 090 26546 ......... ............ A Repair nonunion hand ................................. 8.91 NA 15.14 1.33 NA 25.38 090 26548 ......... ............ A Reconstruct finger joint ................................ 8.02 NA 13.25 1.16 NA 22.43 090 26550 ......... ............ A Construct thumb replacement ..................... 21.21 NA 18.11 2.98 NA 42.30 090 26551 ......... ............ A Great toe-hand transfer ............................... 46.51 NA 33.36 5.65 NA 85.52 090 26553 ......... ............ A Single transfer, toe-hand ............................. 46.20 NA 22.83 3.49 NA 72.52 090 26554 ......... ............ A Double transfer, toe-hand ............................ 54.87 NA 37.75 9.36 NA 101.98 090 26555 ......... ............ A Positional change of finger .......................... 16.61 NA 18.47 2.26 NA 37.34 090 26556 ......... ............ A Toe joint transfer .......................................... 47.19 NA 33.81 8.04 NA 89.04 090 26560 ......... ............ A Repair of web finger .................................... 5.37 NA 10.18 0.76 NA 16.31 090 26561 ......... ............ A Repair of web finger .................................... 10.90 NA 12.81 1.53 NA 25.24 090 26562 ......... ............ A Repair of web finger .................................... 14.98 NA 17.46 1.18 NA 33.62 090 26565 ......... ............ A Correct metacarpal flaw ............................... 6.73 NA 12.32 0.96 NA 20.01 090 26567 ......... ............ A Correct finger deformity ............................... 6.81 NA 12.25 1.02 NA 20.08 090 26568 ......... ............ A Lengthen metacarpal/finger ......................... 9.07 NA 15.87 1.34 NA 26.28 090 26580 ......... ............ A Repair hand deformity ................................. 18.15 NA 14.01 1.88 NA 34.04 090 26587 ......... ............ A Reconstruct extra finger .............................. 14.03 NA 9.06 1.46 NA 24.55 090 26590 ......... ............ A Repair finger deformity ................................ 17.93 NA 14.31 1.62 NA 33.86 090 26591 ......... ............ A Repair muscles of hand ............................... 3.25 NA 10.31 0.49 NA 14.05 090 26593 ......... ............ A Release muscles of hand ............................ 5.30 NA 11.38 0.77 NA 17.45 090 26596 ......... ............ A Excision constricting tissue .......................... 8.94 NA 9.00 1.38 NA 19.32 090 26600 ......... ............ A Treat metacarpal fracture ............................ 1.96 3.61 2.68 0.29 5.86 4.93 090 26605 ......... ............ A Treat metacarpal fracture ............................ 2.85 4.56 3.65 0.45 7.86 6.95 090 26607 ......... ............ A Treat metacarpal fracture ............................ 5.35 NA 6.38 0.84 NA 12.57 090 26608 ......... ............ A Treat metacarpal fracture ............................ 5.35 NA 6.54 0.88 NA 12.77 090 26615 ......... ............ A Treat metacarpal fracture ............................ 5.32 NA 5.73 0.85 NA 11.90 090 26641 ......... ............ A Treat thumb dislocation ............................... 3.93 4.60 3.58 0.43 8.96 7.94 090 26645 ......... ............ A Treat thumb fracture .................................... 4.40 5.18 4.20 0.62 10.20 9.22 090 26650 ......... ............ A Treat thumb fracture .................................... 5.71 NA 6.95 0.94 NA 13.60 090 26665 ......... ............ A Treat thumb fracture .................................... 7.59 NA 6.99 1.19 NA 15.77 090 26670 ......... ............ A Treat hand dislocation ................................. 3.68 4.29 2.99 0.39 8.36 7.06 090 26675 ......... ............ A Treat hand dislocation ................................. 4.63 5.48 4.48 0.72 10.83 9.83 090 26676 ......... ............ A Pin hand dislocation .................................... 5.51 NA 6.99 0.88 NA 13.38 090 26685 ......... ............ A Treat hand dislocation ................................. 6.97 NA 6.44 1.05 NA 14.46 090 26686 ......... ............ A Treat hand dislocation ................................. 7.93 NA 7.21 1.21 NA 16.35 090 26700 ......... ............ A Treat knuckle dislocation ............................. 3.68 3.79 2.91 0.34 7.81 6.93 090 26705 ......... ............ A Treat knuckle dislocation ............................. 4.18 5.35 4.31 0.61 10.14 9.10 090 26706 ......... ............ A Pin knuckle dislocation ................................ 5.11 NA 5.27 0.77 NA 11.15 090 26715 ......... ............ A Treat knuckle dislocation ............................. 5.73 NA 5.91 0.89 NA 12.53 090 26720 ......... ............ A Treat finger fracture, each ........................... 1.66 2.79 2.09 0.22 4.67 3.97 090 26725 ......... ............ A Treat finger fracture, each ........................... 3.33 4.77 3.51 0.50 8.60 7.34 090 26727 ......... ............ A Treat finger fracture, each ........................... 5.22 NA 6.60 0.84 NA 12.66 090 26735 ......... ............ A Treat finger fracture, each ........................... 5.97 NA 6.06 0.94 NA 12.97 090 26740 ......... ............ A Treat finger fracture, each ........................... 1.94 3.14 2.71 0.30 5.38 4.95 090 26742 ......... ............ A Treat finger fracture, each ........................... 3.84 4.99 3.89 0.56 9.39 8.29 090 26746 ......... ............ A Treat finger fracture, each ........................... 5.80 NA 6.12 0.91 NA 12.83 090 26750 ......... ............ A Treat finger fracture, each ........................... 1.70 2.49 2.05 0.20 4.39 3.95 090 26755 ......... ............ A Treat finger fracture, each ........................... 3.10 4.43 3.02 0.41 7.94 6.53 090 26756 ......... ............ A Pin finger fracture, each .............................. 4.38 NA 6.23 0.69 NA 11.30 090 26765 ......... ............ A Treat finger fracture, each ........................... 4.16 NA 4.96 0.62 NA 9.74 090 26770 ......... ............ A Treat finger dislocation ................................ 3.02 3.46 2.46 0.27 6.75 5.75 090 26775 ......... ............ A Treat finger dislocation ................................ 3.70 5.20 3.84 0.49 9.39 8.03 090 26776 ......... ............ A Pin finger dislocation ................................... 4.79 NA 6.40 0.73 NA 11.92 090 26785 ......... ............ A Treat finger dislocation ................................ 4.20 NA 4.99 0.67 NA 9.86 090 26820 ......... ............ A Thumb fusion with graft ............................... 8.25 NA 13.49 1.36 NA 23.10 090 26841 ......... ............ A Fusion of thumb ........................................... 7.12 NA 13.39 1.17 NA 21.68 090 26842 ......... ............ A Thumb fusion with graft ............................... 8.23 NA 13.57 1.24 NA 23.04 090 26843 ......... ............ A Fusion of hand joint ..................................... 7.60 NA 12.53 1.21 NA 21.34 090 26844 ......... ............ A Fusion/graft of hand joint ............................. 8.72 NA 13.55 1.29 NA 23.56 090 26850 ......... ............ A Fusion of knuckle ......................................... 6.96 NA 12.41 1.05 NA 20.42 090 26852 ......... ............ A Fusion of knuckle with graft ......................... 8.45 NA 13.14 1.23 NA 22.82 090 26860 ......... ............ A Fusion of finger joint .................................... 4.68 NA 11.42 0.73 NA 16.83 090


## 47598

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

26861 ......... ............ A Fusion of finger jnt, add-on ......................... 1.74 NA 0.93 0.24 NA 2.91 ZZZ 26862 ......... ............ A Fusion/graft of finger joint ............................ 7.36 NA 12.63 1.05 NA 21.04 090 26863 ......... ............ A Fuse/graft added joint .................................. 3.89 NA 2.10 0.56 NA 6.55 ZZZ 26910 ......... ............ A Amputate metacarpal bone ......................... 7.59 NA 11.57 1.13 NA 20.29 090 26951 ......... ............ A Amputation of finger/thumb ......................... 4.58 NA 10.48 0.70 NA 15.76 090 26952 ......... ............ A Amputation of finger/thumb ......................... 6.30 NA 12.05 0.94 NA 19.29 090 26990 ......... ............ A Drainage of pelvis lesion ............................. 7.47 NA 7.75 1.18 NA 16.40 090 26991 ......... ............ A Drainage of pelvis bursa .............................. 6.67 11.17 5.43 1.07 18.91 13.17 090 26992 ......... ............ A Drainage of bone lesion .............................. 13.00 NA 11.06 2.06 NA 26.12 090 27000 ......... ............ A Incision of hip tendon .................................. 5.61 NA 5.46 0.96 NA 12.03 090 27001 ......... ............ A Incision of hip tendon .................................. 6.93 NA 6.33 1.16 NA 14.42 090 27003 ......... ............ A Incision of hip tendon .................................. 7.33 NA 6.74 1.18 NA 15.25 090 27005 ......... ............ A Incision of hip tendon .................................. 9.65 NA 8.04 1.58 NA 19.27 090 27006 ......... ............ A Incision of hip tendons ................................. 9.67 NA 8.21 1.56 NA 19.44 090 27025 ......... ............ A Incision of hip/thigh fascia ........................... 11.14 NA 8.75 1.75 NA 21.64 090 27030 ......... ............ A Drainage of hip joint .................................... 12.99 NA 9.85 2.10 NA 24.94 090 27033 ......... ............ A Exploration of hip joint ................................. 13.37 NA 10.12 2.20 NA 25.69 090 27035 ......... ............ A Denervation of hip joint ................................ 16.66 NA 12.61 2.43 NA 31.70 090 27036 ......... ............ A Excision of hip joint/muscle ......................... 12.86 NA 10.28 2.11 NA 25.25 090 27040 ......... ............ A Biopsy of soft tissues ................................... 2.87 5.25 2.01 0.30 8.42 5.18 010 27041 ......... ............ A Biopsy of soft tissues ................................... 9.88 NA 6.79 1.30 NA 17.97 090 27047 ......... ............ A Remove hip/pelvis lesion ............................. 7.44 7.14 4.78 1.00 15.58 13.22 090 27048 ......... ............ A Remove hip/pelvis lesion ............................. 6.24 NA 5.12 0.89 NA 12.25 090 27049 ......... ............ A Remove tumor, hip/pelvis ............................ 13.64 NA 8.93 1.95 NA 24.52 090 27050 ......... ............ A Biopsy of sacroiliac joint .............................. 4.35 NA 4.64 0.66 NA 9.65 090 27052 ......... ............ A Biopsy of hip joint ........................................ 6.22 NA 6.09 0.98 NA 13.29 090 27054 ......... ............ A Removal of hip joint lining ........................... 8.53 NA 7.59 1.35 NA 17.47 090 27060 ......... ............ A Removal of ischial bursa ............................. 5.42 NA 4.94 0.78 NA 11.14 090 27062 ......... ............ A Remove femur lesion/bursa ......................... 5.36 NA 5.40 0.91 NA 11.67 090 27065 ......... ............ A Removal of hip bone lesion ......................... 5.89 NA 5.71 0.90 NA 12.50 090 27066 ......... ............ A Removal of hip bone lesion ......................... 10.31 NA 8.73 1.60 NA 20.64 090 27067 ......... ............ A Remove/graft hip bone lesion ...................... 13.81 NA 10.92 2.25 NA 26.98 090 27070 ......... ............ A Partial removal of hip bone ......................... 10.70 NA 9.98 1.67 NA 22.35 090 27071 ......... ............ A Partial removal of hip bone ......................... 11.44 NA 10.98 1.82 NA 24.24 090 27075 ......... ............ A Extensive hip surgery .................................. 34.95 NA 19.82 5.16 NA 59.93 090 27076 ......... ............ A Extensive hip surgery .................................. 22.09 NA 15.05 3.43 NA 40.57 090 27077 ......... ............ A Extensive hip surgery .................................. 39.94 NA 23.29 5.61 NA 68.84 090 27078 ......... ............ A Extensive hip surgery .................................. 13.42 NA 10.70 2.12 NA 26.24 090 27079 ......... ............ A Extensive hip surgery .................................. 13.73 NA 10.31 2.00 NA 26.04 090 27080 ......... ............ A Removal of tail bone .................................... 6.38 NA 5.17 0.92 NA 12.47 090 27086 ......... ............ A Remove hip foreign body ............................ 1.87 4.57 1.82 0.22 6.66 3.91 010 27087 ......... ............ A Remove hip foreign body ............................ 8.53 NA 6.85 1.29 NA 16.67 090 27090 ......... ............ A Removal of hip prosthesis ........................... 11.13 NA 8.76 1.81 NA 21.70 090 27091 ......... ............ A Removal of hip prosthesis ........................... 22.11 NA 13.97 3.49 NA 39.57 090 27093 ......... ............ A Injection for hip x-ray ................................... 1.30 4.50 0.48 0.12 5.92 1.90 000 27095 ......... ............ A Injection for hip x-ray ................................... 1.50 5.81 0.52 0.13 7.44 2.15 000 27096 ......... ............ A Inject sacroiliac joint .................................... 1.40 3.95 0.33 0.10 5.45 1.83 000 27097 ......... ............ A Revision of hip tendon ................................. 8.79 NA 6.63 1.49 NA 16.91 090 27098 ......... ............ A Transfer tendon to pelvis ............................. 8.82 NA 7.26 0.91 NA 16.99 090 27100 ......... ............ A Transfer of abdominal muscle ..................... 11.06 NA 8.97 1.76 NA 21.79 090 27105 ......... ............ A Transfer of spinal muscle ............................ 11.75 NA 9.41 1.32 NA 22.48 090 27110 ......... ............ A Transfer of iliopsoas muscle ........................ 13.24 NA 9.48 1.82 NA 24.54 090 27111 ......... ............ A Transfer of iliopsoas muscle ........................ 12.13 NA 9.36 2.11 NA 23.60 090 27120 ......... ............ A Reconstruction of hip socket ....................... 17.98 NA 11.83 2.73 NA 32.54 090 27122 ......... ............ A Reconstruction of hip socket ....................... 14.96 NA 11.02 2.42 NA 28.40 090 27125 ......... ............ A Partial hip replacement ................................ 14.67 NA 10.60 2.32 NA 27.59 090 27130 ......... ............ A Total hip arthroplasty ................................... 20.09 NA 13.28 3.11 NA 36.48 090 27132 ......... ............ A Total hip arthroplasty ................................... 23.27 NA 15.60 3.64 NA 42.51 090 27134 ......... ............ A Revise hip joint replacement ....................... 28.48 NA 17.76 4.44 NA 50.68 090 27137 ......... ............ A Revise hip joint replacement ....................... 21.14 NA 13.90 3.35 NA 38.39 090 27138 ......... ............ A Revise hip joint replacement ....................... 22.14 NA 14.37 3.51 NA 40.02 090 27140 ......... ............ A Transplant femur ridge ................................ 12.22 NA 9.61 1.97 NA 23.80 090 27146 ......... ............ A Incision of hip bone ..................................... 17.40 NA 12.49 2.61 NA 32.50 090 27147 ......... ............ A Revision of hip bone .................................... 20.55 NA 13.51 2.80 NA 36.86 090 27151 ......... ............ A Incision of hip bones .................................... 22.48 NA 8.26 3.57 NA 34.31 090 27156 ......... ............ A Revision of hip bones .................................. 24.59 NA 16.32 3.52 NA 44.43 090 27158 ......... ............ A Revision of pelvis ......................................... 19.71 NA 11.30 3.14 NA 34.15 090 27161 ......... ............ A Incision of neck of femur ............................. 16.68 NA 12.29 2.77 NA 31.74 090 27165 ......... ............ A Incision/fixation of femur .............................. 17.88 NA 13.07 2.82 NA 33.77 090 27170 ......... ............ A Repair/graft femur head/neck ...................... 16.05 NA 11.49 2.56 NA 30.10 090 27175 ......... ............ A Treat slipped epiphysis ................................ 8.45 NA 6.75 1.47 NA 16.67 090 27176 ......... ............ A Treat slipped epiphysis ................................ 12.03 NA 9.14 2.00 NA 23.17 090 27177 ......... ............ A Treat slipped epiphysis ................................ 15.06 NA 10.99 2.49 NA 28.54 090 27178 ......... ............ A Treat slipped epiphysis ................................ 11.97 NA 8.53 2.08 NA 22.58 090 27179 ......... ............ A Revise head/neck of femur .......................... 12.96 NA 10.09 2.25 NA 25.30 090


## 47599

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

27181 ......... ............ A Treat slipped epiphysis ................................ 14.66 NA 10.31 2.28 NA 27.25 090 27185 ......... ............ A Revision of femur epiphysis ........................ 9.17 NA 7.78 1.59 NA 18.54 090 27187 ......... ............ A Reinforce hip bones ..................................... 13.52 NA 10.55 2.16 NA 26.23 090 27193 ......... ............ A Treat pelvic ring fracture .............................. 5.55 5.32 5.17 0.93 11.80 11.65 090 27194 ......... ............ A Treat pelvic ring fracture .............................. 9.64 NA 7.64 1.62 NA 18.90 090 27200 ......... ............ A Treat tail bone fracture ................................ 1.84 2.23 2.17 0.26 4.33 4.27 090 27202 ......... ............ A Treat tail bone fracture ................................ 7.03 NA 17.13 0.93 NA 25.09 090 27215 ......... ............ A Treat pelvic fracture(s) ................................. 10.03 NA 7.30 1.78 NA 19.11 090 27216 ......... ............ A Treat pelvic ring fracture .............................. 15.17 NA 9.91 2.49 NA 27.57 090 27217 ......... ............ A Treat pelvic ring fracture .............................. 14.09 NA 10.34 2.23 NA 26.66 090 27218 ......... ............ A Treat pelvic ring fracture .............................. 20.12 NA 11.62 3.23 NA 34.97 090 27220 ......... ............ A Treat hip socket fracture .............................. 6.17 5.71 5.62 1.05 12.93 12.84 090 27222 ......... ............ A Treat hip socket fracture .............................. 12.68 NA 10.04 2.17 NA 24.89 090 27226 ......... ............ A Treat hip wall fracture .................................. 14.89 NA 8.03 2.46 NA 25.38 090 27227 ......... ............ A Treat hip fracture(s) ..................................... 23.41 NA 15.53 3.73 NA 42.67 090 27228 ......... ............ A Treat hip fracture(s) ..................................... 27.12 NA 17.75 4.44 NA 49.31 090 27230 ......... ............ A Treat thigh fracture ...................................... 5.49 5.51 5.11 0.90 11.90 11.50 090 27232 ......... ............ A Treat thigh fracture ...................................... 10.66 NA 7.34 1.78 NA 19.78 090 27235 ......... ............ A Treat thigh fracture ...................................... 12.14 NA 9.57 2.08 NA 23.79 090 27236 ......... ............ A Treat thigh fracture ...................................... 15.58 NA 11.04 2.49 NA 29.11 090 27238 ......... ............ A Treat thigh fracture ...................................... 5.51 NA 5.27 0.86 NA 11.64 090 27240 ......... ............ A Treat thigh fracture ...................................... 12.48 NA 9.58 2.06 NA 24.12 090 27244 ......... ............ A Treat thigh fracture ...................................... 15.92 NA 11.42 2.57 NA 29.91 090 27245 ......... ............ A Treat thigh fracture ...................................... 20.28 NA 13.85 3.24 NA 37.37 090 27246 ......... ............ A Treat thigh fracture ...................................... 4.70 4.45 4.42 0.80 9.95 9.92 090 27248 ......... ............ A Treat thigh fracture ...................................... 10.43 NA 8.35 1.68 NA 20.46 090 27250 ......... ............ A Treat hip dislocation .................................... 6.94 NA 4.75 0.61 NA 12.30 090 27252 ......... ............ A Treat hip dislocation .................................... 10.37 NA 7.53 1.58 NA 19.48 090 27253 ......... ............ A Treat hip dislocation .................................... 12.90 NA 9.89 1.91 NA 24.70 090 27254 ......... ............ A Treat hip dislocation .................................... 18.23 NA 12.17 2.97 NA 33.37 090 27256 ......... ............ A Treat hip dislocation .................................... 4.11 3.52 2.09 0.43 8.06 6.63 010 27257 ......... ............ A Treat hip dislocation .................................... 5.21 NA 2.82 0.67 NA 8.70 010 27258 ......... ............ A Treat hip dislocation .................................... 15.41 NA 11.10 2.51 NA 29.02 090 27259 ......... ............ A Treat hip dislocation .................................... 21.52 NA 14.33 3.35 NA 39.20 090 27265 ......... ............ A Treat hip dislocation .................................... 5.04 NA 4.91 0.64 NA 10.59 090 27266 ......... ............ A Treat hip dislocation .................................... 7.48 NA 6.46 1.26 NA 15.20 090 27275 ......... ............ A Manipulation of hip joint ............................... 2.27 NA 2.10 0.38 NA 4.75 010 27280 ......... ............ A Fusion of sacroiliac joint .............................. 13.37 NA 10.55 2.21 NA 26.13 090 27282 ......... ............ A Fusion of pubic bones ................................. 11.32 NA 8.34 1.26 NA 20.92 090 27284 ......... ............ A Fusion of hip joint ........................................ 23.41 NA 15.00 3.26 NA 41.67 090 27286 ......... ............ A Fusion of hip joint ........................................ 23.41 NA 16.02 3.54 NA 42.97 090 27290 ......... ............ A Amputation of leg at hip .............................. 23.25 NA 14.33 3.33 NA 40.91 090 27295 ......... ............ A Amputation of leg at hip .............................. 18.62 NA 11.64 2.77 NA 33.03 090 27301 ......... ............ A Drain thigh/knee lesion ................................ 6.48 10.12 5.14 1.00 17.60 12.62 090 27303 ......... ............ A Drainage of bone lesion .............................. 8.27 NA 7.54 1.35 NA 17.16 090 27305 ......... ............ A Incise thigh tendon & fascia ........................ 5.91 NA 5.50 0.92 NA 12.33 090 27306 ......... ............ A Incision of thigh tendon ............................... 4.61 NA 4.97 0.79 NA 10.37 090 27307 ......... ............ A Incision of thigh tendons .............................. 5.79 NA 5.69 1.01 NA 12.49 090 27310 ......... ............ A Exploration of knee joint .............................. 9.26 NA 7.75 1.51 NA 18.52 090 27315 ......... ............ A Partial removal, thigh nerve ......................... 6.96 NA 4.91 1.21 NA 13.08 090 27320 ......... ............ A Partial removal, thigh nerve ......................... 6.29 NA 5.19 0.94 NA 12.42 090 27323 ......... ............ A Biopsy, thigh soft tissues ............................. 2.28 3.52 1.88 0.27 6.07 4.43 010 27324 ......... ............ A Biopsy, thigh soft tissues ............................. 4.89 NA 4.45 0.73 NA 10.07 090 27327 ......... ............ A Removal of thigh lesion ............................... 4.46 6.01 3.73 0.63 11.10 8.82 090 27328 ......... ............ A Removal of thigh lesion ............................... 5.56 NA 4.65 0.83 NA 11.04 090 27329 ......... ............ A Remove tumor, thigh/knee .......................... 14.12 NA 9.68 2.05 NA 25.85 090 27330 ......... ............ A Biopsy, knee joint lining ............................... 4.96 NA 4.72 0.85 NA 10.53 090 27331 ......... ............ A Explore/treat knee joint ................................ 5.87 NA 5.68 0.95 NA 12.50 090 27332 ......... ............ A Removal of knee cartilage ........................... 8.26 NA 7.26 1.38 NA 16.90 090 27333 ......... ............ A Removal of knee cartilage ........................... 7.29 NA 6.81 1.17 NA 15.27 090 27334 ......... ............ A Remove knee joint lining ............................. 8.69 NA 7.58 1.41 NA 17.68 090 27335 ......... ............ A Remove knee joint lining ............................. 9.99 NA 8.39 1.61 NA 19.99 090 27340 ......... ............ A Removal of kneecap bursa .......................... 4.17 NA 4.69 0.71 NA 9.57 090 27345 ......... ............ A Removal of knee cyst .................................. 5.91 NA 5.77 0.95 NA 12.63 090 27347 ......... ............ A Remove knee cyst ....................................... 5.77 NA 5.58 0.94 NA 12.29 090 27350 ......... ............ A Removal of kneecap .................................... 8.16 NA 7.38 1.31 NA 16.85 090 27355 ......... ............ A Remove femur lesion ................................... 7.64 NA 7.03 1.20 NA 15.87 090 27356 ......... ............ A Remove femur lesion/graft .......................... 9.47 NA 8.11 1.58 NA 19.16 090 27357 ......... ............ A Remove femur lesion/graft .......................... 10.51 NA 8.94 1.81 NA 21.26 090 27358 ......... ............ A Remove femur lesion/fixation ...................... 4.73 NA 2.52 0.76 NA 8.01 ZZZ 27360 ......... ............ A Partial removal, leg bone(s) ........................ 10.48 NA 10.15 1.68 NA 22.31 090 27365 ......... ............ A Extensive leg surgery .................................. 16.25 NA 11.89 2.70 NA 30.84 090 27370 ......... ............ A Injection for knee x-ray ................................ 0.96 3.76 0.32 0.07 4.79 1.35 000 27372 ......... ............ A Removal of foreign body ............................. 5.06 10.10 4.69 0.77 15.93 10.52 090 27380 ......... ............ A Repair of kneecap tendon ........................... 7.15 NA 7.37 1.16 NA 15.68 090


## 47600

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

27381 ......... ............ A Repair/graft kneecap tendon ....................... 10.32 NA 9.17 1.63 NA 21.12 090 27385 ......... ............ A Repair of thigh muscle ................................. 7.75 NA 7.71 1.27 NA 16.73 090 27386 ......... ............ A Repair/graft of thigh muscle ........................ 10.54 NA 9.61 1.69 NA 21.84 090 27390 ......... ............ A Incision of thigh tendon ............................... 5.32 NA 5.43 0.84 NA 11.59 090 27391 ......... ............ A Incision of thigh tendons .............................. 7.19 NA 6.83 1.19 NA 15.21 090 27392 ......... ............ A Incision of thigh tendons .............................. 9.19 NA 7.94 1.52 NA 18.65 090 27393 ......... ............ A Lengthening of thigh tendon ........................ 6.38 NA 6.04 0.98 NA 13.40 090 27394 ......... ............ A Lengthening of thigh tendons ...................... 8.49 NA 7.49 1.37 NA 17.35 090 27395 ......... ............ A Lengthening of thigh tendons ...................... 11.71 NA 9.63 1.80 NA 23.14 090 27396 ......... ............ A Transplant of thigh tendon ........................... 7.85 NA 7.29 1.13 NA 16.27 090 27397 ......... ............ A Transplants of thigh tendons ....................... 11.26 NA 9.27 1.50 NA 22.03 090 27400 ......... ............ A Revise thigh muscles/tendons ..................... 9.01 NA 7.52 1.47 NA 18.00 090 27403 ......... ............ A Repair of knee cartilage .............................. 8.32 NA 7.33 1.34 NA 16.99 090 27405 ......... ............ A Repair of knee ligament .............................. 8.64 NA 7.66 1.41 NA 17.71 090 27407 ......... ............ A Repair of knee ligament .............................. 10.26 NA 8.48 1.65 NA 20.39 090 27409 ......... ............ A Repair of knee ligaments ............................. 12.88 NA 10.10 2.18 NA 25.16 090 27418 ......... ............ A Repair degenerated kneecap ...................... 10.83 NA 9.05 1.70 NA 21.58 090 27420 ......... ............ A Revision of unstable kneecap ..................... 9.82 NA 8.25 1.55 NA 19.62 090 27422 ......... ............ A Revision of unstable kneecap ..................... 9.77 NA 8.25 1.55 NA 19.57 090 27424 ......... ............ A Revision/removal of kneecap ...................... 9.80 NA 8.22 1.54 NA 19.56 090 27425 ......... ............ A Lat retinacular release open ........................ 5.21 NA 5.67 0.89 NA 11.77 090 27427 ......... ............ A Reconstruction, knee ................................... 9.35 NA 7.95 1.47 NA 18.77 090 27428 ......... ............ A Reconstruction, knee ................................... 13.98 NA 11.37 2.30 NA 27.65 090 27429 ......... ............ A Reconstruction, knee ................................... 15.50 NA 12.61 2.61 NA 30.72 090 27430 ......... ............ A Revision of thigh muscles ............................ 9.66 NA 8.15 1.53 NA 19.34 090 27435 ......... ............ A Incision of knee joint .................................... 9.48 NA 8.59 1.45 NA 19.52 090 27437 ......... ............ A Revise kneecap ........................................... 8.45 NA 7.23 1.51 NA 17.19 090 27438 ......... ............ A Revise kneecap with implant ....................... 11.21 NA 8.52 1.80 NA 21.53 090 27440 ......... ............ A Revision of knee joint .................................. 10.41 NA 6.01 1.56 NA 17.98 090 27441 ......... ............ A Revision of knee joint .................................. 10.80 NA 6.71 1.66 NA 19.17 090 27442 ......... ............ A Revision of knee joint .................................. 11.87 NA 8.90 1.86 NA 22.63 090 27443 ......... ............ A Revision of knee joint .................................. 10.91 NA 8.70 1.67 NA 21.28 090 27445 ......... ............ A Revision of knee joint .................................. 17.65 NA 12.32 2.80 NA 32.77 090 27446 ......... ............ A Revision of knee joint .................................. 15.82 NA 11.25 2.44 NA 29.51 090 27447 ......... ............ A Total knee arthroplasty ................................ 21.45 NA 14.57 3.35 NA 39.37 090 27448 ......... ............ A Incision of thigh ............................................ 11.04 NA 8.86 1.67 NA 21.57 090 27450 ......... ............ A Incision of thigh ............................................ 13.96 NA 10.81 2.26 NA 27.03 090 27454 ......... ............ A Realignment of thigh bone .......................... 17.53 NA 12.73 2.84 NA 33.10 090 27455 ......... ............ A Realignment of knee .................................... 12.80 NA 10.02 2.06 NA 24.88 090 27457 ......... ............ A Realignment of knee .................................... 13.43 NA 10.06 2.21 NA 25.70 090 27465 ......... ............ A Shortening of thigh bone ............................. 13.85 NA 10.55 2.31 NA 26.71 090 27466 ......... ............ A Lengthening of thigh bone ........................... 16.31 NA 12.12 2.57 NA 31.00 090 27468 ......... ............ A Shorten/lengthen thighs ............................... 18.94 NA 12.62 2.90 NA 34.46 090 27470 ......... ............ A Repair of thigh ............................................. 16.05 NA 12.08 2.57 NA 30.70 090 27472 ......... ............ A Repair/graft of thigh ..................................... 17.69 NA 12.96 2.85 NA 33.50 090 27475 ......... ............ A Surgery to stop leg growth .......................... 8.63 NA 7.40 1.50 NA 17.53 090 27477 ......... ............ A Surgery to stop leg growth .......................... 9.84 NA 7.90 1.72 NA 19.46 090 27479 ......... ............ A Surgery to stop leg growth .......................... 12.78 NA 10.03 2.22 NA 25.03 090 27485 ......... ............ A Surgery to stop leg growth .......................... 8.83 NA 7.56 1.71 NA 18.10 090 27486 ......... ............ A Revise/replace knee joint ............................ 19.24 NA 13.46 2.99 NA 35.69 090 27487 ......... ............ A Revise/replace knee joint ............................ 25.23 NA 16.52 3.90 NA 45.65 090 27488 ......... ............ A Removal of knee prosthesis ........................ 15.72 NA 11.68 2.49 NA 29.89 090 27495 ......... ............ A Reinforce thigh ............................................. 15.53 NA 11.71 2.52 NA 29.76 090 27496 ......... ............ A Decompression of thigh/knee ...................... 6.10 NA 5.85 0.96 NA 12.91 090 27497 ......... ............ A Decompression of thigh/knee ...................... 7.16 NA 5.77 1.00 NA 13.93 090 27498 ......... ............ A Decompression of thigh/knee ...................... 7.98 NA 6.16 1.27 NA 15.41 090 27499 ......... ............ A Decompression of thigh/knee ...................... 8.99 NA 7.12 1.32 NA 17.43 090 27500 ......... ............ A Treatment of thigh fracture .......................... 5.91 6.11 4.99 0.95 12.97 11.85 090 27501 ......... ............ A Treatment of thigh fracture .......................... 5.91 6.02 5.38 1.01 12.94 12.30 090 27502 ......... ............ A Treatment of thigh fracture .......................... 10.56 NA 8.35 1.73 NA 20.64 090 27503 ......... ............ A Treatment of thigh fracture .......................... 10.56 NA 8.52 1.80 NA 20.88 090 27506 ......... ............ A Treatment of thigh fracture .......................... 17.42 NA 12.93 2.83 NA 33.18 090 27507 ......... ............ A Treatment of thigh fracture .......................... 13.97 NA 10.04 2.24 NA 26.25 090 27508 ......... ............ A Treatment of thigh fracture .......................... 5.82 6.45 5.48 0.95 13.22 12.25 090 27509 ......... ............ A Treatment of thigh fracture .......................... 7.70 NA 8.03 1.30 NA 17.03 090 27510 ......... ............ A Treatment of thigh fracture .......................... 9.12 NA 7.34 1.54 NA 18.00 090 27511 ......... ............ A Treatment of thigh fracture .......................... 13.62 NA 11.29 2.20 NA 27.11 090 27513 ......... ............ A Treatment of thigh fracture .......................... 17.89 NA 13.95 2.91 NA 34.75 090 27514 ......... ............ A Treatment of thigh fracture .......................... 17.27 NA 13.42 2.76 NA 33.45 090 27516 ......... ............ A Treat thigh fx growth plate ........................... 5.36 6.35 5.51 0.89 12.60 11.76 090 27517 ......... ............ A Treat thigh fx growth plate ........................... 8.77 NA 7.44 1.28 NA 17.49 090 27519 ......... ............ A Treat thigh fx growth plate ........................... 15.00 NA 11.71 2.42 NA 29.13 090 27520 ......... ............ A Treat kneecap fracture ................................ 2.86 4.54 3.46 0.44 7.84 6.76 090 27524 ......... ............ A Treat kneecap fracture ................................ 9.99 NA 8.31 1.62 NA 19.92 090 27530 ......... ............ A Treat knee fracture ...................................... 3.77 5.31 4.43 0.62 9.70 8.82 090


## 47601

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

27532 ......... ............ A Treat knee fracture ...................................... 7.29 7.35 6.45 1.25 15.89 14.99 090 27535 ......... ............ A Treat knee fracture ...................................... 11.48 NA 10.20 1.78 NA 23.46 090 27536 ......... ............ A Treat knee fracture ...................................... 15.63 NA 11.67 2.56 NA 29.86 090 27538 ......... ............ A Treat knee fracture(s) .................................. 4.86 6.13 5.20 0.81 11.80 10.87 090 27540 ......... ............ A Treat knee fracture ...................................... 13.08 NA 9.60 2.11 NA 24.79 090 27550 ......... ............ A Treat knee dislocation ................................. 5.75 6.02 4.96 0.73 12.50 11.44 090 27552 ......... ............ A Treat knee dislocation ................................. 7.89 NA 7.08 1.34 NA 16.31 090 27556 ......... ............ A Treat knee dislocation ................................. 14.39 NA 11.79 2.32 NA 28.50 090 27557 ......... ............ A Treat knee dislocation ................................. 16.74 NA 13.25 2.83 NA 32.82 090 27558 ......... ............ A Treat knee dislocation ................................. 17.69 NA 13.18 2.82 NA 33.69 090 27560 ......... ............ A Treat kneecap dislocation ............................ 3.81 4.84 3.24 0.39 9.04 7.44 090 27562 ......... ............ A Treat kneecap dislocation ............................ 5.78 NA 4.88 0.75 NA 11.41 090 27566 ......... ............ A Treat kneecap dislocation ............................ 12.21 NA 9.41 2.03 NA 23.65 090 27570 ......... ............ A Fixation of knee joint ................................... 1.74 NA 1.77 0.30 NA 3.81 010 27580 ......... ............ A Fusion of knee ............................................. 19.34 NA 14.85 3.09 NA 37.28 090 27590 ......... ............ A Amputate leg at thigh .................................. 12.01 NA 7.08 1.68 NA 20.77 090 27591 ......... ............ A Amputate leg at thigh .................................. 12.66 NA 9.04 1.95 NA 23.65 090 27592 ......... ............ A Amputate leg at thigh .................................. 10.00 NA 6.61 1.41 NA 18.02 090 27594 ......... ............ A Amputation follow-up surgery ...................... 6.91 NA 5.49 1.02 NA 13.42 090 27596 ......... ............ A Amputation follow-up surgery ...................... 10.58 NA 7.27 1.55 NA 19.40 090 27598 ......... ............ A Amputate lower leg at knee ......................... 10.51 NA 7.40 1.48 NA 19.39 090 27600 ......... ............ A Decompression of lower leg ........................ 5.64 NA 4.76 0.84 NA 11.24 090 27601 ......... ............ A Decompression of lower leg ........................ 5.63 NA 5.09 0.86 NA 11.58 090 27602 ......... ............ A Decompression of lower leg ........................ 7.34 NA 5.32 1.06 NA 13.72 090 27603 ......... ............ A Drain lower leg lesion .................................. 4.93 7.53 4.17 0.71 13.17 9.81 090 27604 ......... ............ A Drain lower leg bursa .................................. 4.46 6.10 3.96 0.67 11.23 9.09 090 27605 ......... ............ A Incision of achilles tendon ........................... 2.87 7.67 2.32 0.36 10.90 5.55 010 27606 ......... ............ A Incision of achilles tendon ........................... 4.13 NA 3.36 0.66 NA 8.15 010 27607 ......... ............ A Treat lower leg bone lesion ......................... 7.96 NA 6.89 1.25 NA 16.10 090 27610 ......... ............ A Explore/treat ankle joint ............................... 8.33 NA 7.28 1.34 NA 16.95 090 27612 ......... ............ A Exploration of ankle joint ............................. 7.32 NA 6.31 0.97 NA 14.60 090 27613 ......... ............ A Biopsy lower leg soft tissue ......................... 2.17 3.24 1.80 0.22 5.63 4.19 010 27614 ......... ............ A Biopsy lower leg soft tissue ......................... 5.65 7.15 4.44 0.75 13.55 10.84 090 27615 ......... ............ A Remove tumor, lower leg ............................ 12.54 NA 10.73 1.75 NA 25.02 090 27618 ......... ............ A Remove lower leg lesion ............................. 5.08 6.03 4.00 0.68 11.79 9.76 090 27619 ......... ............ A Remove lower leg lesion ............................. 8.39 9.53 5.95 1.16 19.08 15.50 090 27620 ......... ............ A Explore/treat ankle joint ............................... 5.97 NA 5.68 0.87 NA 12.52 090 27625 ......... ............ A Remove ankle joint lining ............................ 8.29 NA 6.75 1.14 NA 16.18 090 27626 ......... ............ A Remove ankle joint lining ............................ 8.90 NA 7.21 1.33 NA 17.44 090 27630 ......... ............ A Removal of tendon lesion ............................ 4.79 7.60 4.38 0.67 13.06 9.84 090 27635 ......... ............ A Remove lower leg bone lesion .................... 7.77 NA 7.09 1.25 NA 16.11 090 27637 ......... ............ A Remove/graft leg bone lesion ...................... 9.84 NA 8.61 1.61 NA 20.06 090 27638 ......... ............ A Remove/graft leg bone lesion ...................... 10.55 NA 8.63 1.70 NA 20.88 090 27640 ......... ............ A Partial removal of tibia ................................. 11.35 NA 11.05 1.78 NA 24.18 090 27641 ......... ............ A Partial removal of fibula ............................... 9.23 NA 9.03 1.39 NA 19.65 090 27645 ......... ............ A Extensive lower leg surgery ........................ 14.15 NA 12.52 2.12 NA 28.79 090 27646 ......... ............ A Extensive lower leg surgery ........................ 12.64 NA 11.52 1.83 NA 25.99 090 27647 ......... ............ A Extensive ankle/heel surgery ....................... 12.22 NA 8.03 1.23 NA 21.48 090 27648 ......... ............ A Injection for ankle x-ray ............................... 0.96 3.57 0.33 0.07 4.60 1.36 000 27650 ......... ............ A Repair achilles tendon ................................. 9.68 NA 7.69 1.44 NA 18.81 090 27652 ......... ............ A Repair/graft achilles tendon ......................... 10.31 NA 8.20 1.51 NA 20.02 090 27654 ......... ............ A Repair of achilles tendon ............................. 10.00 NA 7.43 1.32 NA 18.75 090 27656 ......... ............ A Repair leg fascia defect ............................... 4.56 8.58 3.78 0.62 13.76 8.96 090 27658 ......... ............ A Repair of leg tendon, each .......................... 4.97 NA 4.56 0.70 NA 10.23 090 27659 ......... ............ A Repair of leg tendon, each .......................... 6.80 NA 5.64 0.97 NA 13.41 090 27664 ......... ............ A Repair of leg tendon, each .......................... 4.58 NA 4.55 0.68 NA 9.81 090 27665 ......... ............ A Repair of leg tendon, each .......................... 5.39 NA 4.97 0.82 NA 11.18 090 27675 ......... ............ A Repair lower leg tendons ............................. 7.17 NA 5.97 0.94 NA 14.08 090 27676 ......... ............ A Repair lower leg tendons ............................. 8.41 NA 6.96 0.91 NA 16.28 090 27680 ......... ............ A Release of lower leg tendon ........................ 5.73 NA 5.37 0.87 NA 11.97 090 27681 ......... ............ A Release of lower leg tendons ...................... 6.81 NA 6.15 1.06 NA 14.02 090 27685 ......... ............ A Revision of lower leg tendon ....................... 6.49 7.29 5.46 0.82 14.60 12.77 090 27686 ......... ............ A Revise lower leg tendons ............................ 7.45 NA 6.48 1.21 NA 15.14 090 27687 ......... ............ A Revision of calf tendon ................................ 6.23 NA 5.62 0.89 NA 12.74 090 27690 ......... ............ A Revise lower leg tendon .............................. 8.70 NA 6.65 1.16 NA 16.51 090 27691 ......... ............ A Revise lower leg tendon .............................. 9.95 NA 8.02 1.46 NA 19.43 090 27692 ......... ............ A Revise additional leg tendon ....................... 1.87 NA 0.92 0.28 NA 3.07 ZZZ 27695 ......... ............ A Repair of ankle ligament .............................. 6.50 NA 6.14 1.01 NA 13.65 090 27696 ......... ............ A Repair of ankle ligaments ............................ 8.26 NA 6.71 1.10 NA 16.07 090 27698 ......... ............ A Repair of ankle ligament .............................. 9.35 NA 7.16 1.29 NA 17.80 090 27700 ......... ............ A Revision of ankle joint ................................. 9.28 NA 5.67 1.03 NA 15.98 090 27702 ......... ............ A Reconstruct ankle joint ................................ 13.65 NA 10.44 2.15 NA 26.24 090 27703 ......... ............ A Reconstruction, ankle joint .......................... 15.85 NA 11.21 2.48 NA 29.54 090 27704 ......... ............ A Removal of ankle implant ............................ 7.61 NA 5.59 1.22 NA 14.42 090 27705 ......... ............ A Incision of tibia ............................................. 10.36 NA 8.45 1.60 NA 20.41 090


## 47602

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

27707 ......... ............ A Incision of fibula ........................................... 4.36 NA 5.24 0.74 NA 10.34 090 27709 ......... ............ A Incision of tibia & fibula ............................... 9.94 NA 8.39 1.54 NA 19.87 090 27712 ......... ............ A Realignment of lower leg ............................. 14.23 NA 10.97 2.22 NA 27.42 090 27715 ......... ............ A Revision of lower leg ................................... 14.37 NA 11.09 2.38 NA 27.84 090 27720 ......... ............ A Repair of tibia .............................................. 11.77 NA 9.71 1.90 NA 23.38 090 27722 ......... ............ A Repair/graft of tibia ...................................... 11.80 NA 9.46 1.94 NA 23.20 090 27724 ......... ............ A Repair/graft of tibia ...................................... 18.17 NA 12.68 2.93 NA 33.78 090 27725 ......... ............ A Repair of lower leg ...................................... 15.57 NA 12.18 2.53 NA 30.28 090 27727 ......... ............ A Repair of lower leg ...................................... 13.99 NA 10.68 2.22 NA 26.89 090 27730 ......... ............ A Repair of tibia epiphysis .............................. 7.40 NA 6.42 1.29 NA 15.11 090 27732 ......... ............ A Repair of fibula epiphysis ............................ 5.31 NA 4.93 0.57 NA 10.81 090 27734 ......... ............ A Repair lower leg epiphyses ......................... 8.47 NA 6.61 0.68 NA 15.76 090 27740 ......... ............ A Repair of leg epiphyses ............................... 9.29 NA 7.98 1.58 NA 18.85 090 27742 ......... ............ A Repair of leg epiphyses ............................... 10.28 3.88 3.88 0.68 14.84 14.84 090 27745 ......... ............ A Reinforce tibia .............................................. 10.05 NA 8.44 1.70 NA 20.19 090 27750 ......... ............ A Treatment of tibia fracture ........................... 3.19 4.76 3.86 0.51 8.46 7.56 090 27752 ......... ............ A Treatment of tibia fracture ........................... 5.83 6.64 5.66 0.99 13.46 12.48 090 27756 ......... ............ A Treatment of tibia fracture ........................... 6.77 NA 6.79 1.09 NA 14.65 090 27758 ......... ............ A Treatment of tibia fracture ........................... 11.65 NA 9.41 1.82 NA 22.88 090 27759 ......... ............ A Treatment of tibia fracture ........................... 13.74 NA 10.54 2.23 NA 26.51 090 27760 ......... ............ A Treatment of ankle fracture ......................... 3.01 4.68 3.62 0.44 8.13 7.07 090 27762 ......... ............ A Treatment of ankle fracture ......................... 5.24 6.33 5.27 0.80 12.37 11.31 090 27766 ......... ............ A Treatment of ankle fracture ......................... 8.35 NA 7.36 1.41 NA 17.12 090 27780 ......... ............ A Treatment of fibula fracture ......................... 2.65 4.19 3.24 0.39 7.23 6.28 090 27781 ......... ............ A Treatment of fibula fracture ......................... 4.39 5.49 4.64 0.71 10.59 9.74 090 27784 ......... ............ A Treatment of fibula fracture ......................... 7.10 NA 6.65 1.18 NA 14.93 090 27786 ......... ............ A Treatment of ankle fracture ......................... 2.84 4.46 3.36 0.43 7.73 6.63 090 27788 ......... ............ A Treatment of ankle fracture ......................... 4.44 5.63 4.65 0.71 10.78 9.80 090 27792 ......... ............ A Treatment of ankle fracture ......................... 7.65 NA 7.10 1.28 NA 16.03 090 27808 ......... ............ A Treatment of ankle fracture ......................... 2.83 4.80 3.71 0.44 8.07 6.98 090 27810 ......... ............ A Treatment of ankle fracture ......................... 5.12 6.23 5.15 0.81 12.16 11.08 090 27814 ......... ............ A Treatment of ankle fracture ......................... 10.66 NA 8.75 1.71 NA 21.12 090 27816 ......... ............ A Treatment of ankle fracture ......................... 2.89 4.39 3.43 0.41 7.69 6.73 090 27818 ......... ............ A Treatment of ankle fracture ......................... 5.49 6.37 5.17 0.80 12.66 11.46 090 27822 ......... ............ A Treatment of ankle fracture ......................... 10.98 NA 10.80 1.79 NA 23.57 090 27823 ......... ............ A Treatment of ankle fracture ......................... 12.98 NA 11.64 2.11 NA 26.73 090 27824 ......... ............ A Treat lower leg fracture ............................... 2.89 4.59 3.57 0.44 7.92 6.90 090 27825 ......... ............ A Treat lower leg fracture ............................... 6.18 6.59 5.37 1.00 13.77 12.55 090 27826 ......... ............ A Treat lower leg fracture ............................... 8.53 NA 9.01 1.36 NA 18.90 090 27827 ......... ............ A Treat lower leg fracture ............................... 14.04 NA 12.90 2.31 NA 29.25 090 27828 ......... ............ A Treat lower leg fracture ............................... 16.21 NA 14.06 2.65 NA 32.92 090 27829 ......... ............ A Treat lower leg joint ..................................... 5.48 NA 6.92 0.89 NA 13.29 090 27830 ......... ............ A Treat lower leg dislocation ........................... 3.78 4.41 3.87 0.49 8.68 8.14 090 27831 ......... ............ A Treat lower leg dislocation ........................... 4.55 NA 4.58 0.75 NA 9.88 090 27832 ......... ............ A Treat lower leg dislocation ........................... 6.48 NA 6.36 1.07 NA 13.91 090 27840 ......... ............ A Treat ankle dislocation ................................. 4.57 NA 3.91 0.45 NA 8.93 090 27842 ......... ............ A Treat ankle dislocation ................................. 6.20 NA 5.18 0.92 NA 12.30 090 27846 ......... ............ A Treat ankle dislocation ................................. 9.78 NA 8.12 1.61 NA 19.51 090 27848 ......... ............ A Treat ankle dislocation ................................. 11.18 NA 9.84 1.74 NA 22.76 090 27860 ......... ............ A Fixation of ankle joint ................................... 2.34 NA 1.98 0.37 NA 4.69 010 27870 ......... ............ A Fusion of ankle joint, open .......................... 13.89 NA 10.75 2.04 NA 26.68 090 27871 ......... ............ A Fusion of tibiofibular joint ............................. 9.16 NA 7.85 1.47 NA 18.48 090 27880 ......... ............ A Amputation of lower leg ............................... 11.83 NA 7.48 1.67 NA 20.98 090 27881 ......... ............ A Amputation of lower leg ............................... 12.32 NA 9.16 1.89 NA 23.37 090 27882 ......... ............ A Amputation of lower leg ............................... 8.93 NA 6.90 1.26 NA 17.09 090 27884 ......... ............ A Amputation follow-up surgery ...................... 8.20 NA 6.15 1.21 NA 15.56 090 27886 ......... ............ A Amputation follow-up surgery ...................... 9.31 NA 6.89 1.38 NA 17.58 090 27888 ......... ............ A Amputation of foot at ankle ......................... 9.66 NA 7.76 1.43 NA 18.85 090 27889 ......... ............ A Amputation of foot at ankle ......................... 9.97 NA 6.76 1.40 NA 18.13 090 27892 ......... ............ A Decompression of leg .................................. 7.38 NA 5.92 1.01 NA 14.31 090 27893 ......... ............ A Decompression of leg .................................. 7.34 NA 5.83 1.08 NA 14.25 090 27894 ......... ............ A Decompression of leg .................................. 10.47 NA 8.01 1.58 NA 20.06 090 28001 ......... ............ A Drainage of bursa of foot ............................. 2.73 2.98 1.95 0.23 5.94 4.91 010 28002 ......... ............ A Treatment of foot infection ........................... 4.61 4.99 3.76 0.51 10.11 8.88 010 28003 ......... ............ A Treatment of foot infection ........................... 8.40 6.24 5.22 0.93 15.57 14.55 090 28005 ......... ............ A Treat foot bone lesion .................................. 8.67 NA 6.57 0.95 NA 16.19 090 28008 ......... ............ A Incision of foot fascia ................................... 4.44 4.56 3.21 0.43 9.43 8.08 090 28010 ......... ............ A Incision of toe tendon .................................. 2.84 2.38 2.38 0.27 5.49 5.49 090 28011 ......... ............ A Incision of toe tendons ................................ 4.13 NA 3.30 0.47 NA 7.90 090 28020 ......... ............ A Exploration of foot joint ................................ 5.00 6.03 4.13 0.64 11.67 9.77 090 28022 ......... ............ A Exploration of foot joint ................................ 4.66 5.20 3.85 0.49 10.35 9.00 090 28024 ......... ............ A Exploration of toe joint ................................. 4.37 5.22 3.92 0.43 10.02 8.72 090 28030 ......... ............ A Removal of foot nerve ................................. 6.14 NA 3.61 0.55 NA 10.30 090 28035 ......... ............ A Decompression of tibia nerve ...................... 5.08 5.85 4.09 0.57 11.50 9.74 090 28043 ......... ............ A Excision of foot lesion .................................. 3.53 3.82 3.17 0.37 7.72 7.07 090


## 47603

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

28045 ......... ............ A Excision of foot lesion .................................. 4.71 5.38 3.60 0.49 10.58 8.80 090 28046 ......... ............ A Resection of tumor, foot .............................. 10.16 8.76 6.47 1.17 20.09 17.80 090 28050 ......... ............ A Biopsy of foot joint lining ............................. 4.24 4.89 3.59 0.55 9.68 8.38 090 28052 ......... ............ A Biopsy of foot joint lining ............................. 3.93 4.92 3.43 0.42 9.27 7.78 090 28054 ......... ............ A Biopsy of toe joint lining .............................. 3.44 4.73 3.22 0.34 8.51 7.00 090 28060 ......... ............ A Partial removal, foot fascia .......................... 5.22 5.47 3.87 0.53 11.22 9.62 090 28062 ......... ............ A Removal of foot fascia ................................. 6.51 6.53 4.01 0.61 13.65 11.13 090 28070 ......... ............ A Removal of foot joint lining .......................... 5.09 5.22 3.81 0.56 10.87 9.46 090 28072 ......... ............ A Removal of foot joint lining .......................... 4.57 5.53 4.29 0.63 10.73 9.49 090 28080 ......... ............ A Removal of foot lesion ................................. 3.57 5.12 3.68 0.35 9.04 7.60 090 28086 ......... ............ A Excise foot tendon sheath ........................... 4.77 7.98 4.68 0.69 13.44 10.14 090 28088 ......... ............ A Excise foot tendon sheath ........................... 3.85 5.76 3.89 0.51 10.12 8.25 090 28090 ......... ............ A Removal of foot lesion ................................. 4.40 5.15 3.44 0.46 10.01 8.30 090 28092 ......... ............ A Removal of toe lesions ................................ 3.63 5.22 3.52 0.40 9.25 7.55 090 28100 ......... ............ A Removal of ankle/heel lesion ...................... 5.65 7.98 4.69 0.70 14.33 11.04 090 28102 ......... ............ A Remove/graft foot lesion .............................. 7.72 NA 6.24 0.88 NA 14.84 090 28103 ......... ............ A Remove/graft foot lesion .............................. 6.49 NA 4.61 0.70 NA 11.80 090 28104 ......... ............ A Removal of foot lesion ................................. 5.11 5.49 3.92 0.56 11.16 9.59 090 28106 ......... ............ A Remove/graft foot lesion .............................. 7.15 NA 4.75 0.64 NA 12.54 090 28107 ......... ............ A Remove/graft foot lesion .............................. 5.55 6.54 4.20 0.54 12.63 10.29 090 28108 ......... ............ A Removal of toe lesions ................................ 4.15 4.59 3.25 0.37 9.11 7.77 090 28110 ......... ............ A Part removal of metatarsal .......................... 4.07 5.22 3.22 0.41 9.70 7.70 090 28111 ......... ............ A Part removal of metatarsal .......................... 5.00 6.28 3.65 0.55 11.83 9.20 090 28112 ......... ............ A Part removal of metatarsal .......................... 4.48 5.80 3.56 0.51 10.79 8.55 090 28113 ......... ............ A Part removal of metatarsal .......................... 4.78 6.07 4.32 0.49 11.34 9.59 090 28114 ......... ............ A Removal of metatarsal heads ...................... 9.78 11.63 8.37 1.23 22.64 19.38 090 28116 ......... ............ A Revision of foot ............................................ 7.74 6.80 5.17 0.83 15.37 13.74 090 28118 ......... ............ A Removal of heel bone ................................. 5.95 6.25 4.34 0.69 12.89 10.98 090 28119 ......... ............ A Removal of heel spur .................................. 5.38 5.43 3.72 0.52 11.33 9.62 090 28120 ......... ............ A Part removal of ankle/heel ........................... 5.39 7.30 4.41 0.66 13.35 10.46 090 28122 ......... ............ A Partial removal of foot bone ........................ 7.28 6.84 5.26 0.76 14.88 13.30 090 28124 ......... ............ A Partial removal of toe .................................. 4.80 5.00 3.65 0.42 10.22 8.87 090 28126 ......... ............ A Partial removal of toe .................................. 3.51 4.21 2.99 0.32 8.04 6.82 090 28130 ......... ............ A Removal of ankle bone ................................ 8.10 NA 6.92 1.12 NA 16.14 090 28140 ......... ............ A Removal of metatarsal ................................. 6.90 7.22 4.76 0.79 14.91 12.45 090 28150 ......... ............ A Removal of toe ............................................ 4.08 4.84 3.28 0.41 9.33 7.77 090 28153 ......... ............ A Partial removal of toe .................................. 3.65 4.31 2.68 0.34 8.30 6.67 090 28160 ......... ............ A Partial removal of toe .................................. 3.73 4.57 3.33 0.37 8.67 7.43 090 28171 ......... ............ A Extensive foot surgery ................................. 9.59 NA 5.86 0.83 NA 16.28 090 28173 ......... ............ A Extensive foot surgery ................................. 8.79 7.59 5.19 0.85 17.23 14.83 090 28175 ......... ............ A Extensive foot surgery ................................. 6.04 5.70 3.70 0.53 12.27 10.27 090 28190 ......... ............ A Removal of foot foreign body ...................... 1.96 3.40 1.49 0.17 5.53 3.62 010 28192 ......... ............ A Removal of foot foreign body ...................... 4.63 5.49 3.64 0.46 10.58 8.73 090 28193 ......... ............ A Removal of foot foreign body ...................... 5.72 5.61 3.93 0.56 11.89 10.21 090 28200 ......... ............ A Repair of foot tendon ................................... 4.59 5.10 3.55 0.48 10.17 8.62 090 28202 ......... ............ A Repair/graft of foot tendon ........................... 6.83 7.40 4.49 0.64 14.87 11.96 090 28208 ......... ............ A Repair of foot tendon ................................... 4.36 4.82 3.30 0.42 9.60 8.08 090 28210 ......... ............ A Repair/graft of foot tendon ........................... 6.34 6.22 4.02 0.64 13.20 11.00 090 28220 ......... ............ A Release of foot tendon ................................ 4.52 4.67 3.42 0.40 9.59 8.34 090 28222 ......... ............ A Release of foot tendons .............................. 5.61 5.24 4.12 0.49 11.34 10.22 090 28225 ......... ............ A Release of foot tendon ................................ 3.65 4.28 2.90 0.33 8.26 6.88 090 28226 ......... ............ A Release of foot tendons .............................. 4.52 4.80 3.74 0.45 9.77 8.71 090 28230 ......... ............ A Incision of foot tendon(s) ............................. 4.23 4.67 3.66 0.42 9.32 8.31 090 28232 ......... ............ A Incision of toe tendon .................................. 3.38 4.53 3.31 0.34 8.25 7.03 090 28234 ......... ............ A Incision of foot tendon ................................. 3.36 4.68 3.35 0.34 8.38 7.05 090 28238 ......... ............ A Revision of foot tendon ................................ 7.72 7.25 4.93 0.81 15.78 13.46 090 28240 ......... ............ A Release of big toe ....................................... 4.35 4.64 3.48 0.45 9.44 8.28 090 28250 ......... ............ A Revision of foot fascia ................................. 5.91 5.63 4.13 0.68 12.22 10.72 090 28260 ......... ............ A Release of midfoot joint ............................... 7.95 6.34 4.99 0.92 15.21 13.86 090 28261 ......... ............ A Revision of foot tendon ................................ 11.71 8.62 7.29 1.12 21.45 20.12 090 28262 ......... ............ A Revision of foot and ankle ........................... 15.81 13.56 10.90 2.43 31.80 29.14 090 28264 ......... ............ A Release of midfoot joint ............................... 10.33 7.74 7.28 1.28 19.35 18.89 090 28270 ......... ............ A Release of foot contracture ......................... 4.75 4.89 3.73 0.46 10.10 8.94 090 28272 ......... ............ A Release of toe joint, each ............................ 3.79 4.18 2.85 0.31 8.28 6.95 090 28280 ......... ............ A Fusion of toes .............................................. 5.18 6.25 4.48 0.63 12.06 10.29 090 28285 ......... ............ A Repair of hammertoe ................................... 4.58 4.87 3.42 0.44 9.89 8.44 090 28286 ......... ............ A Repair of hammertoe ................................... 4.55 4.79 3.25 0.41 9.75 8.21 090 28288 ......... ............ A Partial removal of foot bone ........................ 4.73 5.94 4.88 0.53 11.20 10.14 090 28289 ......... ............ A Repair hallux rigidus .................................... 7.03 7.98 5.75 0.87 15.88 13.65 090 28290 ......... ............ A Correction of bunion .................................... 5.65 6.26 4.72 0.69 12.60 11.06 090 28292 ......... ............ A Correction of bunion .................................... 7.03 7.48 5.54 0.67 15.18 13.24 090 28293 ......... ............ A Correction of bunion .................................... 9.14 10.63 6.10 0.79 20.56 16.03 090 28294 ......... ............ A Correction of bunion .................................... 8.55 7.45 4.72 0.81 16.81 14.08 090 28296 ......... ............ A Correction of bunion .................................... 9.17 8.16 5.41 0.88 18.21 15.46 090 28297 ......... ............ A Correction of bunion .................................... 9.17 8.95 6.25 1.08 19.20 16.50 090


## 47604

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

28298 ......... ............ A Correction of bunion .................................... 7.93 7.23 5.00 0.80 15.96 13.73 090 28299 ......... ............ A Correction of bunion .................................... 10.56 8.77 6.06 1.01 20.34 17.63 090 28300 ......... ............ A Incision of heel bone ................................... 9.53 NA 7.02 1.36 NA 17.91 090 28302 ......... ............ A Incision of ankle bone .................................. 9.54 NA 6.88 1.59 NA 18.01 090 28304 ......... ............ A Incision of midfoot bones ............................. 9.15 8.37 5.93 1.05 18.57 16.13 090 28305 ......... ............ A Incise/graft midfoot bones ........................... 10.48 4.63 4.63 0.87 15.98 15.98 090 28306 ......... ............ A Incision of metatarsal ................................... 5.85 7.37 4.41 0.69 13.91 10.95 090 28307 ......... ............ A Incision of metatarsal ................................... 6.32 11.75 5.49 0.82 18.89 12.63 090 28308 ......... ............ A Incision of metatarsal ................................... 5.28 6.27 3.90 0.53 12.08 9.71 090 28309 ......... ............ A Incision of metatarsals ................................. 12.76 NA 8.22 1.70 NA 22.68 090 28310 ......... ............ A Revision of big toe ....................................... 5.42 6.48 4.13 0.53 12.43 10.08 090 28312 ......... ............ A Revision of toe ............................................. 4.54 6.21 4.28 0.51 11.26 9.33 090 28313 ......... ............ A Repair deformity of toe ................................ 5.00 6.67 5.64 0.63 12.30 11.27 090 28315 ......... ............ A Removal of sesamoid bone ......................... 4.85 6.03 3.80 0.46 11.34 9.11 090 28320 ......... ............ A Repair of foot bones .................................... 9.17 NA 6.93 1.27 NA 17.37 090 28322 ......... ............ A Repair of metatarsals .................................. 8.33 10.27 6.50 1.16 19.76 15.99 090 28340 ......... ............ A Resect enlarged toe tissue .......................... 6.97 7.26 4.56 0.58 14.81 12.11 090 28341 ......... ............ A Resect enlarged toe .................................... 8.40 7.45 5.10 0.72 16.57 14.22 090 28344 ......... ............ A Repair extra toe(s) ....................................... 4.25 6.93 3.86 0.51 11.69 8.62 090 28345 ......... ............ A Repair webbed toe(s) .................................. 5.91 7.19 4.97 0.54 13.64 11.42 090 28360 ......... ............ A Reconstruct cleft foot ................................... 13.32 NA 10.75 1.90 NA 25.97 090 28400 ......... ............ A Treatment of heel fracture ........................... 2.16 3.63 3.06 0.32 6.11 5.54 090 28405 ......... ............ A Treatment of heel fracture ........................... 4.56 4.83 4.61 0.71 10.10 9.88 090 28406 ......... ............ A Treatment of heel fracture ........................... 6.30 NA 6.98 1.03 NA 14.31 090 28415 ......... ............ A Treat heel fracture ....................................... 15.95 NA 13.42 2.44 NA 31.81 090 28420 ......... ............ A Treat/graft heel fracture ............................... 16.62 NA 13.08 2.65 NA 32.35 090 28430 ......... ............ A Treatment of ankle fracture ......................... 2.09 3.39 2.58 0.29 5.77 4.96 090 28435 ......... ............ A Treatment of ankle fracture ......................... 3.39 3.90 3.74 0.48 7.77 7.61 090 28436 ......... ............ A Treatment of ankle fracture ......................... 4.70 NA 6.10 0.76 NA 11.56 090 28445 ......... ............ A Treat ankle fracture ..................................... 15.60 NA 11.26 2.40 NA 29.26 090 28450 ......... ............ A Treat midfoot fracture, each ........................ 1.90 3.11 2.50 0.25 5.26 4.65 090 28455 ......... ............ A Treat midfoot fracture, each ........................ 3.09 3.43 3.43 0.41 6.93 6.93 090 28456 ......... ............ A Treat midfoot fracture .................................. 2.68 NA 4.38 0.43 NA 7.49 090 28465 ......... ............ A Treat midfoot fracture, each ........................ 7.00 NA 6.48 0.97 NA 14.45 090 28470 ......... ............ A Treat metatarsal fracture ............................. 1.99 3.12 2.46 0.27 5.38 4.72 090 28475 ......... ............ A Treat metatarsal fracture ............................. 2.97 3.33 3.21 0.38 6.68 6.56 090 28476 ......... ............ A Treat metatarsal fracture ............................. 3.37 NA 5.18 0.51 NA 9.06 090 28485 ......... ............ A Treat metatarsal fracture ............................. 5.70 NA 5.67 0.72 NA 12.09 090 28490 ......... ............ A Treat big toe fracture ................................... 1.09 2.01 1.67 0.12 3.22 2.88 090 28495 ......... ............ A Treat big toe fracture ................................... 1.58 2.18 2.08 0.16 3.92 3.82 090 28496 ......... ............ A Treat big toe fracture ................................... 2.33 9.78 3.77 0.31 12.42 6.41 090 28505 ......... ............ A Treat big toe fracture ................................... 3.80 9.77 4.81 0.49 14.06 9.10 090 28510 ......... ............ A Treatment of toe fracture ............................. 1.09 1.53 1.53 0.11 2.73 2.73 090 28515 ......... ............ A Treatment of toe fracture ............................. 1.46 1.89 1.89 0.14 3.49 3.49 090 28525 ......... ............ A Treat toe fracture ......................................... 3.32 9.36 4.36 0.41 13.09 8.09 090 28530 ......... ............ A Treat sesamoid bone fracture ..................... 1.06 1.45 1.45 0.10 2.61 2.61 090 28531 ......... ............ A Treat sesamoid bone fracture ..................... 2.35 8.98 2.61 0.23 11.56 5.19 090 28540 ......... ............ A Treat foot dislocation ................................... 2.04 2.41 2.41 0.19 4.64 4.64 090 28545 ......... ............ A Treat foot dislocation ................................... 2.45 2.35 2.35 0.36 5.16 5.16 090 28546 ......... ............ A Treat foot dislocation ................................... 3.20 8.03 5.00 0.41 11.64 8.61 090 28555 ......... ............ A Repair foot dislocation ................................. 6.29 11.58 6.67 0.90 18.77 13.86 090 28570 ......... ............ A Treat foot dislocation ................................... 1.66 2.42 2.34 0.20 4.28 4.20 090 28575 ......... ............ A Treat foot dislocation ................................... 3.31 3.74 3.74 0.56 7.61 7.61 090 28576 ......... ............ A Treat foot dislocation ................................... 4.16 10.32 5.68 0.59 15.07 10.43 090 28585 ......... ............ A Repair foot dislocation ................................. 7.98 8.27 6.65 1.01 17.26 15.64 090 28600 ......... ............ A Treat foot dislocation ................................... 1.89 2.82 2.69 0.24 4.95 4.82 090 28605 ......... ............ A Treat foot dislocation ................................... 2.71 3.14 3.14 0.39 6.24 6.24 090 28606 ......... ............ A Treat foot dislocation ................................... 4.89 15.93 6.18 0.78 21.60 11.85 090 28615 ......... ............ A Repair foot dislocation ................................. 7.76 NA 8.16 1.21 NA 17.13 090 28630 ......... ............ A Treat toe dislocation .................................... 1.70 1.57 1.01 0.17 3.44 2.88 010 28635 ......... ............ A Treat toe dislocation .................................... 1.91 2.02 1.53 0.19 4.12 3.63 010 28636 ......... ............ A Treat toe dislocation .................................... 2.77 3.87 2.62 0.38 7.02 5.77 010 28645 ......... ............ A Repair toe dislocation .................................. 4.21 5.81 3.59 0.44 10.46 8.24 090
28660 ......... ............ A Treat toe dislocation .................................... 1.23 1.26 0.81 0.12 2.61 2.16 010
28665 ......... ............ A Treat toe dislocation .................................... 1.92 NA 1.43 0.22 NA 3.57 010
28666 ......... ............ A Treat toe dislocation .................................... 2.66 5.90 2.57 0.38 8.94 5.61 010 28675 ......... ............ A Repair of toe dislocation .............................. 2.92 8.85 3.88 0.40 12.17 7.20 090 28705 ......... ............ A Fusion of foot bones .................................... 18.77 NA 12.65 2.77 NA 34.19 090 28715 ......... ............ A Fusion of foot bones .................................... 13.08 NA 9.98 1.93 NA 24.99 090 28725 ......... ............ A Fusion of foot bones .................................... 11.59 NA 8.50 1.66 NA 21.75 090 28730 ......... ............ A Fusion of foot bones .................................... 10.74 NA 8.71 1.44 NA 20.89 090 28735 ......... ............ A Fusion of foot bones .................................... 10.83 NA 8.08 1.44 NA 20.35 090 28737 ......... ............ A Revision of foot bones ................................. 9.63 NA 7.07 1.12 NA 17.82 090 28740 ......... ............ A Fusion of foot bones .................................... 8.01 11.72 6.66 1.03 20.76 15.70 090 28750 ......... ............ A Fusion of big toe joint .................................. 7.29 13.06 6.84 1.04 21.39 15.17 090


## 47605

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

28755 ......... ............ A Fusion of big toe joint .................................. 4.73 7.02 4.04 0.52 12.27 9.29 090 28760 ......... ............ A Fusion of big toe joint .................................. 7.74 8.24 5.81 0.81 16.79 14.36 090 28800 ......... ............ A Amputation of midfoot .................................. 8.20 NA 6.12 1.04 NA 15.36 090 28805 ......... ............ A Amputation thru metatarsal ......................... 8.38 NA 5.93 1.10 NA 15.41 090 28810 ......... ............ A Amputation toe & metatarsal ....................... 6.20 NA 4.78 0.81 NA 11.79 090 28820 ......... ............ A Amputation of toe ........................................ 4.40 8.56 4.15 0.55 13.51 9.10 090 28825 ......... ............ A Partial amputation of toe ............................. 3.58 8.01 3.87 0.44 12.03 7.89 090 29000 ......... ............ A Application of body cast .............................. 2.25 3.00 1.73 0.47 5.72 4.45 000 29010 ......... ............ A Application of body cast .............................. 2.06 3.29 1.77 0.36 5.71 4.19 000 29015 ......... ............ A Application of body cast .............................. 2.41 2.97 1.60 0.26 5.64 4.27 000 29020 ......... ............ A Application of body cast .............................. 2.11 3.19 1.42 0.21 5.51 3.74 000 29025 ......... ............ A Application of body cast .............................. 2.40 3.19 1.84 0.44 6.03 4.68 000 29035 ......... ............ A Application of body cast .............................. 1.77 3.61 1.58 0.29 5.67 3.64 000 29040 ......... ............ A Application of body cast .............................. 2.22 2.49 1.52 0.18 4.89 3.92 000 29044 ......... ............ A Application of body cast .............................. 2.12 3.97 1.90 0.37 6.46 4.39 000 29046 ......... ............ A Application of body cast .............................. 2.41 3.27 2.08 0.40 6.08 4.89 000 29049 ......... ............ A Application of figure eight ............................ 0.89 1.30 0.53 0.11 2.30 1.53 000 29055 ......... ............ A Application of shoulder cast ........................ 1.78 2.98 1.47 0.28 5.04 3.53 000 29058 ......... ............ A Application of shoulder cast ........................ 1.31 1.56 0.73 0.16 3.03 2.20 000 29065 ......... ............ A Application of long arm cast ........................ 0.87 1.32 0.75 0.14 2.33 1.76 000 29075 ......... ............ A Application of forearm cast .......................... 0.77 1.26 0.68 0.12 2.15 1.57 000 29085 ......... ............ A Apply hand/wrist cast ................................... 0.87 1.28 0.63 0.13 2.28 1.63 000 29086 ......... ............ A Apply finger cast .......................................... 0.62 0.96 0.50 0.08 1.66 1.20 000 29105 ......... ............ A Apply long arm splint ................................... 0.87 1.23 0.51 0.12 2.22 1.50 000 29125 ......... ............ A Apply forearm splint ..................................... 0.59 1.02 0.39 0.07 1.68 1.05 000 29126 ......... ............ A Apply forearm splint ..................................... 0.77 1.21 0.46 0.06 2.04 1.29 000 29130 ......... ............ A Application of finger splint ........................... 0.50 0.47 0.17 0.06 1.03 0.73 000 29131 ......... ............ A Application of finger splint ........................... 0.55 0.74 0.24 0.03 1.32 0.82 000 29200 ......... ............ A Strapping of chest ........................................ 0.65 0.73 0.35 0.05 1.43 1.05 000 29220 ......... ............ A Strapping of low back .................................. 0.64 0.73 0.39 0.05 1.42 1.08 000 29240 ......... ............ A Strapping of shoulder .................................. 0.71 0.86 0.37 0.06 1.63 1.14 000 29260 ......... ............ A Strapping of elbow or wrist .......................... 0.55 0.75 0.33 0.05 1.35 0.93 000 29280 ......... ............ A Strapping of hand or finger .......................... 0.51 0.81 0.33 0.03 1.35 0.87 000 29305 ......... ............ A Application of hip cast ................................. 2.03 3.34 1.76 0.33 5.70 4.12 000 29325 ......... ............ A Application of hip casts ................................ 2.32 3.52 1.95 0.39 6.23 4.66 000 29345 ......... ............ A Application of long leg cast ......................... 1.40 1.76 1.06 0.23 3.39 2.69 000 29355 ......... ............ A Application of long leg cast ......................... 1.53 1.71 1.12 0.24 3.48 2.89 000 29358 ......... ............ A Apply long leg cast brace ............................ 1.43 2.06 1.09 0.23 3.72 2.75 000 29365 ......... ............ A Application of long leg cast ......................... 1.18 1.65 0.95 0.20 3.03 2.33 000 29405 ......... ............ A Apply short leg cast ..................................... 0.86 1.22 0.71 0.13 2.21 1.70 000 29425 ......... ............ A Apply short leg cast ..................................... 1.01 1.23 0.74 0.13 2.37 1.88 000 29435 ......... ............ A Apply short leg cast ..................................... 1.18 1.55 0.92 0.19 2.92 2.29 000 29440 ......... ............ A Addition of walker to cast ............................ 0.57 0.69 0.27 0.08 1.34 0.92 000 29445 ......... ............ A Apply rigid leg cast ...................................... 1.78 1.80 0.96 0.24 3.82 2.98 000 29450 ......... ............ A Application of leg cast ................................. 2.08 1.47 1.10 0.19 3.74 3.37 000 29505 ......... ............ A Application, long leg splint ........................... 0.69 1.18 0.46 0.07 1.94 1.22 000 29515 ......... ............ A Application lower leg splint .......................... 0.73 0.87 0.47 0.08 1.68 1.28 000 29520 ......... ............ A Strapping of hip ........................................... 0.54 0.87 0.47 0.02 1.43 1.03 000 29530 ......... ............ A Strapping of knee ........................................ 0.57 0.79 0.33 0.05 1.41 0.95 000 29540 ......... ............ A Strapping of ankle and/or ft ......................... 0.51 0.42 0.31 0.04 0.97 0.86 000 29550 ......... ............ A Strapping of toes ......................................... 0.47 0.42 0.28 0.04 0.93 0.79 000 29580 ......... ............ A Application of paste boot ............................. 0.57 0.65 0.36 0.06 1.28 0.99 000 29590 ......... ............ A Application of foot splint .............................. 0.76 0.51 0.29 0.06 1.33 1.11 000 29700 ......... ............ A Removal/revision of cast ............................. 0.57 0.89 0.28 0.07 1.53 0.92 000 29705 ......... ............ A Removal/revision of cast ............................. 0.76 0.82 0.38 0.11 1.69 1.25 000 29710 ......... ............ A Removal/revision of cast ............................. 1.34 1.53 0.70 0.20 3.07 2.24 000 29715 ......... ............ A Removal/revision of cast ............................. 0.94 1.17 0.40 0.13 2.24 1.47 000 29720 ......... ............ A Repair of body cast ..................................... 0.68 1.16 0.39 0.11 1.95 1.18 000 29730 ......... ............ A Windowing of cast ....................................... 0.75 0.81 0.35 0.11 1.67 1.21 000 29740 ......... ............ A Wedging of cast ........................................... 1.12 1.15 0.49 0.16 2.43 1.77 000 29750 ......... ............ A Wedging of clubfoot cast ............................. 1.26 1.06 0.58 0.19 2.51 2.03 000 29800 ......... ............ A Jaw arthroscopy/surgery .............................. 6.42 NA 7.06 0.99 NA 14.47 090 29804 ......... ............ A Jaw arthroscopy/surgery .............................. 8.13 NA 7.84 1.30 NA 17.27 090 29805 ......... ............ A Shoulder arthroscopy, dx ............................. 5.88 NA 5.84 1.01 NA 12.73 090 29806 ......... ............ A Shoulder arthroscopy/surgery ...................... 14.35 NA 11.08 2.42 NA 27.85 090 29807 ......... ............ A Shoulder arthroscopy/surgery ...................... 13.88 NA 10.91 2.35 NA 27.14 090 29819 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.61 NA 6.77 1.26 NA 15.64 090 29820 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.06 NA 6.21 1.17 NA 14.44 090 29821 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.71 NA 6.79 1.24 NA 15.74 090 29822 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.42 NA 6.67 1.20 NA 15.29 090 29823 ......... ............ A Shoulder arthroscopy/surgery ...................... 8.16 NA 7.21 1.30 NA 16.67 090 29824 ......... ............ A Shoulder arthroscopy/surgery ...................... 8.24 NA 7.47 1.30 NA 17.01 090 29825 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.61 NA 6.75 1.12 NA 15.48 090 29826 ......... ............ A Shoulder arthroscopy/surgery ...................... 8.98 NA 7.52 1.42 NA 17.92 090 29827 ......... ............ A Arthroscop rotator cuff repr ......................... 15.34 NA 11.52 2.08 NA 28.94 090


## 47606

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

29830 ......... ............ A Elbow arthroscopy ....................................... 5.75 NA 5.33 0.87 NA 11.95 090 29834 ......... ............ A Elbow arthroscopy/surgery .......................... 6.27 NA 5.82 1.02 NA 13.11 090 29835 ......... ............ A Elbow arthroscopy/surgery .......................... 6.47 NA 5.87 1.12 NA 13.46 090 29836 ......... ............ A Elbow arthroscopy/surgery .......................... 7.54 NA 6.77 1.08 NA 15.39 090 29837 ......... ............ A Elbow arthroscopy/surgery .......................... 6.86 NA 6.12 1.11 NA 14.09 090 29838 ......... ............ A Elbow arthroscopy/surgery .......................... 7.70 NA 6.87 1.23 NA 15.80 090 29840 ......... ............ A Wrist arthroscopy ......................................... 5.53 NA 5.31 0.82 NA 11.66 090 29843 ......... ............ A Wrist arthroscopy/surgery ............................ 6.00 NA 5.62 0.90 NA 12.52 090 29844 ......... ............ A Wrist arthroscopy/surgery ............................ 6.36 NA 5.81 0.99 NA 13.16 090 29845 ......... ............ A Wrist arthroscopy/surgery ............................ 7.51 NA 6.47 0.99 NA 14.97 090 29846 ......... ............ A Wrist arthroscopy/surgery ............................ 6.74 NA 6.04 1.04 NA 13.82 090 29847 ......... ............ A Wrist arthroscopy/surgery ............................ 7.07 NA 6.18 1.07 NA 14.32 090 29848 ......... ............ A Wrist endoscopy/surgery ............................. 5.43 NA 5.59 0.87 NA 11.89 090 29850 ......... ............ A Knee arthroscopy/surgery ............................ 8.18 NA 5.06 0.84 NA 14.08 090 29851 ......... ............ A Knee arthroscopy/surgery ............................ 13.08 NA 9.78 2.04 NA 24.90 090 29855 ......... ............ A Tibial arthroscopy/surgery ........................... 10.60 NA 8.75 1.71 NA 21.06 090 29856 ......... ............ A Tibial arthroscopy/surgery ........................... 14.12 NA 10.65 2.46 NA 27.23 090 29860 ......... ............ A Hip arthroscopy, dx ...................................... 8.04 NA 6.94 1.23 NA 16.21 090 29861 ......... ............ A Hip arthroscopy/surgery ............................... 9.14 NA 7.34 1.45 NA 17.93 090 29862 ......... ............ A Hip arthroscopy/surgery ............................... 9.89 NA 8.55 1.62 NA 20.06 090 29863 ......... ............ A Hip arthroscopy/surgery ............................... 9.89 NA 8.49 1.56 NA 19.94 090 29870 ......... ............ A Knee arthroscopy, dx ................................... 5.06 NA 4.88 0.85 NA 10.79 090 29871 ......... ............ A Knee arthroscopy/drainage .......................... 6.54 NA 5.86 1.12 NA 13.52 090 29873 ......... ............ A Knee arthroscopy/surgery ............................ 5.99 NA 6.57 0.89 NA 13.45 090 29874 ......... ............ A Knee arthroscopy/surgery ............................ 7.04 NA 6.06 1.10 NA 14.20 090 29875 ......... ............ A Knee arthroscopy/surgery ............................ 6.30 NA 5.84 1.05 NA 13.19 090 29876 ......... ............ A Knee arthroscopy/surgery ............................ 7.91 NA 7.01 1.36 NA 16.28 090 29877 ......... ............ A Knee arthroscopy/surgery ............................ 7.34 NA 6.73 1.25 NA 15.32 090 29879 ......... ............ A Knee arthroscopy/surgery ............................ 8.03 NA 7.10 1.36 NA 16.49 090 29880 ......... ............ A Knee arthroscopy/surgery ............................ 8.49 NA 7.35 1.43 NA 17.27 090 29881 ......... ............ A Knee arthroscopy/surgery ............................ 7.75 NA 6.95 1.31 NA 16.01 090 29882 ......... ............ A Knee arthroscopy/surgery ............................ 8.64 NA 7.23 1.48 NA 17.35 090 29883 ......... ............ A Knee arthroscopy/surgery ............................ 11.03 NA 9.04 1.88 NA 21.95 090 29884 ......... ............ A Knee arthroscopy/surgery ............................ 7.32 NA 6.68 1.21 NA 15.21 090 29885 ......... ............ A Knee arthroscopy/surgery ............................ 9.08 NA 7.95 1.48 NA 18.51 090 29886 ......... ............ A Knee arthroscopy/surgery ............................ 7.53 NA 6.83 1.29 NA 15.65 090 29887 ......... ............ A Knee arthroscopy/surgery ............................ 9.03 NA 7.92 1.51 NA 18.46 090 29888 ......... ............ A Knee arthroscopy/surgery ............................ 13.88 NA 10.18 2.22 NA 26.28 090 29889 ......... ............ A Knee arthroscopy/surgery ............................ 15.98 NA 12.41 2.67 NA 31.06 090 29891 ......... ............ A Ankle arthroscopy/surgery ........................... 8.39 NA 7.50 1.28 NA 17.17 090 29892 ......... ............ A Ankle arthroscopy/surgery ........................... 8.99 NA 7.72 1.16 NA 17.87 090 29893 ......... ............ A Scope, plantar fasciotomy ........................... 5.21 6.27 3.98 0.45 11.93 9.64 090 29894 ......... ............ A Ankle arthroscopy/surgery ........................... 7.20 NA 5.46 0.99 NA 13.65 090 29895 ......... ............ A Ankle arthroscopy/surgery ........................... 6.98 NA 5.46 0.96 NA 13.40 090 29897 ......... ............ A Ankle arthroscopy/surgery ........................... 7.17 NA 5.87 1.10 NA 14.14 090 29898 ......... ............ A Ankle arthroscopy/surgery ........................... 8.31 NA 6.18 1.11 NA 15.60 090 29899 ......... ............ A Ankle arthroscopy/surgery ........................... 13.89 NA 10.55 2.04 NA 26.48 090 29900 ......... ............ A Mcp joint arthroscopy, dx ............................ 5.41 NA 5.81 0.87 NA 12.09 090 29901 ......... ............ A Mcp joint arthroscopy, surg ......................... 6.12 NA 6.20 0.97 NA 13.29 090 29902 ......... ............ A Mcp joint arthroscopy, surg ......................... 6.69 NA 6.46 0.84 NA 13.99 090 30000 ......... ............ A Drainage of nose lesion ............................... 1.43 4.09 1.40 0.12 5.64 2.95 010 30020 ......... ............ A Drainage of nose lesion ............................... 1.43 3.28 1.47 0.12 4.83 3.02 010 30100 ......... ............ A Intranasal biopsy .......................................... 0.94 1.97 0.82 0.08 2.99 1.84 000 30110 ......... ............ A Removal of nose polyp(s) ............................ 1.63 3.24 1.57 0.14 5.01 3.34 010 30115 ......... ............ A Removal of nose polyp(s) ............................ 4.34 NA 5.76 0.42 NA 10.52 090 30117 ......... ............ A Removal of intranasal lesion ....................... 3.16 13.13 4.62 0.26 16.55 8.04 090 30118 ......... ............ A Removal of intranasal lesion ....................... 9.68 NA 9.19 0.82 NA 19.69 090 30120 ......... ............ A Revision of nose .......................................... 5.26 6.48 5.99 0.56 12.30 11.81 090 30124 ......... ............ A Removal of nose lesion ............................... 3.10 NA 3.62 0.30 NA 7.02 090 30125 ......... ............ A Removal of nose lesion ............................... 7.15 NA 8.32 0.58 NA 16.05 090 30130 ......... ............ A Removal of turbinate bones ........................ 3.37 NA 5.58 0.32 NA 9.27 090 30140 ......... ............ A Removal of turbinate bones ........................ 3.42 NA 6.19 0.36 NA 9.97 090 30150 ......... ............ A Partial removal of nose ................................ 9.13 NA 10.99 0.91 NA 21.03 090 30160 ......... ............ A Removal of nose .......................................... 9.57 NA 10.19 0.87 NA 20.63 090 30200 ......... ............ A Injection treatment of nose .......................... 0.78 1.62 0.74 0.06 2.46 1.58 000 30210 ......... ............ A Nasal sinus therapy ..................................... 1.08 2.10 1.31 0.09 3.27 2.48 010 30220 ......... ............ A Insert nasal septal button ............................ 1.54 4.23 1.53 0.12 5.89 3.19 010 30300 ......... ............ A Remove nasal foreign body ......................... 1.04 4.64 1.93 0.08 5.76 3.05 010 30310 ......... ............ A Remove nasal foreign body ......................... 1.96 NA 3.09 0.17 NA 5.22 010 30320 ......... ............ A Remove nasal foreign body ......................... 4.51 NA 7.03 0.37 NA 11.91 090 30400 ......... ............ R Reconstruction of nose ................................ 9.82 NA 15.46 1.02 NA 26.30 090 30410 ......... ............ R Reconstruction of nose ................................ 12.96 NA 18.32 1.47 NA 32.75 090 30420 ......... ............ R Reconstruction of nose ................................ 15.86 NA 17.87 1.48 NA 35.21 090 30430 ......... ............ R Revision of nose .......................................... 7.20 NA 15.95 0.79 NA 23.94 090 30435 ......... ............ R Revision of nose .......................................... 11.69 NA 19.28 1.33 NA 32.30 090


## 47607

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

30450 ......... ............ R Revision of nose .......................................... 18.62 NA 21.82 1.89 NA 42.33 090 30460 ......... ............ A Revision of nose .......................................... 9.95 NA 9.94 0.91 NA 20.80 090 30462 ......... ............ A Revision of nose .......................................... 19.54 NA 20.20 1.90 NA 41.64 090 30465 ......... ............ A Repair nasal stenosis .................................. 11.62 NA 11.99 1.10 NA 24.71 090 30520 ......... ............ A Repair of nasal septum ............................... 5.69 NA 6.65 0.47 NA 12.81 090 30540 ......... ............ A Repair nasal defect ...................................... 7.74 NA 9.29 0.64 NA 17.67 090 30545 ......... ............ A Repair nasal defect ...................................... 11.36 NA 11.87 0.81 NA 24.04 090 30560 ......... ............ A Release of nasal adhesions ........................ 1.26 4.78 2.13 0.10 6.14 3.49 010 30580 ......... ............ A Repair upper jaw fistula ............................... 6.68 7.76 5.78 0.87 15.31 13.33 090 30600 ......... ............ A Repair mouth/nose fistula ............................ 6.01 7.53 5.02 0.61 14.15 11.64 090
30620 ......... ............ A Intranasal reconstruction ............................. 5.96 NA 8.81 0.56 NA 15.33 090 30630 ......... ............ A Repair nasal septum defect ......................... 7.11 NA 7.94 0.61 NA 15.66 090 30801 ......... ............ A Cauterization, inner nose ............................. 1.09 4.14 1.93 0.09 5.32 3.11 010 30802 ......... ............ A Cauterization, inner nose ............................. 2.03 4.61 2.35 0.17 6.81 4.55 010 30901 ......... ............ A Control of nosebleed ................................... 1.21 1.36 0.32 0.11 2.68 1.64 000 30903 ......... ............ A Control of nosebleed ................................... 1.54 2.71 0.50 0.13 4.38 2.17 000 30905 ......... ............ A Control of nosebleed ................................... 1.97 3.51 0.76 0.17 5.65 2.90 000 30906 ......... ............ A Repeat control of nosebleed ....................... 2.45 3.89 1.20 0.20 6.54 3.85 000 30915 ......... ............ A Ligation, nasal sinus artery .......................... 7.19 NA 6.69 0.60 NA 14.48 090 30920 ......... ............ A Ligation, upper jaw artery ............................ 9.82 NA 8.96 0.80 NA 19.58 090 30930 ......... ............ A Therapy, fracture of nose ............................ 1.26 NA 1.62 0.12 NA 3.00 010 31000 ......... ............ A Irrigation, maxillary sinus ............................. 1.15 2.85 1.40 0.10 4.10 2.65 010 31002 ......... ............ A Irrigation, sphenoid sinus ............................. 1.91 NA 3.26 0.16 NA 5.33 010 31020 ......... ............ A Exploration, maxillary sinus ......................... 2.94 8.54 5.18 0.28 11.76 8.40 090 31030 ......... ............ A Exploration, maxillary sinus ......................... 5.91 11.51 6.66 0.58 18.00 13.15 090 31032 ......... ............ A Explore sinus, remove polyps ..................... 6.56 NA 7.22 0.61 NA 14.39 090 31040 ......... ............ A Exploration behind upper jaw ...................... 9.41 NA 9.85 0.90 NA 20.16 090 31050 ......... ............ A Exploration, sphenoid sinus ......................... 5.27 NA 6.35 0.57 NA 12.19 090 31051 ......... ............ A Sphenoid sinus surgery ............................... 7.10 NA 8.24 0.69 NA 16.03 090 31070 ......... ............ A Exploration of frontal sinus .......................... 4.27 NA 5.93 0.39 NA 10.59 090 31075 ......... ............ A Exploration of frontal sinus .......................... 9.15 NA 9.72 0.80 NA 19.67 090 31080 ......... ............ A Removal of frontal sinus .............................. 11.40 NA 13.54 1.36 NA 26.30 090 31081 ......... ............ A Removal of frontal sinus .............................. 12.73 NA 13.99 2.47 NA 29.19 090 31084 ......... ............ A Removal of frontal sinus .............................. 13.49 NA 13.50 1.23 NA 28.22 090 31085 ......... ............ A Removal of frontal sinus .............................. 14.18 NA 13.94 1.74 NA 29.86 090 31086 ......... ............ A Removal of frontal sinus .............................. 12.84 NA 13.26 1.11 NA 27.21 090 31087 ......... ............ A Removal of frontal sinus .............................. 13.08 NA 12.51 1.28 NA 26.87 090 31090 ......... ............ A Exploration of sinuses ................................. 9.52 NA 12.54 0.94 NA 23.00 090 31200 ......... ............ A Removal of ethmoid sinus ........................... 4.96 NA 9.24 0.31 NA 14.51 090 31201 ......... ............ A Removal of ethmoid sinus ........................... 8.36 NA 9.16 0.82 NA 18.34 090 31205 ......... ............ A Removal of ethmoid sinus ........................... 10.22 NA 11.89 0.73 NA 22.84 090 31225 ......... ............ A Removal of upper jaw .................................. 19.20 NA 17.81 1.69 NA 38.70 090 31230 ......... ............ A Removal of upper jaw .................................. 21.91 NA 19.35 1.89 NA 43.15 090 31231 ......... ............ A Nasal endoscopy, dx ................................... 1.10 3.38 0.88 0.09 4.57 2.07 000 31233 ......... ............ A Nasal/sinus endoscopy, dx .......................... 2.18 4.31 1.47 0.19 6.68 3.84 000 31235 ......... ............ A Nasal/sinus endoscopy, dx .......................... 2.64 4.91 1.72 0.27 7.82 4.63 000 31237 ......... ............ A Nasal/sinus endoscopy, surg ....................... 2.98 5.19 1.88 0.28 8.45 5.14 000 31238 ......... ............ A Nasal/sinus endoscopy, surg ....................... 3.26 5.23 2.08 0.27 8.76 5.61 000 31239 ......... ............ A Nasal/sinus endoscopy, surg ....................... 8.69 NA 8.01 0.62 NA 17.32 010 31240 ......... ............ A Nasal/sinus endoscopy, surg ....................... 2.61 NA 1.73 0.25 NA 4.59 000 31254 ......... ............ A Revision of ethmoid sinus ........................... 4.64 NA 2.84 0.46 NA 7.94 000 31255 ......... ............ A Removal of ethmoid sinus ........................... 6.95 NA 4.10 0.74 NA 11.79 000 31256 ......... ............ A Exploration maxillary sinus .......................... 3.29 NA 2.11 0.34 NA 5.74 000 31267 ......... ............ A Endoscopy, maxillary sinus ......................... 5.45 NA 3.29 0.56 NA 9.30 000 31276 ......... ............ A Sinus endoscopy, surgical ........................... 8.84 NA 5.11 0.92 NA 14.87 000 31287 ......... ............ A Nasal/sinus endoscopy, surg ....................... 3.91 NA 2.45 0.40 NA 6.76 000 31288 ......... ............ A Nasal/sinus endoscopy, surg ....................... 4.57 NA 2.80 0.47 NA 7.84 000 31290 ......... ............ A Nasal/sinus endoscopy, surg ....................... 17.21 NA 12.04 1.41 NA 30.66 010 31291 ......... ............ A Nasal/sinus endoscopy, surg ....................... 18.16 NA 12.46 1.74 NA 32.36 010 31292 ......... ............ A Nasal/sinus endoscopy, surg ....................... 14.74 NA 10.60 1.27 NA 26.61 010 31293 ......... ............ A Nasal/sinus endoscopy, surg ....................... 16.19 NA 11.37 1.17 NA 28.73 010 31294 ......... ............ A Nasal/sinus endoscopy, surg ....................... 19.03 NA 12.86 1.42 NA 33.31 010 31300 ......... ............ A Removal of larynx lesion ............................. 14.27 NA 14.99 1.21 NA 30.47 090 31320 ......... ............ A Diagnostic incision, larynx ........................... 5.25 NA 10.34 0.46 NA 16.05 090 31360 ......... ............ A Removal of larynx ........................................ 17.05 NA 16.72 1.44 NA 35.21 090 31365 ......... ............ A Removal of larynx ........................................ 24.12 NA 20.35 2.03 NA 46.50 090 31367 ......... ............ A Partial removal of larynx .............................. 21.83 NA 21.88 1.81 NA 45.52 090 31368 ......... ............ A Partial removal of larynx .............................. 27.05 NA 25.47 2.26 NA 54.78 090 31370 ......... ............ A Partial removal of larynx .............................. 21.35 NA 22.26 1.77 NA 45.38 090 31375 ......... ............ A Partial removal of larynx .............................. 20.18 NA 20.41 1.65 NA 42.24 090 31380 ......... ............ A Partial removal of larynx .............................. 20.18 NA 20.60 1.64 NA 42.42 090 31382 ......... ............ A Partial removal of larynx .............................. 20.49 NA 21.61 1.72 NA 43.82 090 31390 ......... ............ A Removal of larynx & pharynx ...................... 27.49 NA 24.37 2.32 NA 54.18 090 31395 ......... ............ A Reconstruct larynx & pharynx ..................... 31.04 NA 28.28 2.61 NA 61.93 090 31400 ......... ............ A Revision of larynx ........................................ 10.29 NA 13.80 0.84 NA 24.93 090


## 47608

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

31420 ......... ............ A Removal of epiglottis ................................... 10.20 NA 9.54 0.83 NA 20.57 090 31500 ......... ............ A Insert emergency airway ............................. 2.33 NA 0.55 0.18 NA 3.06 000 31502 ......... ............ A Change of windpipe airway ......................... 0.65 0.31 0.28 0.05 1.01 0.98 000 31505 ......... ............ A Diagnostic laryngoscopy .............................. 0.61 1.45 0.62 0.05 2.11 1.28 000 31510 ......... ............ A Laryngoscopy with biopsy ........................... 1.92 3.32 1.25 0.17 5.41 3.34 000 31511 ......... ............ A Remove foreign body, larynx ....................... 2.16 3.12 1.06 0.19 5.47 3.41 000 31512 ......... ............ A Removal of larynx lesion ............................. 2.07 3.20 1.36 0.17 5.44 3.60 000 31513 ......... ............ A Injection into vocal cord ............................... 2.10 NA 1.46 0.17 NA 3.73 000 31515 ......... ............ A Laryngoscopy for aspiration ........................ 1.80 3.63 1.07 0.14 5.57 3.01 000 31520 ......... ............ A Diagnostic laryngoscopy .............................. 2.56 NA 1.56 0.20 NA 4.32 000 31525 ......... ............ A Diagnostic laryngoscopy .............................. 2.63 3.65 1.66 0.22 6.50 4.51 000 31526 ......... ............ A Diagnostic laryngoscopy .............................. 2.57 NA 1.71 0.21 NA 4.49 000 31527 ......... ............ A Laryngoscopy for treatment ......................... 3.27 NA 1.87 0.27 NA 5.41 000 31528 ......... ............ A Laryngoscopy and dilation ........................... 2.37 NA 1.46 0.20 NA 4.03 000 31529 ......... ............ A Laryngoscopy and dilation ........................... 2.68 NA 1.71 0.22 NA 4.61 000 31530 ......... ............ A Operative laryngoscopy ............................... 3.38 NA 1.95 0.29 NA 5.62 000 31531 ......... ............ A Operative laryngoscopy ............................... 3.58 NA 2.27 0.29 NA 6.14 000 31535 ......... ............ A Operative laryngoscopy ............................... 3.16 NA 1.99 0.26 NA 5.41 000 31536 ......... ............ A Operative laryngoscopy ............................... 3.55 NA 2.24 0.29 NA 6.08 000 31540 ......... ............ A Operative laryngoscopy ............................... 4.12 NA 2.54 0.34 NA 7.00 000 31541 ......... ............ A Operative laryngoscopy ............................... 4.52 NA 2.77 0.37 NA 7.66 000 31560 ......... ............ A Operative laryngoscopy ............................... 5.45 NA 3.15 0.44 NA 9.04 000 31561 ......... ............ A Operative laryngoscopy ............................... 5.99 NA 3.36 0.40 NA 9.75 000 31570 ......... ............ A Laryngoscopy with injection ......................... 3.86 5.67 2.38 0.31 9.84 6.55 000 31571 ......... ............ A Laryngoscopy with injection ......................... 4.26 NA 2.59 0.35 NA 7.20 000 31575 ......... ............ A Diagnostic laryngoscopy .............................. 1.10 1.90 0.89 0.09 3.09 2.08 000 31576 ......... ............ A Laryngoscopy with biopsy ........................... 1.97 3.66 1.29 0.15 5.78 3.41 000 31577 ......... ............ A Remove foreign body, larynx ....................... 2.47 3.76 1.53 0.20 6.43 4.20 000 31578 ......... ............ A Removal of larynx lesion ............................. 2.84 4.28 1.52 0.23 7.35 4.59 000 31579 ......... ............ A Diagnostic laryngoscopy .............................. 2.26 3.78 1.48 0.19 6.23 3.93 000 31580 ......... ............ A Revision of larynx ........................................ 12.36 NA 15.92 1.00 NA 29.28 090 31582 ......... ............ A Revision of larynx ........................................ 21.59 NA 25.84 1.76 NA 49.19 090 31584 ......... ............ A Treat larynx fracture .................................... 19.61 NA 18.15 1.57 NA 39.33 090 31585 ......... ............ A Treat larynx fracture .................................... 4.63 NA 6.70 0.49 NA 11.82 090 31586 ......... ............ A Treat larynx fracture .................................... 8.02 NA 10.86 0.65 NA 19.53 090 31587 ......... ............ A Revision of larynx ........................................ 11.97 NA 9.26 0.99 NA 22.22 090 31588 ......... ............ A Revision of larynx ........................................ 13.09 NA 13.60 1.05 NA 27.74 090 31590 ......... ............ A Reinnervate larynx ....................................... 6.96 NA 15.54 0.85 NA 23.35 090 31595 ......... ............ A Larynx nerve surgery ................................... 8.33 NA 10.58 0.79 NA 19.70 090 31600 ......... ............ A Incision of windpipe ..................................... 7.17 NA 3.18 0.80 NA 11.15 000 31601 ......... ............ A Incision of windpipe ..................................... 4.44 NA 2.39 0.47 NA 7.30 000 31603 ......... ............ A Incision of windpipe ..................................... 4.14 NA 1.71 0.45 NA 6.30 000 31605 ......... ............ A Incision of windpipe ..................................... 3.57 NA 1.18 0.39 NA 5.14 000 31610 ......... ............ A Incision of windpipe ..................................... 8.75 NA 8.27 0.80 NA 17.82 090 31611 ......... ............ A Surgery/speech prosthesis .......................... 5.63 NA 6.11 0.47 NA 12.21 090 31612 ......... ............ A Puncture/clear windpipe .............................. 0.91 1.10 0.35 0.08 2.09 1.34 000 31613 ......... ............ A Repair windpipe opening ............................. 4.58 NA 5.99 0.45 NA 11.02 090 31614 ......... ............ A Repair windpipe opening ............................. 7.11 NA 8.71 0.62 NA 16.44 090 31615 ......... ............ A Visualization of windpipe ............................. 2.09 2.59 1.20 0.16 4.84 3.45 000 31622 ......... ............ A Dx bronchoscope/wash ............................... 2.78 5.71 1.06 0.19 8.68 4.03 000 31623 ......... ............ A Dx bronchoscope/brush ............................... 2.88 6.51 1.05 0.16 9.55 4.09 000 31624 ......... ............ A Dx bronchoscope/lavage ............................. 2.88 5.85 1.05 0.16 8.89 4.09 000 31625 ......... ............ A Bronchoscopy w/biopsy(s) ........................... 3.36 5.91 1.21 0.20 9.47 4.77 000 31628 ......... ............ A Bronchoscopy/lung bx, each ....................... 3.80 6.13 1.30 0.19 10.12 5.29 000 31629 ......... ............ A Bronchoscopy/needle bx, each ................... 4.09 13.50 1.40 0.17 17.76 5.66 000 31630 ......... ............ A Bronchoscopy dilate/fx repr ......................... 3.81 NA 1.70 0.35 NA 5.86 000 31631 ......... ............ A Bronchoscopy, dilate w/stent ....................... 4.36 NA 1.74 0.37 NA 6.47 000 31632 ......... ............ A Bronchoscopy/lung bx, add-l ....................... 1.03 0.83 0.31 0.19 2.05 1.53 ZZZ 31633 ......... ............ A Bronchoscopy/needle bx add-l .................... 1.32 0.93 0.40 0.17 2.42 1.89 ZZZ 31635 ......... ............ A Bronchoscopy w/fb removal ........................ 3.67 6.17 1.43 0.27 10.11 5.37 000 31640 ......... ............ A Bronchoscopy w/tumor excise ..................... 4.93 NA 2.07 0.44 NA 7.44 000 31641 ......... ............ A Bronchoscopy, treat blockage ..................... 5.02 NA 1.88 0.37 NA 7.27 000 31643 ......... ............ A Diag bronchoscope/catheter ........................ 3.49 NA 1.23 0.20 NA 4.92 000 31645 ......... ............ A Bronchoscopy, clear airways ....................... 3.16 5.21 1.13 0.18 8.55 4.47 000 31646 ......... ............ A Bronchoscopy, reclear airway ..................... 2.72 4.93 1.00 0.16 7.81 3.88 000 31656 ......... ............ A Bronchoscopy, inj for x-ray .......................... 2.17 6.44 0.83 0.13 8.74 3.13 000 31700 ......... ............ A Insertion of airway catheter ......................... 1.34 2.17 0.69 0.08 3.59 2.11 000 31708 ......... ............ A Instill airway contrast dye ............................ 1.41 2.12 0.46 0.07 3.60 1.94 000 31710 ......... ............ A Insertion of airway catheter ......................... 1.30 NA 0.41 0.09 NA 1.80 000 31715 ......... ............ A Injection for bronchus x-ray ......................... 1.11 NA 0.34 0.07 NA 1.52 000 31717 ......... ............ A Bronchial brush biopsy ................................ 2.12 8.66 0.79 0.10 10.88 3.01 000 31720 ......... ............ A Clearance of airways ................................... 1.06 0.33 0.33 0.08 1.47 1.47 000 31725 ......... ............ A Clearance of airways ................................... 1.96 0.65 0.58 0.13 2.74 2.67 000 31730 ......... ............ A Intro, windpipe wire/tube .............................. 2.85 2.20 0.99 0.22 5.27 4.06 000 31750 ......... ............ A Repair of windpipe ....................................... 13.00 NA 17.58 1.14 NA 31.72 090


## 47609

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

31755 ......... ............ A Repair of windpipe ....................................... 15.91 NA 24.51 1.41 NA 41.83 090 31760 ......... ............ A Repair of windpipe ....................................... 22.32 NA 10.76 3.08 NA 36.16 090 31766 ......... ............ A Reconstruction of windpipe ......................... 30.38 NA 13.67 4.53 NA 48.58 090 31770 ......... ............ A Repair/graft of bronchus .............................. 22.48 NA 10.28 2.76 NA 35.52 090
31775 ......... ............ A Reconstruct bronchus .................................. 23.50 NA 11.82 3.06 NA 38.38 090 31780 ......... ............ A Reconstruct windpipe .................................. 17.69 NA 11.07 1.72 NA 30.48 090 31781 ......... ............ A Reconstruct windpipe .................................. 23.49 NA 12.15 2.51 NA 38.15 090 31785 ......... ............ A Remove windpipe lesion .............................. 17.20 NA 10.20 1.54 NA 28.94 090 31786 ......... ............ A Remove windpipe lesion .............................. 23.94 NA 13.12 3.33 NA 40.39 090 31800 ......... ............ A Repair of windpipe injury ............................. 7.42 NA 9.29 0.76 NA 17.47 090 31805 ......... ............ A Repair of windpipe injury ............................. 13.11 NA 7.25 1.78 NA 22.14 090 31820 ......... ............ A Closure of windpipe lesion .......................... 4.48 5.66 3.65 0.40 10.54 8.53 090 31825 ......... ............ A Repair of windpipe defect ............................ 6.80 7.66 5.37 0.58 15.04 12.75 090 31830 ......... ............ A Revise windpipe scar ................................... 4.49 5.76 3.98 0.43 10.68 8.90 090 32000 ......... ............ A Drainage of chest ........................................ 1.54 3.10 0.48 0.09 4.73 2.11 000 32002 ......... ............ A Treatment of collapsed lung ........................ 2.19 3.24 1.06 0.13 5.56 3.38 000 32005 ......... ............ A Treat lung lining chemically ......................... 2.19 6.50 0.70 0.22 8.91 3.11 000 32020 ......... ............ A Insertion of chest tube ................................. 3.97 NA 1.35 0.42 NA 5.74 000 32035 ......... ............ A Exploration of chest ..................................... 8.66 NA 5.88 1.18 NA 15.72 090 32036 ......... ............ A Exploration of chest ..................................... 9.67 NA 6.46 1.32 NA 17.45 090 32095 ......... ............ A Biopsy through chest wall ............................ 8.35 NA 5.38 1.10 NA 14.83 090 32100 ......... ............ A Exploration/biopsy of chest .......................... 15.22 NA 7.84 2.03 NA 25.09 090 32110 ......... ............ A Explore/repair chest ..................................... 22.97 NA 10.74 3.01 NA 36.72 090 32120 ......... ............ A Re-exploration of chest ................................ 11.52 NA 7.10 1.54 NA 20.16 090 32124 ......... ............ A Explore chest free adhesions ...................... 12.70 NA 7.23 1.77 NA 21.70 090 32140 ......... ............ A Removal of lung lesion(s) ............................ 13.91 NA 7.70 1.88 NA 23.49 090 32141 ......... ............ A Remove/treat lung lesions ........................... 13.98 NA 7.57 1.86 NA 23.41 090 32150 ......... ............ A Removal of lung lesion(s) ............................ 14.13 NA 7.63 1.88 NA 23.64 090 32151 ......... ............ A Remove lung foreign body .......................... 14.19 NA 8.03 1.61 NA 23.83 090 32160 ......... ............ A Open chest heart massage ......................... 9.29 NA 5.28 1.20 NA 15.77 090 32200 ......... ............ A Drain, open, lung lesion ............................... 15.27 NA 8.62 1.25 NA 25.14 090 32201 ......... ............ A Drain, percut, lung lesion ............................. 3.99 21.04 1.30 0.24 25.27 5.53 000 32215 ......... ............ A Treat chest lining ......................................... 11.31 NA 6.92 1.50 NA 19.73 090 32220 ......... ............ A Release of lung ............................................ 23.96 NA 12.96 3.20 NA 40.12 090 32225 ......... ............ A Partial release of lung .................................. 13.94 NA 7.68 1.86 NA 23.48 090 32310 ......... ............ A Removal of chest lining ............................... 13.42 NA 7.41 1.77 NA 22.60 090 32320 ......... ............ A Free/remove chest lining ............................. 23.96 NA 12.16 3.23 NA 39.35 090 32400 ......... ............ A Needle biopsy chest lining ........................... 1.76 2.14 0.55 0.10 4.00 2.41 000 32402 ......... ............ A Open biopsy chest lining ............................. 7.55 NA 5.14 1.00 NA 13.69 090 32405 ......... ............ A Biopsy, lung or mediastinum ....................... 1.93 0.67 0.63 0.12 2.72 2.68 000 32420 ......... ............ A Puncture/clear lung ...................................... 2.18 NA 0.68 0.14 NA 3.00 000 32440 ......... ............ A Removal of lung ........................................... 24.96 NA 12.89 3.33 NA 41.18 090 32442 ......... ............ A Sleeve pneumonectomy .............................. 26.20 NA 14.75 3.14 NA 44.09 090 32445 ......... ............ A Removal of lung ........................................... 25.05 NA 14.06 3.55 NA 42.66 090 32480 ......... ............ A Partial removal of lung ................................. 23.71 NA 12.05 3.16 NA 38.92 090 32482 ......... ............ A Bilobectomy ................................................. 24.96 NA 12.90 3.30 NA 41.16 090 32484 ......... ............ A Segmentectomy ........................................... 20.66 NA 11.38 2.82 NA 34.86 090 32486 ......... ............ A Sleeve lobectomy ........................................ 23.88 NA 13.24 3.36 NA 40.48 090 32488 ......... ............ A Completion pneumonectomy ....................... 25.67 NA 13.78 3.55 NA 43.00 090 32491 ......... ............ R Lung volume reduction ................................ 21.22 NA 12.62 3.11 NA 36.95 090 32500 ......... ............ A Partial removal of lung ................................. 21.97 NA 12.35 2.92 NA 37.24 090 32501 ......... ............ A Repair bronchus add-on .............................. 4.68 NA 1.53 0.64 NA 6.85 ZZZ 32520 ......... ............ A Remove lung & revise chest ....................... 21.65 NA 11.31 2.91 NA 35.87 090 32522 ......... ............ A Remove lung & revise chest ....................... 24.16 NA 12.11 3.29 NA 39.56 090 32525 ......... ............ A Remove lung & revise chest ....................... 26.46 NA 12.79 3.49 NA 42.74 090 32540 ......... ............ A Removal of lung lesion ................................ 14.62 NA 9.63 1.96 NA 26.21 090 32601 ......... ............ A Thoracoscopy, diagnostic ............................ 5.45 NA 2.35 0.73 NA 8.53 000 32602 ......... ............ A Thoracoscopy, diagnostic ............................ 5.95 NA 2.51 0.80 NA 9.26 000 32603 ......... ............ A Thoracoscopy, diagnostic ............................ 7.80 NA 3.03 1.09 NA 11.92 000 32604 ......... ............ A Thoracoscopy, diagnostic ............................ 8.77 NA 3.44 1.12 NA 13.33 000 32605 ......... ............ A Thoracoscopy, diagnostic ............................ 6.92 NA 2.90 0.91 NA 10.73 000 32606 ......... ............ A Thoracoscopy, diagnostic ............................ 8.39 NA 3.33 0.85 NA 12.57 000 32650 ......... ............ A Thoracoscopy, surgical ................................ 10.73 NA 6.76 1.44 NA 18.93 090 32651 ......... ............ A Thoracoscopy, surgical ................................ 12.89 NA 7.23 1.75 NA 21.87 090 32652 ......... ............ A Thoracoscopy, surgical ................................ 18.63 NA 10.14 2.53 NA 31.30 090 32653 ......... ............ A Thoracoscopy, surgical ................................ 12.85 NA 6.97 1.76 NA 21.58 090 32654 ......... ............ A Thoracoscopy, surgical ................................ 12.42 NA 7.53 1.64 NA 21.59 090 32655 ......... ............ A Thoracoscopy, surgical ................................ 13.08 NA 7.24 1.75 NA 22.07 090 32656 ......... ............ A Thoracoscopy, surgical ................................ 12.89 NA 7.93 1.80 NA 22.62 090 32657 ......... ............ A Thoracoscopy, surgical ................................ 13.63 NA 7.68 1.86 NA 23.17 090 32658 ......... ............ A Thoracoscopy, surgical ................................ 11.61 NA 7.35 1.62 NA 20.58 090 32659 ......... ............ A Thoracoscopy, surgical ................................ 11.57 NA 7.45 1.55 NA 20.57 090 32660 ......... ............ A Thoracoscopy, surgical ................................ 17.40 NA 9.47 1.87 NA 28.74 090 32661 ......... ............ A Thoracoscopy, surgical ................................ 13.23 NA 7.79 1.77 NA 22.79 090 32662 ......... ............ A Thoracoscopy, surgical ................................ 16.42 NA 8.81 2.26 NA 27.49 090


## 47610

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

32663 ......... ............ A Thoracoscopy, surgical ................................ 18.44 NA 10.75 2.56 NA 31.75 090 32664 ......... ............ A Thoracoscopy, surgical ................................ 14.18 NA 7.63 2.06 NA 23.87 090 32665 ......... ............ A Thoracoscopy, surgical ................................ 15.52 NA 8.13 2.03 NA 25.68 090 32800 ......... ............ A Repair lung hernia ....................................... 13.67 NA 7.45 1.91 NA 23.03 090 32810 ......... ............ A Close chest after drainage .......................... 13.03 NA 7.55 1.83 NA 22.41 090 32815 ......... ............ A Close bronchial fistula ................................. 23.12 NA 10.99 3.11 NA 37.22 090 32820 ......... ............ A Reconstruct injured chest ............................ 21.45 NA 12.22 3.02 NA 36.69 090 32851 ......... ............ A Lung transplant, single ................................ 38.57 NA 27.68 5.44 NA 71.69 090 32852 ......... ............ A Lung transplant with bypass ........................ 41.74 NA 33.18 5.79 NA 80.71 090 32853 ......... ............ A Lung transplant, double ............................... 47.74 NA 31.75 6.35 NA 85.84 090 32854 ......... ............ A Lung transplant with bypass ........................ 50.90 NA 34.78 7.07 NA 92.75 090 32900 ......... ............ A Removal of rib(s) ......................................... 20.24 NA 9.90 2.79 NA 32.93 090 32905 ......... ............ A Revise & repair chest wall ........................... 20.72 NA 10.14 2.87 NA 33.73 090 32906 ......... ............ A Revise & repair chest wall ........................... 26.73 NA 12.08 3.74 NA 42.55 090 32940 ......... ............ A Revision of lung ........................................... 19.40 NA 9.49 2.66 NA 31.55 090 32960 ......... ............ A Therapeutic pneumothorax .......................... 1.84 1.76 0.57 0.19 3.79 2.60 000 32997 ......... ............ A Total lung lavage ......................................... 5.99 NA 1.90 0.42 NA 8.31 000 33010 ......... ............ A Drainage of heart sac .................................. 2.24 NA 0.78 0.15 NA 3.17 000 33011 ......... ............ A Repeat drainage of heart sac ...................... 2.24 NA 0.81 0.17 NA 3.22 000 33015 ......... ............ A Incision of heart sac .................................... 6.79 NA 4.95 0.64 NA 12.38 090 33020 ......... ............ A Incision of heart sac .................................... 12.59 NA 6.80 1.62 NA 21.01 090 33025 ......... ............ A Incision of heart sac .................................... 12.07 NA 6.36 1.60 NA 20.03 090 33030 ......... ............ A Partial removal of heart sac ........................ 18.68 NA 9.54 2.53 NA 30.75 090 33031 ......... ............ A Partial removal of heart sac ........................ 21.76 NA 10.05 2.89 NA 34.70 090 33050 ......... ............ A Removal of heart sac lesion ........................ 14.34 NA 7.86 1.83 NA 24.03 090 33120 ......... ............ A Removal of heart lesion ............................... 24.52 NA 11.62 3.25 NA 39.39 090 33130 ......... ............ A Removal of heart lesion ............................... 21.36 NA 10.14 2.80 NA 34.30 090 33140 ......... ............ A Heart revascularize (tmr) ............................. 19.97 NA 10.89 2.66 NA 33.52 090 33141 ......... ............ A Heart tmr w/other procedure ....................... 4.83 NA 1.57 0.62 NA 7.02 ZZZ 33200 ......... ............ A Insertion of heart pacemaker ....................... 12.46 NA 6.94 1.52 NA 20.92 090 33201 ......... ............ A Insertion of heart pacemaker ....................... 10.16 NA 6.69 1.18 NA 18.03 090 33206 ......... ............ A Insertion of heart pacemaker ....................... 6.66 NA 4.54 0.54 NA 11.74 090 33207 ......... ............ A Insertion of heart pacemaker ....................... 8.03 NA 4.73 0.63 NA 13.39 090 33208 ......... ............ A Insertion of heart pacemaker ....................... 8.12 NA 4.84 0.60 NA 13.56 090 33210 ......... ............ A Insertion of heart electrode .......................... 3.30 NA 1.25 0.20 NA 4.75 000 33211 ......... ............ A Insertion of heart electrode .......................... 3.39 NA 1.31 0.23 NA 4.93 000 33212 ......... ............ A Insertion of pulse generator ......................... 5.51 NA 3.40 0.47 NA 9.38 090 33213 ......... ............ A Insertion of pulse generator ......................... 6.36 NA 3.76 0.50 NA 10.62 090 33214 ......... ............ A Upgrade of pacemaker system ................... 7.74 NA 4.97 0.58 NA 13.29 090 33215 ......... ............ A Reposition pacing-defib lead ....................... 4.75 NA 3.18 0.39 NA 8.32 090 33216 ......... ............ A Insert lead pace-defib, one .......................... 5.77 NA 4.28 0.39 NA 10.44 090 33217 ......... ............ A Insert lead pace-defib, dual ......................... 5.74 NA 4.31 0.43 NA 10.48 090 33218 ......... ............ A Repair lead pace-defib, one ........................ 5.43 NA 4.34 0.43 NA 10.20 090 33220 ......... ............ A Repair lead pace-defib, dual ....................... 5.51 NA 4.31 0.43 NA 10.25 090 33222 ......... ............ A Revise pocket, pacemaker .......................... 4.95 NA 4.34 0.42 NA 9.71 090 33223 ......... ............ A Revise pocket, pacing-defib ........................ 6.45 NA 4.61 0.47 NA 11.53 090 33224 ......... ............ A Insert pacing lead & connect ....................... 9.04 NA 3.99 0.43 NA 13.46 000 33225 ......... ............ A L ventric pacing lead add-on ....................... 8.33 NA 3.25 0.43 NA 12.01 ZZZ 33226 ......... ............ A Reposition l ventric lead .............................. 8.68 NA 3.81 0.43 NA 12.92 000 33233 ......... ............ A Removal of pacemaker system ................... 3.29 NA 3.28 0.24 NA 6.81 090 33234 ......... ............ A Removal of pacemaker system ................... 7.81 NA 4.92 0.60 NA 13.33 090 33235 ......... ............ A Removal pacemaker electrode .................... 9.39 NA 6.82 0.76 NA 16.97 090 33236 ......... ............ A Remove electrode/thoracotomy ................... 12.58 NA 7.45 1.72 NA 21.75 090 33237 ......... ............ A Remove electrode/thoracotomy ................... 13.69 NA 7.79 1.63 NA 23.11 090 33238 ......... ............ A Remove electrode/thoracotomy ................... 15.20 NA 8.22 1.94 NA 25.36 090 33240 ......... ............ A Insert pulse generator .................................. 7.59 NA 4.63 0.50 NA 12.72 090 33241 ......... ............ A Remove pulse generator ............................. 3.24 NA 2.97 0.22 NA 6.43 090 33243 ......... ............ A Remove eltrd/thoracotomy ........................... 22.61 NA 11.45 2.80 NA 36.86 090 33244 ......... ............ A Remove eltrd, transven ............................... 13.74 NA 8.90 1.02 NA 23.66 090 33245 ......... ............ A Insert epic eltrd pace-defib .......................... 14.28 NA 7.99 1.85 NA 24.12 090 33246 ......... ............ A Insert epic eltrd/generator ............................ 20.68 NA 10.35 2.46 NA 33.49 090 33249 ......... ............ A Eltrd/insert pace-defib .................................. 14.21 NA 8.44 0.86 NA 23.51 090 33250 ......... ............ A Ablate heart dysrhythm focus ...................... 21.82 NA 11.05 2.79 NA 35.66 090 33251 ......... ............ A Ablate heart dysrhythm focus ...................... 24.84 NA 11.68 2.87 NA 39.39 090
33253 ......... ............ A Reconstruct atria .......................................... 31.01 NA 13.84 4.04 NA 48.89 090 33261 ......... ............ A Ablate heart dysrhythm focus ...................... 24.84 NA 11.79 2.82 NA 39.45 090 33282 ......... ............ A Implant pat-active ht record ......................... 4.16 NA 4.07 0.25 NA 8.48 090 33284 ......... ............ A Remove pat-active ht record ....................... 2.50 NA 3.55 0.16 NA 6.21 090 33300 ......... ............ A Repair of heart wound ................................. 17.89 NA 9.25 2.33 NA 29.47 090 33305 ......... ............ A Repair of heart wound ................................. 21.41 NA 10.64 2.79 NA 34.84 090 33310 ......... ............ A Exploratory heart surgery ............................ 18.48 NA 9.60 2.58 NA 30.66 090 33315 ......... ............ A Exploratory heart surgery ............................ 22.34 NA 10.90 2.87 NA 36.11 090 33320 ......... ............ A Repair major blood vessel(s) ....................... 16.76 NA 8.25 1.83 NA 26.84 090 33321 ......... ............ A Repair major vessel ..................................... 20.17 NA 9.81 2.69 NA 32.67 090 33322 ......... ............ A Repair major blood vessel(s) ....................... 20.59 NA 10.38 2.65 NA 33.62 090


## 47611

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

33330 ......... ............ A Insert major vessel graft .............................. 21.40 NA 10.28 2.65 NA 34.33 090 33332 ......... ............ A Insert major vessel graft .............................. 23.92 NA 10.53 3.11 NA 37.56 090 33335 ......... ............ A Insert major vessel graft .............................. 29.96 NA 13.35 3.86 NA 47.17 090 33400 ......... ............ A Repair of aortic valve ................................... 28.46 NA 15.65 3.69 NA 47.80 090 33401 ......... ............ A Valvuloplasty, open ...................................... 23.87 NA 13.50 1.30 NA 38.67 090 33403 ......... ............ A Valvuloplasty, w/cp bypass .......................... 24.85 NA 14.30 3.53 NA 42.68 090 33404 ......... ............ A Prepare heart-aorta conduit ......................... 28.50 NA 14.53 4.02 NA 47.05 090 33405 ......... ............ A Replacement of aortic valve ........................ 34.95 NA 18.28 4.55 NA 57.78 090 33406 ......... ............ A Replacement of aortic valve ........................ 37.44 NA 19.11 4.93 NA 61.48 090 33410 ......... ............ A Replacement of aortic valve ........................ 32.41 NA 16.58 4.05 NA 53.04 090 33411 ......... ............ A Replacement of aortic valve ........................ 36.20 NA 18.74 4.86 NA 59.80 090 33412 ......... ............ A Replacement of aortic valve ........................ 41.94 NA 20.40 5.61 NA 67.95 090 33413 ......... ............ A Replacement of aortic valve ........................ 43.43 NA 20.80 5.94 NA 70.17 090 33414 ......... ............ A Repair of aortic valve ................................... 30.30 NA 14.15 4.00 NA 48.45 090 33415 ......... ............ A Revision, subvalvular tissue ........................ 27.11 NA 12.05 3.56 NA 42.72 090 33416 ......... ............ A Revise ventricle muscle ............................... 30.30 NA 13.52 4.14 NA 47.96 090 33417 ......... ............ A Repair of aortic valve ................................... 28.49 NA 13.63 3.96 NA 46.08 090 33420 ......... ............ A Revision of mitral valve ............................... 22.67 NA 9.61 1.89 NA 34.17 090 33422 ......... ............ A Revision of mitral valve ............................... 25.90 NA 13.64 3.39 NA 42.93 090 33425 ......... ............ A Repair of mitral valve ................................... 26.96 NA 13.05 3.59 NA 43.60 090 33426 ......... ............ A Repair of mitral valve ................................... 32.95 NA 17.13 4.25 NA 54.33 090 33427 ......... ............ A Repair of mitral valve ................................... 39.94 NA 19.35 5.27 NA 64.56 090 33430 ......... ............ A Replacement of mitral valve ........................ 33.45 NA 17.29 4.36 NA 55.10 090 33460 ......... ............ A Revision of tricuspid valve ........................... 23.56 NA 11.32 3.23 NA 38.11 090 33463 ......... ............ A Valvuloplasty, tricuspid ................................ 25.58 NA 12.92 3.36 NA 41.86 090 33464 ......... ............ A Valvuloplasty, tricuspid ................................ 27.29 NA 13.53 3.52 NA 44.34 090 33465 ......... ............ A Replace tricuspid valve ................................ 28.75 NA 12.98 3.88 NA 45.61 090 33468 ......... ............ A Revision of tricuspid valve ........................... 30.07 NA 13.68 4.35 NA 48.10 090 33470 ......... ............ A Revision of pulmonary valve ....................... 20.78 NA 10.71 2.01 NA 33.50 090 33471 ......... ............ A Valvotomy, pulmonary valve ........................ 22.22 NA 9.77 3.31 NA 35.30 090 33472 ......... ............ A Revision of pulmonary valve ....................... 22.22 NA 11.89 3.11 NA 37.22 090 33474 ......... ............ A Revision of pulmonary valve ....................... 23.01 NA 10.89 2.70 NA 36.60 090 33475 ......... ............ A Replacement, pulmonary valve ................... 32.95 NA 15.41 4.30 NA 52.66 090 33476 ......... ............ A Revision of heart chamber .......................... 25.73 NA 11.97 2.97 NA 40.67 090 33478 ......... ............ A Revision of heart chamber .......................... 26.70 NA 13.06 3.85 NA 43.61 090 33496 ......... ............ A Repair, prosth valve clot .............................. 27.21 NA 12.76 3.60 NA 43.57 090 33500 ......... ............ A Repair heart vessel fistula ........................... 25.51 NA 11.47 3.33 NA 40.31 090 33501 ......... ............ A Repair heart vessel fistula ........................... 17.75 NA 8.29 2.04 NA 28.08 090 33502 ......... ............ A Coronary artery correction ........................... 21.01 NA 11.10 2.11 NA 34.22 090 33503 ......... ............ A Coronary artery graft ................................... 21.75 NA 9.78 1.84 NA 33.37 090 33504 ......... ............ A Coronary artery graft ................................... 24.62 NA 11.84 3.32 NA 39.78 090 33505 ......... ............ A Repair artery w/tunnel ................................. 26.80 NA 12.93 2.67 NA 42.40 090 33506 ......... ............ A Repair artery, translocation ......................... 35.45 NA 14.59 3.85 NA 53.89 090 33508 ......... ............ A Endoscopic vein harvest .............................. 0.31 NA 0.10 0.88 NA 1.29 ZZZ 33510 ......... ............ A CABG, vein, single ...................................... 28.96 NA 16.33 3.75 NA 49.04 090 33511 ......... ............ A CABG, vein, two .......................................... 29.96 NA 17.07 3.83 NA 50.86 090 33512 ......... ............ A CABG, vein, three ........................................ 31.75 NA 17.60 4.13 NA 53.48 090 33513 ......... ............ A CABG, vein, four .......................................... 31.95 NA 17.78 4.16 NA 53.89 090 33514 ......... ............ A CABG, vein, five .......................................... 32.70 NA 18.05 4.00 NA 54.75 090 33516 ......... ............ A Cabg, vein, six or more ............................... 34.95 NA 18.79 4.51 NA 58.25 090 33517 ......... ............ A CABG, artery-vein, single ............................ 2.57 NA 0.84 0.33 NA 3.74 ZZZ 33518 ......... ............ A CABG, artery-vein, two ................................ 4.84 NA 1.58 0.63 NA 7.05 ZZZ 33519 ......... ............ A CABG, artery-vein, three ............................. 7.11 NA 2.32 0.92 NA 10.35 ZZZ 33521 ......... ............ A CABG, artery-vein, four ............................... 9.39 NA 3.07 1.20 NA 13.66 ZZZ 33522 ......... ............ A CABG, artery-vein, five ................................ 11.65 NA 3.80 1.49 NA 16.94 ZZZ 33523 ......... ............ A Cabg, art-vein, six or more .......................... 13.93 NA 4.52 1.81 NA 20.26 ZZZ 33530 ......... ............ A Coronary artery, bypass/reop ...................... 5.85 NA 1.90 0.77 NA 8.52 ZZZ 33533 ......... ............ A CABG, arterial, single .................................. 29.96 NA 16.46 3.86 NA 50.28 090 33534 ......... ............ A CABG, arterial, two ...................................... 32.15 NA 17.70 4.13 NA 53.98 090 33535 ......... ............ A CABG, arterial, three ................................... 34.45 NA 18.13 4.43 NA 57.01 090 33536 ......... ............ A Cabg, arterial, four or more ......................... 37.44 NA 18.28 4.60 NA 60.32 090 33542 ......... ............ A Removal of heart lesion ............................... 28.81 NA 13.01 3.79 NA 45.61 090 33545 ......... ............ A Repair of heart damage ............................... 36.72 NA 15.64 4.81 NA 57.17 090 33572 ......... ............ A Open coronary endarterectomy ................... 4.44 NA 1.45 0.58 NA 6.47 ZZZ 33600 ......... ............ A Closure of valve ........................................... 29.47 NA 12.55 4.13 NA 46.15 090 33602 ......... ............ A Closure of valve ........................................... 28.50 NA 12.46 3.25 NA 44.21 090 33606 ......... ............ A Anastomosis/artery-aorta ............................. 30.69 NA 13.69 4.33 NA 48.71 090 33608 ......... ............ A Repair anomaly w/conduit ........................... 31.04 NA 14.11 4.41 NA 49.56 090 33610 ......... ............ A Repair by enlargement ................................ 30.56 NA 13.66 4.56 NA 48.78 090 33611 ......... ............ A Repair double ventricle ................................ 33.95 NA 14.15 4.11 NA 52.21 090 33612 ......... ............ A Repair double ventricle ................................ 34.95 NA 15.17 5.18 NA 55.30 090 33615 ......... ............ A Repair, modified fontan ............................... 33.95 NA 13.27 2.90 NA 50.12 090 33617 ......... ............ A Repair single ventricle ................................. 36.94 NA 16.02 4.88 NA 57.84 090 33619 ......... ............ A Repair single ventricle ................................. 44.93 NA 20.82 3.60 NA 69.35 090 33641 ......... ............ A Repair heart septum defect ......................... 21.36 NA 9.59 2.73 NA 33.68 090


## 47612

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

33645 ......... ............ A Revision of heart veins ................................ 24.78 NA 11.78 3.26 NA 39.82 090 33647 ......... ............ A Repair heart septum defects ....................... 28.69 NA 13.79 3.12 NA 45.60 090 33660 ......... ............ A Repair of heart defects ................................ 29.96 NA 13.50 3.88 NA 47.34 090 33665 ......... ............ A Repair of heart defects ................................ 28.56 NA 13.85 4.21 NA 46.62 090 33670 ......... ............ A Repair of heart chambers ............................ 34.95 NA 13.20 3.47 NA 51.62 090 33681 ......... ............ A Repair heart septum defect ......................... 30.56 NA 14.69 4.03 NA 49.28 090 33684 ......... ............ A Repair heart septum defect ......................... 29.61 NA 13.63 4.08 NA 47.32 090 33688 ......... ............ A Repair heart septum defect ......................... 30.57 NA 10.52 4.39 NA 45.48 090 33690 ......... ............ A Reinforce pulmonary artery ......................... 19.52 NA 10.19 2.66 NA 32.37 090 33692 ......... ............ A Repair of heart defects ................................ 30.70 NA 13.94 4.58 NA 49.22 090 33694 ......... ............ A Repair of heart defects ................................ 33.95 NA 14.23 3.71 NA 51.89 090 33697 ......... ............ A Repair of heart defects ................................ 35.95 NA 14.87 4.32 NA 55.14 090 33702 ......... ............ A Repair of heart defects ................................ 26.50 NA 12.58 4.00 NA 43.08 090 33710 ......... ............ A Repair of heart defects ................................ 29.67 NA 14.00 3.01 NA 46.68 090 33720 ......... ............ A Repair of heart defect .................................. 26.52 NA 12.29 3.60 NA 42.41 090 33722 ......... ............ A Repair of heart defect .................................. 28.37 NA 13.88 4.33 NA 46.58 090 33730 ......... ............ A Repair heart-vein defect(s) .......................... 34.20 NA 14.13 4.32 NA 52.65 090 33732 ......... ............ A Repair heart-vein defect .............................. 28.12 NA 13.41 2.88 NA 44.41 090 33735 ......... ............ A Revision of heart chamber .......................... 21.36 NA 9.06 1.56 NA 31.98 090 33736 ......... ............ A Revision of heart chamber .......................... 23.48 NA 11.87 2.50 NA 37.85 090 33737 ......... ............ A Revision of heart chamber .......................... 21.73 NA 10.95 3.30 NA 35.98 090 33750 ......... ............ A Major vessel shunt ....................................... 21.38 NA 10.24 2.56 NA 34.18 090 33755 ......... ............ A Major vessel shunt ....................................... 21.76 NA 8.82 3.24 NA 33.82 090 33762 ......... ............ A Major vessel shunt ....................................... 21.76 NA 10.17 3.18 NA 35.11 090 33764 ......... ............ A Major vessel shunt & graft ........................... 21.76 NA 10.25 2.15 NA 34.16 090 33766 ......... ............ A Major vessel shunt ....................................... 22.73 NA 11.68 3.39 NA 37.80 090 33767 ......... ............ A Major vessel shunt ....................................... 24.46 NA 11.75 2.74 NA 38.95 090 33770 ......... ............ A Repair great vessels defect ......................... 36.94 NA 14.69 5.42 NA 57.05 090 33771 ......... ............ A Repair great vessels defect ......................... 34.60 NA 12.42 5.63 NA 52.65 090 33774 ......... ............ A Repair great vessels defect ......................... 30.93 NA 14.75 4.70 NA 50.38 090 33775 ......... ............ A Repair great vessels defect ......................... 32.15 NA 15.02 5.23 NA 52.40 090 33776 ......... ............ A Repair great vessels defect ......................... 33.99 NA 15.80 5.52 NA 55.31 090 33777 ......... ............ A Repair great vessels defect ......................... 33.41 NA 14.87 5.44 NA 53.72 090 33778 ......... ............ A Repair great vessels defect ......................... 39.94 NA 16.89 5.83 NA 62.66 090 33779 ......... ............ A Repair great vessels defect ......................... 36.16 NA 15.39 1.74 NA 53.29 090 33780 ......... ............ A Repair great vessels defect ......................... 41.69 NA 19.06 5.15 NA 65.90 090 33781 ......... ............ A Repair great vessels defect ......................... 36.40 NA 13.48 5.92 NA 55.80 090 33786 ......... ............ A Repair arterial trunk ..................................... 38.94 NA 16.70 2.03 NA 57.67 090 33788 ......... ............ A Revision of pulmonary artery ....................... 26.58 NA 11.95 4.02 NA 42.55 090 33800 ......... ............ A Aortic suspension ........................................ 16.22 NA 8.16 2.28 NA 26.66 090 33802 ......... ............ A Repair vessel defect .................................... 17.63 NA 9.24 1.66 NA 28.53 090 33803 ......... ............ A Repair vessel defect .................................... 19.57 NA 9.78 3.17 NA 32.52 090 33813 ......... ............ A Repair septal defect ..................................... 20.62 NA 10.93 1.13 NA 32.68 090 33814 ......... ............ A Repair septal defect ..................................... 25.73 NA 12.66 3.56 NA 41.95 090 33820 ......... ............ A Revise major vessel .................................... 16.27 NA 8.39 2.19 NA 26.85 090 33822 ......... ............ A Revise major vessel .................................... 17.29 NA 8.98 1.92 NA 28.19 090 33824 ......... ............ A Revise major vessel .................................... 19.49 NA 10.01 2.91 NA 32.41 090 33840 ......... ............ A Remove aorta constriction ........................... 20.60 NA 10.31 2.45 NA 33.36 090 33845 ......... ............ A Remove aorta constriction ........................... 22.09 NA 11.36 3.13 NA 36.58 090 33851 ......... ............ A Remove aorta constriction ........................... 21.24 NA 10.71 2.81 NA 34.76 090 33852 ......... ............ A Repair septal defect ..................................... 23.67 NA 11.38 2.55 NA 37.60 090 33853 ......... ............ A Repair septal defect ..................................... 31.67 NA 14.84 4.13 NA 50.64 090 33860 ......... ............ A Ascending aortic graft .................................. 37.94 NA 16.46 5.05 NA 59.45 090 33861 ......... ............ A Ascending aortic graft .................................. 41.94 NA 17.72 5.45 NA 65.11 090 33863 ......... ............ A Ascending aortic graft .................................. 44.93 NA 18.70 5.46 NA 69.09 090 33870 ......... ............ A Transverse aortic arch graft ........................ 43.93 NA 18.39 5.96 NA 68.28 090 33875 ......... ............ A Thoracic aortic graft ..................................... 33.01 NA 14.11 4.43 NA 51.55 090 33877 ......... ............ A Thoracoabdominal graft ............................... 42.54 NA 16.33 5.46 NA 64.33 090 33910 ......... ............ A Remove lung artery emboli ......................... 24.55 NA 11.45 3.32 NA 39.32 090 33915 ......... ............ A Remove lung artery emboli ......................... 20.99 NA 9.64 1.73 NA 32.36 090 33916 ......... ............ A Surgery of great vessel ............................... 25.79 NA 11.37 3.47 NA 40.63 090 33917 ......... ............ A Repair pulmonary artery .............................. 24.46 NA 12.21 3.25 NA 39.92 090 33918 ......... ............ A Repair pulmonary atresia ............................ 26.41 NA 12.13 4.12 NA 42.66 090 33919 ......... ............ A Repair pulmonary atresia ............................ 39.94 NA 17.52 4.45 NA 61.91 090 33920 ......... ............ A Repair pulmonary atresia ............................ 31.90 NA 13.85 3.50 NA 49.25 090 33922 ......... ............ A Transect pulmonary artery ........................... 23.48 NA 10.92 3.25 NA 37.65 090 33924 ......... ............ A Remove pulmonary shunt ............................ 5.49 NA 1.83 0.70 NA 8.02 ZZZ 33935 ......... ............ R Transplantation, heart/lung .......................... 60.87 NA 28.77 9.19 NA 98.83 090 33945 ......... ............ R Transplantation of heart ............................... 42.04 NA 21.38 5.91 NA 69.33 090
33960 ......... ............ A External circulation assist ............................ 19.33 NA 4.90 2.46 NA 26.69 000
33961 ......... ............ A External circulation assist ............................ 10.91 NA 3.61 1.08 NA 15.60 ZZZ 33967 ......... ............ A Insert ia percut device ................................. 4.84 NA 1.83 0.35 NA 7.02 000
33968 ......... ............ A Remove aortic assist device ........................ 0.64 NA 0.23 0.06 NA 0.93 000
33970 ......... ............ A Aortic circulation assist ................................ 6.74 NA 2.28 0.81 NA 9.83 000
33971 ......... ............ A Aortic circulation assist ................................ 9.68 NA 6.03 1.21 NA 16.92 090


## 47613

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

33973 ......... ............ A Insert balloon device .................................... 9.75 NA 3.30 1.18 NA 14.23 000 33974 ......... ............ A Remove intra-aortic balloon ......................... 14.39 NA 7.91 1.71 NA 24.01 090 33975 ......... ............ A Implant ventricular device ............................ 20.97 NA 6.27 2.95 NA 30.19 XXX 33976 ......... ............ A Implant ventricular device ............................ 22.97 NA 7.53 2.73 NA 33.23 XXX 33977 ......... ............ A Remove ventricular device .......................... 19.26 NA 11.08 2.68 NA 33.02 090 33978 ......... ............ A Remove ventricular device .......................... 21.70 NA 11.75 3.03 NA 36.48 090 33979 ......... ............ A Insert intracorporeal device ......................... 45.93 NA 14.89 4.80 NA 65.62 XXX 33980 ......... ............ A Remove intracorporeal device ..................... 56.17 NA 25.22 5.55 NA 86.94 090 34001 ......... ............ A Removal of artery clot ................................. 12.89 NA 6.71 1.76 NA 21.36 090 34051 ......... ............ A Removal of artery clot ................................. 15.19 NA 7.77 2.20 NA 25.16 090 34101 ......... ............ A Removal of artery clot ................................. 9.99 NA 5.35 1.36 NA 16.70 090 34111 ......... ............ A Removal of arm artery clot .......................... 9.99 NA 5.35 1.36 NA 16.70 090 34151 ......... ............ A Removal of artery clot ................................. 24.96 NA 10.39 3.34 NA 38.69 090 34201 ......... ............ A Removal of artery clot ................................. 10.01 NA 5.41 1.38 NA 16.80 090 34203 ......... ............ A Removal of leg artery clot ........................... 16.48 NA 8.05 2.25 NA 26.78 090 34401 ......... ............ A Removal of vein clot .................................... 24.96 NA 10.65 3.00 NA 38.61 090 34421 ......... ............ A Removal of vein clot .................................... 11.98 NA 6.28 1.48 NA 19.74 090 34451 ......... ............ A Removal of vein clot .................................... 26.96 NA 11.42 3.65 NA 42.03 090 34471 ......... ............ A Removal of vein clot .................................... 10.16 NA 5.31 0.88 NA 16.35 090 34490 ......... ............ A Removal of vein clot .................................... 9.85 NA 5.43 1.34 NA 16.62 090 34501 ......... ............ A Repair valve, femoral vein ........................... 15.98 NA 8.50 2.31 NA 26.79 090 34502 ......... ............ A Reconstruct vena cava ................................ 26.91 NA 12.28 3.41 NA 42.60 090 34510 ......... ............ A Transposition of vein valve .......................... 18.92 NA 9.43 2.39 NA 30.74 090 34520 ......... ............ A Cross-over vein graft ................................... 17.92 NA 8.48 1.63 NA 28.03 090 34530 ......... ............ A Leg vein fusion ............................................ 16.62 NA 8.61 2.16 NA 27.39 090 34800 ......... ............ A Endovasc abdo repair w/tube ...................... 20.72 NA 9.15 2.35 NA 32.22 090 34802 ......... ............ A Endovasc abdo repr w/device ..................... 22.97 NA 9.77 2.34 NA 35.08 090 34804 ......... ............ A Endovasc abdo repr w/device ..................... 22.97 NA 9.79 2.35 NA 35.11 090 34805 ......... ............ A Endovasc abdo repair w/pros ...................... 21.85 NA 9.66 1.99 NA 33.50 090
34808 ......... ............ A Endovasc abdo occlud device ..................... 4.12 NA 1.37 0.50 NA 5.99 ZZZ 34812 ......... ............ A Xpose for endoprosth, femorl ...................... 6.74 NA 2.23 1.09 NA 10.06 000 34813 ......... ............ A Femoral endovas graft add-on .................... 4.79 NA 1.57 0.65 NA 7.01 ZZZ 34820 ......... ............ A Xpose for endoprosth, iliac .......................... 9.74 NA 3.23 1.35 NA 14.32 000 34825 ......... ............ A Endovasc extend prosth, init ....................... 11.98 NA 6.13 1.29 NA 19.40 090 34826 ......... ............ A Endovasc exten prosth, add-l ...................... 4.12 NA 1.37 0.45 NA 5.94 ZZZ 34830 ......... ............ A Open aortic tube prosth repr ....................... 32.54 NA 13.68 3.75 NA 49.97 090 34831 ......... ............ A Open aortoiliac prosth repr .......................... 35.29 NA 11.73 3.95 NA 50.97 090 34832 ......... ............ A Open aortofemor prosth repr ....................... 35.29 NA 14.60 4.05 NA 53.94 090 34833 ......... ............ A Xpose for endoprosth, iliac .......................... 11.98 NA 4.42 0.84 NA 17.24 000 34834 ......... ............ A Xpose, endoprosth, brachial ........................ 5.34 NA 2.19 0.59 NA 8.12 000 34900 ......... ............ A Endovasc iliac repr w/graft .......................... 16.36 NA 7.59 1.80 NA 25.75 090 35001 ......... ............ A Repair defect of artery ................................. 19.61 NA 9.54 2.64 NA 31.79 090 35002 ......... ............ A Repair artery rupture, neck .......................... 20.97 NA 9.68 2.38 NA 33.03 090 35005 ......... ............ A Repair defect of artery ................................. 18.09 NA 8.83 2.29 NA 29.21 090 35011 ......... ............ A Repair defect of artery ................................. 17.97 NA 7.97 2.42 NA 28.36 090 35013 ......... ............ A Repair artery rupture, arm ........................... 21.97 NA 9.66 2.98 NA 34.61 090 35021 ......... ............ A Repair defect of artery ................................. 19.62 NA 9.41 2.43 NA 31.46 090 35022 ......... ............ A Repair artery rupture, chest ......................... 23.15 NA 9.86 2.32 NA 35.33 090 35045 ......... ............ A Repair defect of arm artery ......................... 17.54 NA 7.53 2.38 NA 27.45 090 35081 ......... ............ A Repair defect of artery ................................. 27.97 NA 11.44 3.66 NA 43.07 090 35082 ......... ............ A Repair artery rupture, aorta ......................... 38.44 NA 15.27 5.10 NA 58.81 090 35091 ......... ............ A Repair defect of artery ................................. 35.35 NA 13.55 4.76 NA 53.66 090 35092 ......... ............ A Repair artery rupture, aorta ......................... 44.93 NA 17.61 5.97 NA 68.51 090 35102 ......... ............ A Repair defect of artery ................................. 30.71 NA 12.34 4.09 NA 47.14 090 35103 ......... ............ A Repair artery rupture, groin ......................... 40.44 NA 15.82 5.49 NA 61.75 090 35111 ......... ............ A Repair defect of artery ................................. 24.96 NA 10.45 3.35 NA 38.76 090 35112 ......... ............ A Repair artery rupture,spleen ........................ 29.96 NA 11.95 3.89 NA 45.80 090 35121 ......... ............ A Repair defect of artery ................................. 29.96 NA 12.35 4.05 NA 46.36 090 35122 ......... ............ A Repair artery rupture, belly .......................... 34.95 NA 13.78 4.48 NA 53.21 090 35131 ......... ............ A Repair defect of artery ................................. 24.96 NA 10.73 3.49 NA 39.18 090 35132 ......... ............ A Repair artery rupture, groin ......................... 29.96 NA 12.36 4.07 NA 46.39 090 35141 ......... ............ A Repair defect of artery ................................. 19.97 NA 8.90 2.72 NA 31.59 090 35142 ......... ............ A Repair artery rupture, thigh ......................... 23.27 NA 10.35 3.11 NA 36.73 090 35151 ......... ............ A Repair defect of artery ................................. 22.61 NA 9.98 3.04 NA 35.63 090 35152 ......... ............ A Repair artery rupture, knee ......................... 25.58 NA 11.36 3.35 NA 40.29 090 35161 ......... ............ A Repair defect of artery ................................. 18.73 NA 9.13 2.48 NA 30.34 090 35162 ......... ............ A Repair artery rupture ................................... 19.75 NA 9.56 2.75 NA 32.06 090 35180 ......... ............ A Repair blood vessel lesion .......................... 13.60 NA 6.94 1.97 NA 22.51 090 35182 ......... ............ A Repair blood vessel lesion .......................... 29.96 NA 12.78 4.09 NA 46.83 090 35184 ......... ............ A Repair blood vessel lesion .......................... 17.97 NA 8.29 2.45 NA 28.71 090 35188 ......... ............ A Repair blood vessel lesion .......................... 14.26 NA 7.62 1.98 NA 23.86 090 35189 ......... ............ A Repair blood vessel lesion .......................... 27.96 NA 11.94 3.68 NA 43.58 090 35190 ......... ............ A Repair blood vessel lesion .......................... 12.73 NA 6.47 1.71 NA 20.91 090 35201 ......... ............ A Repair blood vessel lesion .......................... 16.12 NA 7.98 2.13 NA 26.23 090 35206 ......... ............ A Repair blood vessel lesion .......................... 13.23 NA 6.57 1.83 NA 21.63 090


## 47614

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

35207 ......... ............ A Repair blood vessel lesion .......................... 10.13 NA 7.53 1.46 NA 19.12 090 35211 ......... ............ A Repair blood vessel lesion .......................... 22.09 NA 10.64 2.89 NA 35.62 090 35216 ......... ............ A Repair blood vessel lesion .......................... 18.72 NA 8.99 2.49 NA 30.20 090 35221 ......... ............ A Repair blood vessel lesion .......................... 24.35 NA 9.92 3.20 NA 37.47 090 35226 ......... ............ A Repair blood vessel lesion .......................... 14.48 NA 7.46 1.89 NA 23.83 090 35231 ......... ............ A Repair blood vessel lesion .......................... 19.97 NA 9.75 2.74 NA 32.46 090 35236 ......... ............ A Repair blood vessel lesion .......................... 17.08 NA 7.90 2.35 NA 27.33 090 35241 ......... ............ A Repair blood vessel lesion .......................... 23.09 NA 11.14 3.00 NA 37.23 090 35246 ......... ............ A Repair blood vessel lesion .......................... 26.41 NA 11.43 3.21 NA 41.05 090 35251 ......... ............ A Repair blood vessel lesion .......................... 30.15 NA 11.77 3.99 NA 45.91 090 35256 ......... ............ A Repair blood vessel lesion .......................... 18.33 NA 8.37 2.51 NA 29.21 090 35261 ......... ............ A Repair blood vessel lesion .......................... 17.77 NA 8.00 2.41 NA 28.18 090 35266 ......... ............ A Repair blood vessel lesion .......................... 14.89 NA 7.01 1.98 NA 23.88 090 35271 ......... ............ A Repair blood vessel lesion .......................... 22.09 NA 10.53 2.99 NA 35.61 090 35276 ......... ............ A Repair blood vessel lesion .......................... 24.21 NA 11.22 3.24 NA 38.67 090 35281 ......... ............ A Repair blood vessel lesion .......................... 27.96 NA 11.69 3.73 NA 43.38 090 35286 ......... ............ A Repair blood vessel lesion .......................... 16.14 NA 8.07 2.22 NA 26.43 090 35301 ......... ............ A Rechanneling of artery ................................ 18.67 NA 8.44 2.52 NA 29.63 090 35311 ......... ............ A Rechanneling of artery ................................ 26.96 NA 11.73 3.47 NA 42.16 090 35321 ......... ............ A Rechanneling of artery ................................ 15.98 NA 7.37 2.18 NA 25.53 090 35331 ......... ............ A Rechanneling of artery ................................ 26.16 NA 11.22 3.56 NA 40.94 090 35341 ......... ............ A Rechanneling of artery ................................ 25.07 NA 10.85 3.44 NA 39.36 090 35351 ......... ............ A Rechanneling of artery ................................ 22.97 NA 9.58 3.16 NA 35.71 090 35355 ......... ............ A Rechanneling of artery ................................ 18.47 NA 8.08 2.51 NA 29.06 090 35361 ......... ............ A Rechanneling of artery ................................ 28.16 NA 11.69 3.84 NA 43.69 090 35363 ......... ............ A Rechanneling of artery ................................ 30.15 NA 12.56 4.16 NA 46.87 090 35371 ......... ............ A Rechanneling of artery ................................ 14.70 NA 6.94 2.01 NA 23.65 090 35372 ......... ............ A Rechanneling of artery ................................ 17.97 NA 8.04 2.47 NA 28.48 090 35381 ......... ............ A Rechanneling of artery ................................ 15.79 NA 7.81 2.14 NA 25.74 090 35390 ......... ............ A Reoperation, carotid add-on ........................ 3.19 NA 1.06 0.43 NA 4.68 ZZZ 35400 ......... ............ A Angioscopy .................................................. 3.00 NA 1.11 0.42 NA 4.53 ZZZ 35450 ......... ............ A Repair arterial blockage ............................... 10.05 NA 3.55 1.24 NA 14.84 000 35452 ......... ............ A Repair arterial blockage ............................... 6.90 NA 2.60 0.82 NA 10.32 000 35454 ......... ............ A Repair arterial blockage ............................... 6.03 NA 2.31 0.82 NA 9.16 000 35456 ......... ............ A Repair arterial blockage ............................... 7.34 NA 2.76 0.99 NA 11.09 000 35458 ......... ............ A Repair arterial blockage ............................... 9.48 NA 3.46 1.21 NA 14.15 000 35459 ......... ............ A Repair arterial blockage ............................... 8.62 NA 3.16 1.16 NA 12.94 000 35460 ......... ............ A Repair venous blockage .............................. 6.03 NA 2.26 0.82 NA 9.11 000 35470 ......... ............ A Repair arterial blockage ............................... 8.62 90.69 3.34 0.70 100.01 12.66 000 35471 ......... ............ A Repair arterial blockage ............................... 10.05 102.73 3.94 0.69 113.47 14.68 000 35472 ......... ............ A Repair arterial blockage ............................... 6.90 65.72 2.74 0.59 73.21 10.23 000 35473 ......... ............ A Repair arterial blockage ............................... 6.03 61.03 2.42 0.51 67.57 8.96 000 35474 ......... ............ A Repair arterial blockage ............................... 7.35 89.50 2.89 0.56 97.41 10.80 000 35475 ......... ............ R Repair arterial blockage ............................... 9.48 56.75 3.55 0.63 66.86 13.66 000 35476 ......... ............ A Repair venous blockage .............................. 6.03 45.31 2.35 0.39 51.73 8.77 000 35480 ......... ............ A Atherectomy, open ....................................... 11.06 NA 4.03 1.27 NA 16.36 000 35481 ......... ............ A Atherectomy, open ....................................... 7.60 NA 2.87 0.99 NA 11.46 000 35482 ......... ............ A Atherectomy, open ....................................... 6.64 NA 2.56 0.85 NA 10.05 000 35483 ......... ............ A Atherectomy, open ....................................... 8.09 NA 3.02 1.05 NA 12.16 000 35484 ......... ............ A Atherectomy, open ....................................... 10.42 NA 3.76 1.28 NA 15.46 000 35485 ......... ............ A Atherectomy, open ....................................... 9.48 NA 3.53 1.30 NA 14.31 000 35490 ......... ............ A Atherectomy, percutaneous ......................... 11.06 NA 4.69 0.63 NA 16.38 000 35491 ......... ............ A Atherectomy, percutaneous ......................... 7.60 NA 3.28 0.51 NA 11.39 000 35492 ......... ............ A Atherectomy, percutaneous ......................... 6.64 NA 3.19 0.42 NA 10.25 000 35493 ......... ............ A Atherectomy, percutaneous ......................... 8.09 NA 3.80 0.57 NA 12.46 000 35494 ......... ............ A Atherectomy, percutaneous ......................... 10.42 NA 4.45 0.79 NA 15.66 000 35495 ......... ............ A Atherectomy, percutaneous ......................... 9.48 NA 4.38 0.69 NA 14.55 000 35500 ......... ............ A Harvest vein for bypass ............................... 6.44 NA 2.02 0.88 NA 9.34 ZZZ 35501 ......... ............ A Artery bypass graft ...................................... 19.16 NA 8.46 2.67 NA 30.29 090 35506 ......... ............ A Artery bypass graft ...................................... 19.64 NA 9.45 2.69 NA 31.78 090 35507 ......... ............ A Artery bypass graft ...................................... 19.64 NA 9.41 2.66 NA 31.71 090 35508 ......... ............ A Artery bypass graft ...................................... 18.62 NA 9.43 2.43 NA 30.48 090 35509 ......... ............ A Artery bypass graft ...................................... 18.04 NA 8.75 2.47 NA 29.26 090 35510 ......... ............ A Artery bypass graft ...................................... 22.97 NA 10.16 2.10 NA 35.23 090 35511 ......... ............ A Artery bypass graft ...................................... 21.17 NA 9.34 2.38 NA 32.89 090 35512 ......... ............ A Artery bypass graft ...................................... 22.47 NA 9.99 2.10 NA 34.56 090 35515 ......... ............ A Artery bypass graft ...................................... 18.62 NA 9.27 2.50 NA 30.39 090 35516 ......... ............ A Artery bypass graft ...................................... 16.30 NA 6.80 2.19 NA 25.29 090 35518 ......... ............ A Artery bypass graft ...................................... 21.17 NA 8.96 2.84 NA 32.97 090 35521 ......... ............ A Artery bypass graft ...................................... 22.17 NA 9.82 2.98 NA 34.97 090 35522 ......... ............ A Artery bypass graft ...................................... 21.73 NA 9.74 2.10 NA 33.57 090 35525 ......... ............ A Artery bypass graft ...................................... 20.60 NA 9.36 2.10 NA 32.06 090 35526 ......... ............ A Artery bypass graft ...................................... 29.91 NA 12.49 2.43 NA 44.83 090 35531 ......... ............ A Artery bypass graft ...................................... 36.15 NA 14.46 5.00 NA 55.61 090 35533 ......... ............ A Artery bypass graft ...................................... 27.96 NA 11.71 3.59 NA 43.26 090


## 47615

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

35536 ......... ............ A Artery bypass graft ...................................... 31.65 NA 12.92 4.36 NA 48.93 090 35541 ......... ............ A Artery bypass graft ...................................... 25.76 NA 11.19 3.49 NA 40.44 090 35546 ......... ............ A Artery bypass graft ...................................... 25.50 NA 10.85 2.66 NA 39.01 090 35548 ......... ............ A Artery bypass graft ...................................... 21.54 NA 9.41 2.84 NA 33.79 090 35549 ......... ............ A Artery bypass graft ...................................... 23.31 NA 10.37 3.18 NA 36.86 090 35551 ......... ............ A Artery bypass graft ...................................... 26.63 NA 11.48 3.71 NA 41.82 090 35556 ......... ............ A Artery bypass graft ...................................... 21.73 NA 9.71 2.86 NA 34.30 090 35558 ......... ............ A Artery bypass graft ...................................... 21.17 NA 9.53 2.83 NA 33.53 090 35560 ......... ............ A Artery bypass graft ...................................... 31.95 NA 13.29 4.40 NA 49.64 090 35563 ......... ............ A Artery bypass graft ...................................... 24.16 NA 10.50 3.39 NA 38.05 090 35565 ......... ............ A Artery bypass graft ...................................... 23.17 NA 10.12 3.14 NA 36.43 090 35566 ......... ............ A Artery bypass graft ...................................... 26.88 NA 11.37 3.63 NA 41.88 090 35571 ......... ............ A Artery bypass graft ...................................... 24.02 NA 10.84 3.26 NA 38.12 090 35572 ......... ............ A Harvest femoropopliteal vein ....................... 6.81 NA 2.23 0.76 NA 9.80 ZZZ 35582 ......... ............ A Vein bypass graft ......................................... 27.09 NA 11.55 3.32 NA 41.96 090 35583 ......... ............ A Vein bypass graft ......................................... 22.34 NA 10.15 2.97 NA 35.46 090 35585 ......... ............ A Vein bypass graft ......................................... 28.35 NA 12.23 3.81 NA 44.39 090 35587 ......... ............ A Vein bypass graft ......................................... 24.71 NA 11.44 3.34 NA 39.49 090 35600 ......... ............ A Harvest artery for cabg ................................ 4.94 NA 1.62 0.64 NA 7.20 ZZZ 35601 ......... ............ A Artery bypass graft ...................................... 17.47 NA 8.61 2.36 NA 28.44 090 35606 ......... ............ A Artery bypass graft ...................................... 18.68 NA 9.00 2.52 NA 30.20 090 35612 ......... ............ A Artery bypass graft ...................................... 15.74 NA 7.88 2.10 NA 25.72 090 35616 ......... ............ A Artery bypass graft ...................................... 15.68 NA 8.10 2.18 NA 25.96 090 35621 ......... ............ A Artery bypass graft ...................................... 19.97 NA 8.67 2.76 NA 31.40 090 35623 ......... ............ A Bypass graft, not vein .................................. 23.96 NA 10.48 3.30 NA 37.74 090 35626 ......... ............ A Artery bypass graft ...................................... 27.71 NA 11.96 3.80 NA 43.47 090 35631 ......... ............ A Artery bypass graft ...................................... 33.95 NA 13.81 4.64 NA 52.40 090 35636 ......... ............ A Artery bypass graft ...................................... 29.46 NA 12.28 3.84 NA 45.58 090 35641 ......... ............ A Artery bypass graft ...................................... 24.53 NA 11.05 3.28 NA 38.86 090 35642 ......... ............ A Artery bypass graft ...................................... 17.95 NA 8.67 1.88 NA 28.50 090 35645 ......... ............ A Artery bypass graft ...................................... 17.44 NA 8.27 2.21 NA 27.92 090 35646 ......... ............ A Artery bypass graft ...................................... 30.95 NA 13.08 4.20 NA 48.23 090 35647 ......... ............ A Artery bypass graft ...................................... 27.96 NA 11.76 3.78 NA 43.50 090 35650 ......... ............ A Artery bypass graft ...................................... 18.97 NA 8.35 2.55 NA 29.87 090 35651 ......... ............ A Artery bypass graft ...................................... 25.00 NA 10.73 3.08 NA 38.81 090 35654 ......... ............ A Artery bypass graft ...................................... 24.96 NA 10.63 3.40 NA 38.99 090 35656 ......... ............ A Artery bypass graft ...................................... 19.50 NA 8.60 2.61 NA 30.71 090 35661 ......... ............ A Artery bypass graft ...................................... 18.97 NA 8.91 2.56 NA 30.44 090 35663 ......... ............ A Artery bypass graft ...................................... 21.97 NA 9.96 2.99 NA 34.92 090 35665 ......... ............ A Artery bypass graft ...................................... 20.97 NA 9.43 2.84 NA 33.24 090 35666 ......... ............ A Artery bypass graft ...................................... 22.16 NA 10.64 3.00 NA 35.80 090 35671 ......... ............ A Artery bypass graft ...................................... 19.30 NA 9.36 2.62 NA 31.28 090 35681 ......... ............ A Composite bypass graft ............................... 1.60 NA 0.53 0.20 NA 2.33 ZZZ 35682 ......... ............ A Composite bypass graft ............................... 7.19 NA 2.38 0.95 NA 10.52 ZZZ 35683 ......... ............ A Composite bypass graft ............................... 8.49 NA 2.81 1.10 NA 12.40 ZZZ 35685 ......... ............ A Bypass graft patency/patch ......................... 4.04 NA 1.35 0.56 NA 5.95 ZZZ 35686 ......... ............ A Bypass graft/av fist patency ........................ 3.34 NA 1.12 0.47 NA 4.93 ZZZ 35691 ......... ............ A Arterial transposition .................................... 18.02 NA 8.39 2.46 NA 28.87 090 35693 ......... ............ A Arterial transposition .................................... 15.34 NA 7.71 2.07 NA 25.12 090 35694 ......... ............ A Arterial transposition .................................... 19.13 NA 8.59 2.63 NA 30.35 090 35695 ......... ............ A Arterial transposition .................................... 19.13 NA 8.54 2.70 NA 30.37 090 35697 ......... ............ A Reimplant artery each ................................. 3.00 NA 1.02 0.41 NA 4.43 ZZZ 35700 ......... ............ A Reoperation, bypass graft ........................... 3.08 NA 1.02 0.42 NA 4.52 ZZZ 35701 ......... ............ A Exploration, carotid artery ............................ 8.49 NA 5.15 1.16 NA 14.80 090 35721 ......... ............ A Exploration, femoral artery .......................... 7.17 NA 4.45 0.99 NA 12.61 090 35741 ......... ............ A Exploration popliteal artery .......................... 7.99 NA 4.68 1.08 NA 13.75 090 35761 ......... ............ A Exploration of artery/vein ............................. 5.36 NA 4.04 0.73 NA 10.13 090 35800 ......... ............ A Explore neck vessels ................................... 7.01 NA 4.65 0.93 NA 12.59 090 35820 ......... ............ A Explore chest vessels .................................. 12.86 NA 7.18 1.72 NA 21.76 090 35840 ......... ............ A Explore abdominal vessels .......................... 9.76 NA 5.28 1.27 NA 16.31 090 35860 ......... ............ A Explore limb vessels .................................... 5.54 NA 4.03 0.75 NA 10.32 090 35870 ......... ............ A Repair vessel graft defect ............................ 22.14 NA 9.75 2.89 NA 34.78 090 35875 ......... ............ A Removal of clot in graft ............................... 10.11 NA 5.20 1.36 NA 16.67 090 35876 ......... ............ A Removal of clot in graft ............................... 16.97 NA 7.54 2.28 NA 26.79 090 35879 ......... ............ A Revise graft w/vein ...................................... 15.98 NA 7.71 2.16 NA 25.85 090 35881 ......... ............ A Revise graft w/vein ...................................... 17.97 NA 8.68 2.42 NA 29.07 090 35901 ......... ............ A Excision, graft, neck .................................... 8.18 NA 5.32 1.09 NA 14.59 090 35903 ......... ............ A Excision, graft, extremity ............................. 9.38 NA 6.18 1.27 NA 16.83 090 35905 ......... ............ A Excision, graft, thorax .................................. 31.20 NA 13.18 4.40 NA 48.78 090 35907 ......... ............ A Excision, graft, abdomen ............................. 34.95 NA 14.15 4.76 NA 53.86 090
36000 ......... ............ A Place needle in vein .................................... 0.18 0.60 0.05 0.01 0.79 0.24 XXX 36002 ......... ............ A Pseudoaneurysm injection trt ...................... 1.96 2.87 0.97 0.18 5.01 3.11 000 36005 ......... ............ A Injection ext venography .............................. 0.95 7.89 0.31 0.06 8.90 1.32 000
36010 ......... ............ A Place catheter in vein .................................. 2.43 20.07 0.79 0.20 22.70 3.42 XXX
36011 ......... ............ A Place catheter in vein .................................. 3.14 28.80 1.06 0.24 32.18 4.44 XXX


## 47616

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

36012 ......... ............ A Place catheter in vein .................................. 3.51 19.13 1.19 0.23 22.87 4.93 XXX 36013 ......... ............ A Place catheter in artery ............................... 2.52 22.22 0.69 0.25 24.99 3.46 XXX 36014 ......... ............ A Place catheter in artery ............................... 3.02 20.50 1.03 0.20 23.72 4.25 XXX 36015 ......... ............ A Place catheter in artery ............................... 3.51 24.30 1.19 0.22 28.03 4.92 XXX 36100 ......... ............ A Establish access to artery ........................... 3.02 12.32 1.11 0.28 15.62 4.41 XXX 36120 ......... ............ A Establish access to artery ........................... 2.01 10.85 0.64 0.15 13.01 2.80 XXX 36140 ......... ............ A Establish access to artery ........................... 2.01 13.05 0.64 0.16 15.22 2.81 XXX 36145 ......... ............ A Artery to vein shunt ..................................... 2.01 12.75 0.66 0.13 14.89 2.80 XXX 36160 ......... ............ A Establish access to aorta ............................ 2.52 13.81 0.84 0.25 16.58 3.61 XXX 36200 ......... ............ A Place catheter in aorta ................................ 3.02 16.90 1.01 0.23 20.15 4.26 XXX 36215 ......... ............ A Place catheter in artery ............................... 4.67 27.75 1.60 0.31 32.73 6.58 XXX 36216 ......... ............ A Place catheter in artery ............................... 5.27 29.86 1.79 0.36 35.49 7.42 XXX 36217 ......... ............ A Place catheter in artery ............................... 6.29 56.62 2.17 0.44 63.35 8.90 XXX 36218 ......... ............ A Place catheter in artery ............................... 1.01 5.18 0.34 0.07 6.26 1.42 ZZZ 36245 ......... ............ A Place catheter in artery ............................... 4.67 33.09 1.68 0.33 38.09 6.68 XXX 36246 ......... ............ A Place catheter in artery ............................... 5.27 30.97 1.81 0.38 36.62 7.46 XXX 36247 ......... ............ A Place catheter in artery ............................... 6.29 50.83 2.14 0.47 57.59 8.90 XXX 36248 ......... ............ A Place catheter in artery ............................... 1.01 4.12 0.34 0.07 5.20 1.42 ZZZ 36260 ......... ............ A Insertion of infusion pump ........................... 9.70 NA 4.91 1.26 NA 15.87 090 36261 ......... ............ A Revision of infusion pump ........................... 5.44 NA 3.68 0.62 NA 9.74 090 36262 ......... ............ A Removal of infusion pump ........................... 4.01 NA 2.75 0.52 NA 7.28 090 36400 ......... ............ A Bl draw < 3 yrs fem/jugular ......................... 0.38 0.28 0.09 0.03 0.69 0.50 XXX 36405 ......... ............ A Bl draw < 3 yrs scalp vein ........................... 0.31 0.26 0.08 0.02 0.59 0.41 XXX 36406 ......... ............ A Bl draw < 3 yrs other vein ........................... 0.18 0.29 0.05 0.01 0.48 0.24 XXX 36410 ......... ............ A Non-routine bl draw > 3 yrs ......................... 0.18 0.30 0.05 0.01 0.49 0.24 XXX 36420 ......... ............ A Vein access cutdown < 1 yr ........................ 1.01 0.34 0.27 0.06 1.41 1.34 XXX 36425 ......... ............ A Vein access cutdown > 1 yr ........................ 0.76 NA 0.22 0.06 NA 1.04 XXX 36430 ......... ............ A Blood transfusion service ............................ 0.00 1.00 NA 0.06 1.06 NA XXX 36440 ......... ............ A Bl push transfuse, 2 yr or < ......................... 1.03 NA 0.29 0.07 NA 1.39 XXX 36450 ......... ............ A Bl exchange/transfuse, nb ........................... 2.23 NA 0.70 0.10 NA 3.03 XXX 36455 ......... ............ A Bl exchange/transfuse non-nb ..................... 2.43 NA 1.01 0.14 NA 3.58 XXX 36460 ......... ............ A Transfusion service, fetal ............................. 6.58 NA 2.24 0.88 NA 9.70 XXX 36470 ......... ............ A Injection therapy of vein .............................. 1.09 2.69 0.73 0.13 3.91 1.95 010 36471 ......... ............ A Injection therapy of veins ............................. 1.57 3.08 0.96 0.19 4.84 2.72 010 36481 ......... ............ A Insertion of catheter, vein ............................ 6.98 6.04 2.58 0.48 13.50 10.04 000 36500 ......... ............ A Insertion of catheter, vein ............................ 3.51 NA 1.36 0.24 NA 5.11 000 36510 ......... ............ A Insertion of catheter, vein ............................ 1.09 3.95 0.61 0.08 5.12 1.78 000 36511 ......... ............ A Apheresis wbc ............................................. 1.74 NA 0.73 0.08 NA 2.55 000 36512 ......... ............ A Apheresis rbc ............................................... 1.74 NA 0.74 0.08 NA 2.56 000 36513 ......... ............ A Apheresis platelets ...................................... 1.74 NA 0.73 0.08 NA 2.55 000 36514 ......... ............ A Apheresis plasma ........................................ 1.74 17.69 0.71 0.08 19.51 2.53 000 36515 ......... ............ A Apheresis, adsorp/reinfuse .......................... 1.74 65.03 0.65 0.08 66.85 2.47 000 36516 ......... ............ A Apheresis, selective ..................................... 1.22 84.13 0.48 0.08 85.43 1.78 000 36522 ......... ............ A Photopheresis .............................................. 1.67 30.87 1.13 0.14 32.68 2.94 000 36550 ......... ............ A Declot vascular device ................................. 0.00 0.40 NA 0.37 0.77 NA XXX 36555 ......... ............ A Insert non-tunnel cv cath ............................. 2.68 5.80 0.80 0.12 8.60 3.60 000 36556 ......... ............ A Insert non-tunnel cv cath ............................. 2.50 5.75 0.74 0.19 8.44 3.43 000 36557 ......... ............ A Insert tunneled cv cath ................................ 5.09 21.23 2.64 0.58 26.90 8.31 010 36558 ......... ............ A Insert tunneled cv cath ................................ 4.79 21.12 2.54 0.58 26.49 7.91 010 36560 ......... ............ A Insert tunneled cv cath ................................ 6.24 29.79 3.03 0.58 36.61 9.85 010 36561 ......... ............ A Insert tunneled cv cath ................................ 5.99 29.70 2.94 0.58 36.27 9.51 010 36563 ......... ............ A Insert tunneled cv cath ................................ 6.19 26.76 2.98 0.83 33.78 10.00 010 36565 ......... ............ A Insert tunneled cv cath ................................ 5.99 24.81 2.94 0.58 31.38 9.51 010 36566 ......... ............ A Insert tunneled cv cath ................................ 6.49 25.60 3.11 0.58 32.67 10.18 010 36568 ......... ............ A Insert tunneled cv cath ................................ 1.92 7.60 0.58 0.12 9.64 2.62 000 36569 ......... ............ A Insert tunneled cv cath ................................ 1.82 7.42 0.57 0.19 9.43 2.58 000 36570 ......... ............ A Insert tunneled cv cath ................................ 5.31 33.30 2.72 0.58 39.19 8.61 010 36571 ......... ............ A Insert tunneled cv cath ................................ 5.29 33.38 2.71 0.58 39.25 8.58 010 36575 ......... ............ A Repair tunneled cv cath ............................... 0.67 4.07 0.26 0.22 4.96 1.15 000 36576 ......... ............ A Repair tunneled cv cath ............................... 3.19 6.98 1.83 0.21 10.38 5.23 010 36578 ......... ............ A Replace tunneled cv cath ............................ 3.49 11.20 2.30 0.21 14.90 6.00 010 36580 ......... ............ A Replace tunneled cv cath ............................ 1.31 7.08 0.41 0.19 8.58 1.91 000 36581 ......... ............ A Replace tunneled cv cath ............................ 3.43 19.63 1.91 0.21 23.27 5.55 010 36582 ......... ............ A Replace tunneled cv cath ............................ 5.19 26.19 2.85 0.21 31.59 8.25 010 36583 ......... ............ A Replace tunneled cv cath ............................ 5.24 26.21 2.87 0.20 31.65 8.31 010 36584 ......... ............ A Replace tunneled cv cath ............................ 1.20 7.11 0.55 0.19 8.50 1.94 000 36585 ......... ............ A Replace tunneled cv cath ............................ 4.79 28.01 2.72 0.21 33.01 7.72 010
36589 ......... ............ A Removal tunneled cv cath ........................... 2.27 2.24 1.39 0.25 4.76 3.91 010
36590 ......... ............ A Removal tunneled cv cath ........................... 3.30 3.38 1.72 0.43 7.11 5.45 010
36595 ......... ............ A Mech remov tunneled cv cath ..................... 3.59 17.42 1.45 0.33 21.34 5.37 000
36596 ......... ............ A Mech remov tunneled cv cath ..................... 0.75 3.71 0.50 0.39 4.85 1.64 000 36597 ......... ............ A Reposition venous catheter ......................... 1.21 2.41 0.44 0.08 3.70 1.73 000 36600 ......... ............ A Withdrawal of arterial blood ......................... 0.32 0.49 0.09 0.02 0.83 0.43 XXX 36620 ......... ............ A Insertion catheter, artery .............................. 1.15 NA 0.23 0.07 NA 1.45 000 36625 ......... ............ A Insertion catheter, artery .............................. 2.11 NA 0.53 0.21 NA 2.85 000


## 47617

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

36640 ......... ............ A Insertion catheter, artery .............................. 2.10 NA 1.05 0.22 NA 3.37 000 36660 ......... ............ A Insertion catheter, artery .............................. 1.40 NA 0.44 0.09 NA 1.93 000 36680 ......... ............ A Insert needle, bone cavity ........................... 1.20 NA 0.49 0.13 NA 1.82 000 36800 ......... ............ A Insertion of cannula ..................................... 2.43 NA 1.80 0.23 NA 4.46 000 36810 ......... ............ A Insertion of cannula ..................................... 3.96 NA 1.68 0.47 NA 6.11 000 36815 ......... ............ A Insertion of cannula ..................................... 2.62 NA 1.17 0.33 NA 4.12 000 36819 ......... ............ A Av fusion/uppr arm vein ............................... 13.98 NA 6.36 1.87 NA 22.21 090 36820 ......... ............ A Av fusion/forearm vein ................................. 13.98 NA 6.37 1.88 NA 22.23 090 36821 ......... ............ A Av fusion direct any site .............................. 8.92 NA 4.67 1.18 NA 14.77 090 36822 ......... ............ A Insertion of cannula(s) ................................. 5.41 NA 4.41 0.73 NA 10.55 090 36823 ......... ............ A Insertion of cannula(s) ................................. 20.97 NA 9.38 2.64 NA 32.99 090 36825 ......... ............ A Artery-vein autograft .................................... 9.83 NA 5.07 1.29 NA 16.19 090 36830 ......... ............ A Artery-vein nonautograft .............................. 11.98 NA 5.25 1.60 NA 18.83 090 36831 ......... ............ A Open thrombect av fistula ........................... 7.99 NA 3.94 1.07 NA 13.00 090 36832 ......... ............ A Av fistula revision, open .............................. 10.48 NA 4.74 1.39 NA 16.61 090 36833 ......... ............ A Av fistula revision ......................................... 11.93 NA 5.21 1.60 NA 18.74 090 36834 ......... ............ A Repair A-V aneurysm .................................. 9.92 NA 4.79 1.34 NA 16.05 090 36835 ......... ............ A Artery to vein shunt ..................................... 7.14 NA 4.34 0.99 NA 12.47 090 36838 ......... ............ A Dist revas ligation, hemo ............................. 20.60 NA 9.37 2.99 NA 32.96 090 36860 ......... ............ A External cannula declotting ......................... 2.01 1.77 0.67 0.13 3.91 2.81 000 36861 ......... ............ A Cannula declotting ....................................... 2.52 NA 1.49 0.25 NA 4.26 000 36870 ......... ............ A Percut thrombect av fistula .......................... 5.15 32.39 3.14 0.33 37.87 8.62 090 37140 ......... ............ A Revision of circulation .................................. 23.56 NA 10.46 1.71 NA 35.73 090 37145 ......... ............ A Revision of circulation .................................. 24.57 NA 10.87 2.99 NA 38.43 090 37160 ......... ............ A Revision of circulation .................................. 21.57 NA 9.25 2.79 NA 33.61 090 37180 ......... ............ A Revision of circulation .................................. 24.57 NA 10.29 3.12 NA 37.98 090 37181 ......... ............ A Splice spleen/kidney veins .......................... 26.64 NA 10.99 3.37 NA 41.00 090 37182 ......... ............ A Insert hepatic shunt (tips) ............................ 16.97 NA 6.04 0.59 NA 23.60 000 37183 ......... ............ A Remove hepatic shunt (tips) ........................ 7.99 NA 3.01 0.59 NA 11.59 000 37195 ......... ............ A Thrombolytic therapy, stroke ....................... 0.00 8.04 NA 0.46 8.50 NA XXX 37200 ......... ............ A Transcatheter biopsy ................................... 4.55 NA 1.49 0.27 NA 6.31 000 37201 ......... ............ A Transcatheter therapy infuse ....................... 4.99 NA 2.54 0.35 NA 7.88 000 37202 ......... ............ A Transcatheter therapy infuse ....................... 5.67 NA 3.02 0.53 NA 9.22 000 37203 ......... ............ A Transcatheter retrieval ................................. 5.02 33.39 2.03 0.33 38.74 7.38 000 37204 ......... ............ A Transcatheter occlusion ............................... 18.11 NA 5.89 1.37 NA 25.37 000 37205 ......... ............ A Transcatheter stent ...................................... 8.27 NA 3.75 0.59 NA 12.61 000 37206 ......... ............ A Transcatheter stent add-on ......................... 4.12 NA 1.43 0.31 NA 5.86 ZZZ 37207 ......... ............ A Transcatheter stent ...................................... 8.27 NA 3.15 1.10 NA 12.52 000 37208 ......... ............ A Transcatheter stent add-on ......................... 4.12 NA 1.38 0.55 NA 6.05 ZZZ 37209 ......... ............ A Exchange arterial catheter ........................... 2.27 NA 0.74 0.16 NA 3.17 000 37250 ......... ............ A Iv us first vessel add-on .............................. 2.10 NA 0.75 0.20 NA 3.05 ZZZ 37251 ......... ............ A Iv us each add vessel add-on ..................... 1.60 NA 0.55 0.19 NA 2.34 ZZZ 37500 ......... ............ A Endoscopy ligate perf veins ........................ 10.98 NA 6.88 0.48 NA 18.34 090 37565 ......... ............ A Ligation of neck vein .................................... 10.86 NA 5.61 1.31 NA 17.78 090 37600 ......... ............ A Ligation of neck artery ................................. 11.23 NA 6.62 1.30 NA 19.15 090 37605 ......... ............ A Ligation of neck artery ................................. 13.09 NA 6.90 1.93 NA 21.92 090 37606 ......... ............ A Ligation of neck artery ................................. 6.27 NA 4.56 0.94 NA 11.77 090 37607 ......... ............ A Ligation of a-v fistula ................................... 6.15 NA 3.57 0.83 NA 10.55 090 37609 ......... ............ A Temporal artery procedure .......................... 3.00 4.51 1.96 0.36 7.87 5.32 010 37615 ......... ............ A Ligation of neck artery ................................. 5.72 NA 4.10 0.69 NA 10.51 090 37616 ......... ............ A Ligation of chest artery ................................ 16.47 NA 8.10 2.19 NA 26.76 090 37617 ......... ............ A Ligation of abdomen artery .......................... 22.03 NA 9.17 2.85 NA 34.05 090 37618 ......... ............ A Ligation of extremity artery .......................... 4.83 NA 3.62 0.65 NA 9.10 090 37620 ......... ............ A Revision of major vein ................................. 10.54 NA 5.70 0.94 NA 17.18 090 37650 ......... ............ A Revision of major vein ................................. 7.79 NA 4.69 1.05 NA 13.53 090 37660 ......... ............ A Revision of major vein ................................. 20.97 NA 9.05 2.60 NA 32.62 090 37700 ......... ............ A Revise leg vein ............................................ 3.72 NA 2.80 0.52 NA 7.04 090 37720 ......... ............ A Removal of leg vein ..................................... 5.65 NA 3.71 0.79 NA 10.15 090 37730 ......... ............ A Removal of leg veins ................................... 7.32 NA 4.26 0.97 NA 12.55 090 37735 ......... ............ A Removal of leg veins/lesion ......................... 10.51 NA 5.50 1.48 NA 17.49 090 37760 ......... ............ A Ligation, leg veins, open .............................. 10.45 NA 5.35 1.38 NA 17.18 090 37765 ......... ............ A Phleb veins - extrem - to 20 ........................ 7.34 NA 4.61 0.48 NA 12.43 090 37766 ......... ............ A Phleb veins - extrem 20+ ............................ 9.29 NA 5.31 0.48 NA 15.08 090 37780 ......... ............ A Revision of leg vein ..................................... 3.83 NA 2.86 0.54 NA 7.23 090 37785 ......... ............ A Ligate/divide/excise vein .............................. 3.83 5.22 2.73 0.53 9.58 7.09 090 37788 ......... ............ A Revascularization, penis .............................. 21.98 NA 9.18 1.56 NA 32.72 090
37790 ......... ............ A Penile venous occlusion .............................. 8.33 NA 4.47 0.62 NA 13.42 090 38100 ......... ............ A Removal of spleen, total .............................. 14.48 NA 6.19 1.85 NA 22.52 090 38101 ......... ............ A Removal of spleen, partial ........................... 15.29 NA 6.54 2.01 NA 23.84 090 38102 ......... ............ A Removal of spleen, total .............................. 4.79 NA 1.63 0.61 NA 7.03 ZZZ 38115 ......... ............ A Repair of ruptured spleen ............................ 15.80 NA 6.65 1.97 NA 24.42 090 38120 ......... ............ A Laparoscopy, splenectomy .......................... 16.97 NA 7.38 2.18 NA 26.53 090 38200 ......... ............ A Injection for spleen x-ray ............................. 2.64 NA 0.89 0.17 NA 3.70 000 38205 ......... ............ R Harvest allogenic stem cells ........................ 1.50 NA 0.68 0.06 NA 2.24 000
38206 ......... ............ R Harvest auto stem cells ............................... 1.50 NA 0.67 0.06 NA 2.23 000


## 47618

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

38220 ......... ............ A Bone marrow aspiration ............................... 1.08 3.97 0.52 0.06 5.11 1.66 XXX 38221 ......... ............ A Bone marrow biopsy .................................... 1.37 4.19 0.65 0.07 5.63 2.09 XXX 38230 ......... ............ R Bone marrow collection ............................... 4.53 NA 3.27 0.33 NA 8.13 010 38240 ......... ............ R Bone marrow/stem transplant ...................... 2.24 NA 1.03 0.11 NA 3.38 XXX 38241 ......... ............ R Bone marrow/stem transplant ...................... 2.24 NA 1.04 0.11 NA 3.39 XXX 38242 ......... ............ A Lymphocyte infuse transplant ...................... 1.71 NA 0.78 0.07 NA 2.56 000 38300 ......... ............ A Drainage, lymph node lesion ....................... 1.99 4.36 2.06 0.22 6.57 4.27 010 38305 ......... ............ A Drainage, lymph node lesion ....................... 5.99 NA 4.47 0.60 NA 11.06 090 38308 ......... ............ A Incision of lymph channels .......................... 6.44 NA 3.76 0.85 NA 11.05 090 38380 ......... ............ A Thoracic duct procedure .............................. 7.45 NA 5.68 0.80 NA 13.93 090 38381 ......... ............ A Thoracic duct procedure .............................. 12.86 NA 6.90 1.81 NA 21.57 090 38382 ......... ............ A Thoracic duct procedure .............................. 10.06 NA 5.79 1.40 NA 17.25 090 38500 ......... ............ A Biopsy/removal, lymph nodes ...................... 3.74 3.71 2.08 0.48 7.93 6.30 010 38505 ......... ............ A Needle biopsy, lymph nodes ....................... 1.14 2.06 0.79 0.10 3.30 2.03 000 38510 ......... ............ A Biopsy/removal, lymph nodes ...................... 6.42 5.54 3.48 0.74 12.70 10.64 010 38520 ......... ............ A Biopsy/removal, lymph nodes ...................... 6.66 NA 4.06 0.84 NA 11.56 090 38525 ......... ............ A Biopsy/removal, lymph nodes ...................... 6.06 NA 3.33 0.79 NA 10.18 090 38530 ......... ............ A Biopsy/removal, lymph nodes ...................... 7.97 NA 4.43 1.06 NA 13.46 090 38542 ......... ............ A Explore deep node(s), neck ........................ 5.90 NA 4.48 0.63 NA 11.01 090 38550 ......... ............ A Removal, neck/armpit lesion ....................... 6.91 NA 3.96 0.87 NA 11.74 090 38555 ......... ............ A Removal, neck/armpit lesion ....................... 14.12 NA 8.57 1.67 NA 24.36 090 38562 ......... ............ A Removal, pelvic lymph nodes ...................... 10.47 NA 5.79 1.21 NA 17.47 090 38564 ......... ............ A Removal, abdomen lymph nodes ................ 10.81 NA 5.27 1.31 NA 17.39 090 38570 ......... ............ A Laparoscopy, lymph node biop ................... 9.24 NA 3.97 1.12 NA 14.33 010 38571 ......... ............ A Laparoscopy, lymphadenectomy ................. 14.66 NA 5.64 1.20 NA 21.50 010 38572 ......... ............ A Laparoscopy, lymphadenectomy ................. 16.57 NA 7.07 1.89 NA 25.53 010 38700 ......... ............ A Removal of lymph nodes, neck ................... 8.23 NA 6.22 0.76 NA 15.21 090 38720 ......... ............ A Removal of lymph nodes, neck ................... 13.59 NA 9.35 1.24 NA 24.18 090 38724 ......... ............ A Removal of lymph nodes, neck ................... 14.52 NA 9.82 1.32 NA 25.66 090 38740 ......... ............ A Remove armpit lymph nodes ....................... 10.01 NA 4.98 1.30 NA 16.29 090 38745 ......... ............ A Remove armpit lymph nodes ....................... 13.08 NA 6.14 1.68 NA 20.90 090 38746 ......... ............ A Remove thoracic lymph nodes .................... 4.88 NA 1.61 0.67 NA 7.16 ZZZ 38747 ......... ............ A Remove abdominal lymph nodes ................ 4.88 NA 1.66 0.62 NA 7.16 ZZZ 38760 ......... ............ A Remove groin lymph nodes ......................... 12.93 NA 6.16 1.65 NA 20.74 090 38765 ......... ............ A Remove groin lymph nodes ......................... 19.95 NA 8.85 2.44 NA 31.24 090 38770 ......... ............ A Remove pelvis lymph nodes ....................... 13.21 NA 5.76 1.37 NA 20.34 090 38780 ......... ............ A Remove abdomen lymph nodes .................. 16.57 NA 8.22 1.88 NA 26.67 090 38790 ......... ............ A Inject for lymphatic x-ray ............................. 1.29 7.42 0.76 0.13 8.84 2.18 000 38792 ......... ............ A Identify sentinel node ................................... 0.52 NA 0.44 0.06 NA 1.02 000 38794 ......... ............ A Access thoracic lymph duct ......................... 4.44 NA 3.43 0.21 NA 8.08 090 39000 ......... ............ A Exploration of chest ..................................... 6.09 NA 4.68 0.83 NA 11.60 090 39010 ......... ............ A Exploration of chest ..................................... 11.77 NA 6.64 1.59 NA 20.00 090 39200 ......... ............ A Removal chest lesion .................................. 13.60 NA 6.78 1.82 NA 22.20 090 39220 ......... ............ A Removal chest lesion .................................. 17.39 NA 8.50 2.23 NA 28.12 090 39400 ......... ............ A Visualization of chest ................................... 5.60 NA 4.85 0.79 NA 11.24 010 39501 ......... ............ A Repair diaphragm laceration ....................... 13.17 NA 6.48 1.68 NA 21.33 090 39502 ......... ............ A Repair paraesophageal hernia .................... 16.31 NA 7.16 2.10 NA 25.57 090 39503 ......... ............ A Repair of diaphragm hernia ......................... 94.86 NA 33.37 11.59 NA 139.82 090 39520 ......... ............ A Repair of diaphragm hernia ......................... 16.08 NA 8.06 2.10 NA 26.24 090 39530 ......... ............ A Repair of diaphragm hernia ......................... 15.39 NA 7.15 1.97 NA 24.51 090 39531 ......... ............ A Repair of diaphragm hernia ......................... 16.40 NA 7.40 2.10 NA 25.90 090 39540 ......... ............ A Repair of diaphragm hernia ......................... 13.30 NA 6.25 1.67 NA 21.22 090 39541 ......... ............ A Repair of diaphragm hernia ......................... 14.39 NA 6.60 1.86 NA 22.85 090 39545 ......... ............ A Revision of diaphragm ................................. 13.35 NA 7.57 1.81 NA 22.73 090 39560 ......... ............ A Resect diaphragm, simple ........................... 11.98 NA 6.31 1.55 NA 19.84 090 39561 ......... ............ A Resect diaphragm, complex ........................ 17.47 NA 9.35 2.27 NA 29.09 090 40490 ......... ............ A Biopsy of lip ................................................. 1.22 1.63 0.61 0.11 2.96 1.94 000 40500 ......... ............ A Partial excision of lip .................................... 4.27 6.90 4.33 0.45 11.62 9.05 090 40510 ......... ............ A Partial excision of lip .................................... 4.69 6.61 4.01 0.51 11.81 9.21 090 40520 ......... ............ A Partial excision of lip .................................... 4.66 7.53 4.10 0.55 12.74 9.31 090 40525 ......... ............ A Reconstruct lip with flap .............................. 7.54 NA 6.29 0.88 NA 14.71 090 40527 ......... ............ A Reconstruct lip with flap .............................. 9.12 NA 7.33 1.01 NA 17.46 090 40530 ......... ............ A Partial removal of lip .................................... 5.39 7.81 4.57 0.60 13.80 10.56 090 40650 ......... ............ A Repair lip ...................................................... 3.63 6.79 3.32 0.39 10.81 7.34 090 40652 ......... ............ A Repair lip ...................................................... 4.25 7.74 4.27 0.53 12.52 9.05 090 40654 ......... ............ A Repair lip ...................................................... 5.30 8.59 4.93 0.67 14.56 10.90 090 40700 ......... ............ A Repair cleft lip/nasal .................................... 12.77 NA 9.06 1.08 NA 22.91 090 40701 ......... ............ A Repair cleft lip/nasal .................................... 15.83 NA 11.30 2.36 NA 29.49 090 40702 ......... ............ A Repair cleft lip/nasal .................................... 13.02 NA 8.27 0.92 NA 22.21 090 40720 ......... ............ A Repair cleft lip/nasal .................................... 13.53 NA 9.86 1.74 NA 25.13 090 40761 ......... ............ A Repair cleft lip/nasal .................................... 14.70 NA 10.24 1.70 NA 26.64 090 40800 ......... ............ A Drainage of mouth lesion ............................ 1.17 2.97 1.77 0.12 4.26 3.06 010 40801 ......... ............ A Drainage of mouth lesion ............................ 2.53 4.01 2.74 0.32 6.86 5.59 010 40804 ......... ............ A Removal, foreign body, mouth .................... 1.24 3.41 1.87 0.12 4.77 3.23 010 40805 ......... ............ A Removal, foreign body, mouth .................... 2.69 4.48 2.81 0.29 7.46 5.79 010


## 47619

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

40806 ......... ............ A Incision of lip fold ......................................... 0.31 1.83 0.50 0.03 2.17 0.84 000 40808 ......... ............ A Biopsy of mouth lesion ................................ 0.96 2.65 1.48 0.10 3.71 2.54 010 40810 ......... ............ A Excision of mouth lesion .............................. 1.31 2.88 1.66 0.13 4.32 3.10 010 40812 ......... ............ A Excise/repair mouth lesion .......................... 2.31 3.71 2.40 0.28 6.30 4.99 010 40814 ......... ............ A Excise/repair mouth lesion .......................... 3.41 4.94 3.89 0.40 8.75 7.70 090 40816 ......... ............ A Excision of mouth lesion .............................. 3.66 5.17 3.99 0.39 9.22 8.04 090 40818 ......... ............ A Excise oral mucosa for graft ........................ 2.41 5.17 3.97 0.21 7.79 6.59 090 40819 ......... ............ A Excise lip or cheek fold ............................... 2.41 4.08 3.09 0.27 6.76 5.77 090 40820 ......... ............ A Treatment of mouth lesion ........................... 1.28 3.93 2.44 0.12 5.33 3.84 010 40830 ......... ............ A Repair mouth laceration .............................. 1.76 3.73 2.11 0.17 5.66 4.04 010 40831 ......... ............ A Repair mouth laceration .............................. 2.46 4.65 3.05 0.28 7.39 5.79 010 40840 ......... ............ R Reconstruction of mouth .............................. 8.72 9.77 6.96 0.98 19.47 16.66 090 40842 ......... ............ R Reconstruction of mouth .............................. 8.72 10.04 6.78 0.94 19.70 16.44 090 40843 ......... ............ R Reconstruction of mouth .............................. 12.08 11.93 7.80 1.39 25.40 21.27 090 40844 ......... ............ R Reconstruction of mouth .............................. 15.99 15.74 11.55 2.12 33.85 29.66 090 40845 ......... ............ R Reconstruction of mouth .............................. 18.55 17.03 13.19 2.02 37.60 33.76 090 41000 ......... ............ A Drainage of mouth lesion ............................ 1.30 2.32 1.41 0.12 3.74 2.83 010 41005 ......... ............ A Drainage of mouth lesion ............................ 1.26 3.33 1.73 0.15 4.74 3.14 010 41006 ......... ............ A Drainage of mouth lesion ............................ 3.24 4.79 3.16 0.34 8.37 6.74 090 41007 ......... ............ A Drainage of mouth lesion ............................ 3.10 5.11 3.02 0.34 8.55 6.46 090 41008 ......... ............ A Drainage of mouth lesion ............................ 3.36 4.67 3.20 0.44 8.47 7.00 090 41009 ......... ............ A Drainage of mouth lesion ............................ 3.58 4.96 3.56 0.45 8.99 7.59 090 41010 ......... ............ A Incision of tongue fold ................................. 1.06 3.44 1.60 0.09 4.59 2.75 010 41015 ......... ............ A Drainage of mouth lesion ............................ 3.95 5.39 4.14 0.49 9.83 8.58 090 41016 ......... ............ A Drainage of mouth lesion ............................ 4.06 5.60 4.22 0.51 10.17 8.79 090 41017 ......... ............ A Drainage of mouth lesion ............................ 4.06 5.62 4.30 0.53 10.21 8.89 090 41018 ......... ............ A Drainage of mouth lesion ............................ 5.09 6.13 4.58 0.65 11.87 10.32 090 41100 ......... ............ A Biopsy of tongue .......................................... 1.63 2.42 1.42 0.15 4.20 3.20 010 41105 ......... ............ A Biopsy of tongue .......................................... 1.42 2.30 1.32 0.13 3.85 2.87 010 41108 ......... ............ A Biopsy of floor of mouth .............................. 1.05 2.07 1.13 0.10 3.22 2.28 010 41110 ......... ............ A Excision of tongue lesion ............................. 1.51 2.99 1.64 0.13 4.63 3.28 010 41112 ......... ............ A Excision of tongue lesion ............................. 2.73 4.46 3.22 0.28 7.47 6.23 090 41113 ......... ............ A Excision of tongue lesion ............................. 3.19 4.73 3.46 0.35 8.27 7.00 090 41114 ......... ............ A Excision of tongue lesion ............................. 8.46 NA 7.18 0.84 NA 16.48 090 41115 ......... ............ A Excision of tongue fold ................................ 1.74 3.28 1.85 0.19 5.21 3.78 010 41116 ......... ............ A Excision of mouth lesion .............................. 2.44 4.35 2.80 0.23 7.02 5.47 090 41120 ......... ............ A Partial removal of tongue ............................ 9.76 NA 15.31 0.84 NA 25.91 090 41130 ......... ............ A Partial removal of tongue ............................ 11.13 NA 16.19 0.96 NA 28.28 090 41135 ......... ............ A Tongue and neck surgery ............................ 23.06 NA 23.23 2.01 NA 48.30 090 41140 ......... ............ A Removal of tongue ...................................... 25.46 NA 26.66 2.50 NA 54.62 090 41145 ......... ............ A Tongue removal, neck surgery .................... 30.01 NA 30.53 2.59 NA 63.13 090 41150 ......... ............ A Tongue, mouth, jaw surgery ........................ 23.01 NA 24.70 2.05 NA 49.76 090 41153 ......... ............ A Tongue, mouth, neck surgery ...................... 23.73 NA 25.01 2.10 NA 50.84 090 41155 ......... ............ A Tongue, jaw, & neck surgery ....................... 27.68 NA 26.79 2.44 NA 56.91 090 41250 ......... ............ A Repair tongue laceration ............................. 1.91 2.76 1.19 0.18 4.85 3.28 010 41251 ......... ............ A Repair tongue laceration ............................. 2.27 3.27 1.56 0.22 5.76 4.05 010 41252 ......... ............ A Repair tongue laceration ............................. 2.97 3.89 2.26 0.31 7.17 5.54 010 41500 ......... ............ A Fixation of tongue ........................................ 3.70 NA 7.45 0.32 NA 11.47 090 41510 ......... ............ A Tongue to lip surgery ................................... 3.41 NA 7.99 0.38 NA 11.78 090 41520 ......... ............ A Reconstruction, tongue fold ......................... 2.73 4.62 3.61 0.27 7.62 6.61 090 41800 ......... ............ A Drainage of gum lesion ............................... 1.17 2.59 1.29 0.12 3.88 2.58 010 41805 ......... ............ A Removal foreign body, gum ........................ 1.24 2.67 2.22 0.15 4.06 3.61 010 41806 ......... ............ A Removal foreign body,jawbone ................... 2.69 3.58 3.03 0.35 6.62 6.07 010 41822 ......... ............ R Excision of gum lesion ................................. 2.31 3.88 1.86 0.34 6.53 4.51 010 41823 ......... ............ R Excision of gum lesion ................................. 3.30 5.56 4.00 0.44 9.30 7.74 090 41825 ......... ............ A Excision of gum lesion ................................. 1.31 3.06 2.24 0.15 4.52 3.70 010 41826 ......... ............ A Excision of gum lesion ................................. 2.31 2.43 2.10 0.30 5.04 4.71 010 41827 ......... ............ A Excision of gum lesion ................................. 3.41 5.51 3.66 0.37 9.29 7.44 090 41828 ......... ............ R Excision of gum lesion ................................. 3.09 3.80 2.96 0.44 7.33 6.49 010 41830 ......... ............ R Removal of gum tissue ................................ 3.34 4.95 3.62 0.45 8.74 7.41 010 41872 ......... ............ R Repair gum .................................................. 2.59 5.01 3.45 0.22 7.82 6.26 090 41874 ......... ............ R Repair tooth socket ...................................... 3.09 4.83 3.17 0.45 8.37 6.71 090 42000 ......... ............ A Drainage mouth roof lesion ......................... 1.23 2.57 1.26 0.11 3.91 2.60 010 42100 ......... ............ A Biopsy roof of mouth ................................... 1.31 2.08 1.36 0.13 3.52 2.80 010 42104 ......... ............ A Excision lesion, mouth roof ......................... 1.64 2.53 1.55 0.16 4.33 3.35 010 42106 ......... ............ A Excision lesion, mouth roof ......................... 2.10 3.22 2.44 0.25 5.57 4.79 010 42107 ......... ............ A Excision lesion, mouth roof ......................... 4.43 5.70 3.94 0.46 10.59 8.83 090 42120 ......... ............ A Remove palate/lesion .................................. 6.16 NA 11.77 0.53 NA 18.46 090 42140 ......... ............ A Excision of uvula .......................................... 1.62 3.72 2.09 0.13 5.47 3.84 090 42145 ......... ............ A Repair palate, pharynx/uvula ....................... 8.04 NA 7.49 0.66 NA 16.19 090 42160 ......... ............ A Treatment mouth roof lesion ....................... 1.80 4.25 2.29 0.16 6.21 4.25 010 42180 ......... ............ A Repair palate ............................................... 2.50 3.07 2.10 0.21 5.78 4.81 010 42182 ......... ............ A Repair palate ............................................... 3.82 3.87 3.02 0.40 8.09 7.24 010 42200 ......... ............ A Reconstruct cleft palate ............................... 11.98 NA 10.20 1.22 NA 23.40 090 42205 ......... ............ A Reconstruct cleft palate ............................... 13.27 NA 10.06 1.44 NA 24.77 090


## 47620

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

42210 ......... ............ A Reconstruct cleft palate ............................... 14.48 NA 11.44 2.00 NA 27.92 090 42215 ......... ............ A Reconstruct cleft palate ............................... 8.81 NA 9.05 1.31 NA 19.17 090 42220 ......... ............ A Reconstruct cleft palate ............................... 7.01 NA 6.77 0.49 NA 14.27 090 42225 ......... ............ A Reconstruct cleft palate ............................... 9.53 NA 16.94 0.97 NA 27.44 090 42226 ......... ............ A Lengthening of palate .................................. 9.99 NA 14.63 0.89 NA 25.51 090 42227 ......... ............ A Lengthening of palate .................................. 9.51 NA 15.40 1.02 NA 25.93 090 42235 ......... ............ A Repair palate ............................................... 7.86 NA 11.86 0.82 NA 20.54 090 42260 ......... ............ A Repair nose to lip fistula .............................. 9.79 10.17 7.06 0.98 20.94 17.83 090 42280 ......... ............ A Preparation, palate mold ............................. 1.54 1.95 1.14 0.21 3.70 2.89 010 42281 ......... ............ A Insertion, palate prosthesis .......................... 1.93 2.62 1.87 0.16 4.71 3.96 010 42300 ......... ............ A Drainage of salivary gland ........................... 1.93 2.82 1.81 0.17 4.92 3.91 010 42305 ......... ............ A Drainage of salivary gland ........................... 6.06 NA 4.72 0.53 NA 11.31 090 42310 ......... ............ A Drainage of salivary gland ........................... 1.56 2.26 1.54 0.15 3.97 3.25 010 42320 ......... ............ A Drainage of salivary gland ........................... 2.35 3.26 2.09 0.23 5.84 4.67 010 42325 ......... ............ A Create salivary cyst drain ............................ 2.75 4.61 2.31 0.22 7.58 5.28 090 42326 ......... ............ A Create salivary cyst drain ............................ 3.77 5.89 3.16 0.23 9.89 7.16 090 42330 ......... ............ A Removal of salivary stone ........................... 2.21 3.14 1.84 0.19 5.54 4.24 010 42335 ......... ............ A Removal of salivary stone ........................... 3.31 4.90 3.14 0.30 8.51 6.75 090 42340 ......... ............ A Removal of salivary stone ........................... 4.59 6.04 3.93 0.41 11.04 8.93 090 42400 ......... ............ A Biopsy of salivary gland ............................... 0.78 1.65 0.72 0.06 2.49 1.56 000 42405 ......... ............ A Biopsy of salivary gland ............................... 3.29 4.02 2.45 0.29 7.60 6.03 010 42408 ......... ............ A Excision of salivary cyst .............................. 4.53 5.90 3.61 0.42 10.85 8.56 090 42409 ......... ............ A Drainage of salivary cyst ............................. 2.81 4.52 2.76 0.23 7.56 5.80 090 42410 ......... ............ A Excise parotid gland/lesion .......................... 9.33 NA 6.21 0.93 NA 16.47 090 42415 ......... ............ A Excise parotid gland/lesion .......................... 16.86 NA 10.84 1.49 NA 29.19 090 42420 ......... ............ A Excise parotid gland/lesion .......................... 19.56 NA 12.35 1.72 NA 33.63 090 42425 ......... ............ A Excise parotid gland/lesion .......................... 13.00 NA 8.60 1.14 NA 22.74 090 42426 ......... ............ A Excise parotid gland/lesion .......................... 21.23 NA 12.99 1.86 NA 36.08 090 42440 ......... ............ A Excise submaxillary gland ........................... 6.96 NA 4.79 0.61 NA 12.36 090 42450 ......... ............ A Excise sublingual gland ............................... 4.61 5.89 4.24 0.42 10.92 9.27 090 42500 ......... ............ A Repair salivary duct ..................................... 4.29 5.67 4.18 0.41 10.37 8.88 090 42505 ......... ............ A Repair salivary duct ..................................... 6.17 7.12 5.35 0.56 13.85 12.08 090 42507 ......... ............ A Parotid duct diversion .................................. 6.10 NA 6.53 0.49 NA 13.12 090 42508 ......... ............ A Parotid duct diversion .................................. 9.09 NA 8.34 0.74 NA 18.17 090 42509 ......... ............ A Parotid duct diversion .................................. 11.52 NA 10.17 1.50 NA 23.19 090 42510 ......... ............ A Parotid duct diversion .................................. 8.14 NA 7.78 0.66 NA 16.58 090 42550 ......... ............ A Injection for salivary x-ray ............................ 1.25 3.25 0.41 0.08 4.58 1.74 000 42600 ......... ............ A Closure of salivary fistula ............................ 4.81 6.57 4.12 0.40 11.78 9.33 090 42650 ......... ............ A Dilation of salivary duct ............................... 0.77 1.10 0.71 0.07 1.94 1.55 000 42660 ......... ............ A Dilation of salivary duct ............................... 1.13 1.35 0.85 0.09 2.57 2.07 000 42665 ......... ............ A Ligation of salivary duct ............................... 2.53 4.16 2.59 0.21 6.90 5.33 090 42700 ......... ............ A Drainage of tonsil abscess .......................... 1.62 2.65 1.71 0.13 4.40 3.46 010 42720 ......... ............ A Drainage of throat abscess ......................... 5.41 4.82 3.78 0.48 10.71 9.67 010 42725 ......... ............ A Drainage of throat abscess ......................... 10.70 NA 8.21 0.96 NA 19.87 090 42800 ......... ............ A Biopsy of throat ............................................ 1.39 2.18 1.40 0.12 3.69 2.91 010 42802 ......... ............ A Biopsy of throat ............................................ 1.54 4.77 2.06 0.13 6.44 3.73 010 42804 ......... ............ A Biopsy of upper nose/throat ........................ 1.24 3.74 1.73 0.10 5.08 3.07 010 42806 ......... ............ A Biopsy of upper nose/throat ........................ 1.58 4.08 1.93 0.13 5.79 3.64 010 42808 ......... ............ A Excise pharynx lesion .................................. 2.30 3.09 1.93 0.19 5.58 4.42 010 42809 ......... ............ A Remove pharynx foreign body .................... 1.81 2.33 1.35 0.16 4.30 3.32 010 42810 ......... ............ A Excision of neck cyst ................................... 3.25 5.71 3.54 0.31 9.27 7.10 090 42815 ......... ............ A Excision of neck cyst ................................... 7.06 NA 6.40 0.63 NA 14.09 090 42820 ......... ............ A Remove tonsils and adenoids ..................... 3.90 NA 3.29 0.33 NA 7.52 090 42821 ......... ............ A Remove tonsils and adenoids ..................... 4.28 NA 3.50 0.35 NA 8.13 090 42825 ......... ............ A Removal of tonsils ....................................... 3.41 NA 3.17 0.28 NA 6.86 090 42826 ......... ............ A Removal of tonsils ....................................... 3.37 NA 3.03 0.28 NA 6.68 090 42830 ......... ............ A Removal of adenoids ................................... 2.57 NA 2.56 0.21 NA 5.34 090 42831 ......... ............ A Removal of adenoids ................................... 2.71 NA 2.84 0.22 NA 5.77 090 42835 ......... ............ A Removal of adenoids ................................... 2.30 NA 2.46 0.21 NA 4.97 090 42836 ......... ............ A Removal of adenoids ................................... 3.18 NA 2.95 0.26 NA 6.39 090 42842 ......... ............ A Extensive surgery of throat .......................... 8.75 NA 10.99 0.72 NA 20.46 090 42844 ......... ............ A Extensive surgery of throat .......................... 14.29 NA 16.23 1.24 NA 31.76 090 42845 ......... ............ A Extensive surgery of throat .......................... 24.25 NA 23.17 2.07 NA 49.49 090 42860 ......... ............ A Excision of tonsil tags .................................. 2.22 NA 2.40 0.19 NA 4.81 090 42870 ......... ............ A Excision of lingual tonsil .............................. 5.39 NA 8.57 0.45 NA 14.41 090 42890 ......... ............ A Partial removal of pharynx ........................... 12.92 NA 14.15 1.10 NA 28.17 090 42892 ......... ............ A Revision of pharyngeal walls ....................... 15.81 NA 17.17 1.33 NA 34.31 090 42894 ......... ............ A Revision of pharyngeal walls ....................... 22.85 NA 22.01 1.91 NA 46.77 090 42900 ......... ............ A Repair throat wound .................................... 5.24 NA 3.66 0.55 NA 9.45 010 42950 ......... ............ A Reconstruction of throat .............................. 8.09 NA 11.85 0.72 NA 20.66 090 42953 ......... ............ A Repair throat, esophagus ............................ 8.95 NA 17.22 0.88 NA 27.05 090 42955 ......... ............ A Surgical opening of throat ........................... 7.38 NA 10.69 0.70 NA 18.77 090 42960 ......... ............ A Control throat bleeding ................................ 2.33 NA 1.95 0.18 NA 4.46 010 42961 ......... ............ A Control throat bleeding ................................ 5.58 NA 4.96 0.46 NA 11.00 090 42962 ......... ............ A Control throat bleeding ................................ 7.13 NA 5.91 0.62 NA 13.66 090


## 47621

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

42970 ......... ............ A Control nose/throat bleeding ....................... 5.42 NA 4.22 0.40 NA 10.04 090 42971 ......... ............ A Control nose/throat bleeding ....................... 6.20 NA 5.12 0.54 NA 11.86 090 42972 ......... ............ A Control nose/throat bleeding ....................... 7.19 NA 5.69 0.59 NA 13.47 090 43020 ......... ............ A Incision of esophagus .................................. 8.08 NA 5.41 0.92 NA 14.41 090 43030 ......... ............ A Throat muscle surgery ................................. 7.68 NA 5.48 0.70 NA 13.86 090 43045 ......... ............ A Incision of esophagus .................................. 20.09 NA 10.71 2.22 NA 33.02 090 43100 ......... ............ A Excision of esophagus lesion ...................... 9.18 NA 6.23 0.98 NA 16.39 090 43101 ......... ............ A Excision of esophagus lesion ...................... 16.22 NA 7.89 2.09 NA 26.20 090 43107 ......... ............ A Removal of esophagus ................................ 39.94 NA 17.05 5.03 NA 62.02 090 43108 ......... ............ A Removal of esophagus ................................ 34.14 NA 14.21 4.27 NA 52.62 090 43112 ......... ............ A Removal of esophagus ................................ 43.43 NA 18.14 5.61 NA 67.18 090 43113 ......... ............ A Removal of esophagus ................................ 35.22 NA 15.11 4.43 NA 54.76 090 43116 ......... ............ A Partial removal of esophagus ...................... 31.17 NA 16.69 3.02 NA 50.88 090 43117 ......... ............ A Partial removal of esophagus ...................... 39.94 NA 16.29 4.98 NA 61.21 090 43118 ......... ............ A Partial removal of esophagus ...................... 33.15 NA 13.79 4.27 NA 51.21 090 43121 ......... ............ A Partial removal of esophagus ...................... 29.15 NA 12.68 4.06 NA 45.89 090 43122 ......... ............ A Partial removal of esophagus ...................... 39.94 NA 16.40 5.11 NA 61.45 090 43123 ......... ............ A Partial removal of esophagus ...................... 33.15 NA 14.10 4.49 NA 51.74 090 43124 ......... ............ A Removal of esophagus ................................ 27.28 NA 13.09 3.28 NA 43.65 090 43130 ......... ............ A Removal of esophagus pouch ..................... 11.73 NA 7.57 1.22 NA 20.52 090 43135 ......... ............ A Removal of esophagus pouch ..................... 16.08 NA 8.11 2.16 NA 26.35 090 43200 ......... ............ A Esophagus endoscopy ................................ 1.59 4.15 1.07 0.13 5.87 2.79 000 43201 ......... ............ A Esoph scope w/submucous inj .................... 2.09 4.61 1.10 0.13 6.83 3.32 000 43202 ......... ............ A Esophagus endoscopy, biopsy .................... 1.89 5.59 0.94 0.16 7.64 2.99 000 43204 ......... ............ A Esoph scope w/sclerosis inj ........................ 3.76 NA 1.52 0.30 NA 5.58 000 43205 ......... ............ A Esophagus endoscopy/ligation .................... 3.78 NA 1.52 0.29 NA 5.59 000 43215 ......... ............ A Esophagus endoscopy ................................ 2.60 NA 1.20 0.23 NA 4.03 000 43216 ......... ............ A Esophagus endoscopy/lesion ...................... 2.40 NA 1.19 0.20 NA 3.79 000 43217 ......... ............ A Esophagus endoscopy ................................ 2.90 7.02 1.19 0.25 10.17 4.34 000 43219 ......... ............ A Esophagus endoscopy ................................ 2.80 NA 1.35 0.23 NA 4.38 000 43220 ......... ............ A Esoph endoscopy, dilation ........................... 2.10 NA 0.97 0.17 NA 3.24 000 43226 ......... ............ A Esoph endoscopy, dilation ........................... 2.34 NA 1.03 0.19 NA 3.56 000 43227 ......... ............ A Esoph endoscopy, repair ............................. 3.59 NA 1.45 0.28 NA 5.32 000 43228 ......... ............ A Esoph endoscopy, ablation ......................... 3.76 NA 1.55 0.35 NA 5.66 000 43231 ......... ............ A Esoph endoscopy w/us exam ...................... 3.19 NA 1.31 0.23 NA 4.73 000 43232 ......... ............ A Esoph endoscopy w/us fn bx ...................... 4.47 NA 1.81 0.31 NA 6.59 000 43234 ......... ............ A Upper GI endoscopy, exam ......................... 2.01 5.37 0.87 0.17 7.55 3.05 000 43235 ......... ............ A Uppr gi endoscopy, diagnosis ..................... 2.39 5.22 1.02 0.19 7.80 3.60 000 43236 ......... ............ A Uppr gi scope w/submuc inj ........................ 2.92 6.45 1.22 0.19 9.56 4.33 000 43237 ......... ............ A Endoscopic us exam, esoph ....................... 3.98 NA 1.59 0.43 NA 6.00 000 43238 ......... ............ A Uppr gi endoscopy w/us fn bx ..................... 5.02 NA 1.96 0.43 NA 7.41 000 43239 ......... ............ A Upper GI endoscopy, biopsy ....................... 2.87 5.77 1.19 0.23 8.87 4.29 000 43240 ......... ............ A Esoph endoscope w/drain cyst .................... 6.85 NA 2.60 0.54 NA 9.99 000 43241 ......... ............ A Upper GI endoscopy with tube .................... 2.59 NA 1.10 0.21 NA 3.90 000 43242 ......... ............ A Uppr gi endoscopy w/us fn bx ..................... 7.30 NA 2.73 0.53 NA 10.56 000 43243 ......... ............ A Upper gi endoscopy & inject ....................... 4.56 NA 1.79 0.34 NA 6.69 000 43244 ......... ............ A Upper GI endoscopy/ligation ....................... 5.04 NA 1.96 0.37 NA 7.37 000 43245 ......... ............ A Uppr gi scope dilate strictr ........................... 3.18 NA 1.30 0.28 NA 4.76 000 43246 ......... ............ A Place gastrostomy tube ............................... 4.32 NA 1.69 0.34 NA 6.35 000 43247 ......... ............ A Operative upper GI endoscopy ................... 3.38 NA 1.37 0.27 NA 5.02 000 43248 ......... ............ A Uppr gi endoscopy/guide wire ..................... 3.15 NA 1.31 0.24 NA 4.70 000 43249 ......... ............ A Esoph endoscopy, dilation ........................... 2.90 NA 1.21 0.22 NA 4.33 000 43250 ......... ............ A Upper GI endoscopy/tumor ......................... 3.20 NA 1.31 0.26 NA 4.77 000 43251 ......... ............ A Operative upper GI endoscopy ................... 3.69 NA 1.48 0.29 NA 5.46 000 43255 ......... ............ A Operative upper GI endoscopy ................... 4.81 NA 1.88 0.36 NA 7.05 000 43256 ......... ............ A Uppr gi endoscopy w stent .......................... 4.34 NA 1.71 0.37 NA 6.42 000 43258 ......... ............ A Operative upper GI endoscopy ................... 4.54 NA 1.78 0.35 NA 6.67 000 43259 ......... ............ A Endoscopic ultrasound exam ...................... 5.19 NA 1.99 0.36 NA 7.54 000 43260 ......... ............ A Endo cholangiopancreatograph ................... 5.95 NA 2.28 0.44 NA 8.67 000 43261 ......... ............ A Endo cholangiopancreatograph ................... 6.26 NA 2.39 0.46 NA 9.11 000 43262 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.78 0.55 NA 10.71 000 43263 ......... ............ A Endo cholangiopancreatograph ................... 7.28 NA 2.76 0.55 NA 10.59 000 43264 ......... ............ A Endo cholangiopancreatograph ................... 8.89 NA 3.31 0.66 NA 12.86 000 43265 ......... ............ A Endo cholangiopancreatograph ................... 10.00 NA 3.69 0.74 NA 14.43 000 43267 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.78 0.56 NA 10.72 000 43268 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.88 0.55 NA 10.81 000 43269 ......... ............ A Endo cholangiopancreatograph ................... 8.20 NA 3.07 0.61 NA 11.88 000 43271 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.77 0.54 NA 10.69 000 43272 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.78 0.55 NA 10.71 000 43280 ......... ............ A Laparoscopy, fundoplasty ............................ 17.22 NA 7.28 2.20 NA 26.70 090 43300 ......... ............ A Repair of esophagus ................................... 9.13 NA 6.45 1.01 NA 16.59 090 43305 ......... ............ A Repair esophagus and fistula ...................... 17.36 NA 10.72 1.53 NA 29.61 090 43310 ......... ............ A Repair of esophagus ................................... 25.35 NA 11.08 3.44 NA 39.87 090 43312 ......... ............ A Repair esophagus and fistula ...................... 28.38 NA 11.93 3.43 NA 43.74 090 43313 ......... ............ A Esophagoplasty congenital .......................... 45.21 NA 18.82 6.55 NA 70.58 090


## 47622

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

43314 ......... ............ A Tracheo-esophagoplasty cong .................... 50.19 NA 19.15 6.67 NA 76.01 090 43320 ......... ............ A Fuse esophagus & stomach ........................ 19.90 NA 9.21 2.41 NA 31.52 090 43324 ......... ............ A Revise esophagus & stomach ..................... 20.54 NA 8.77 2.59 NA 31.90 090 43325 ......... ............ A Revise esophagus & stomach ..................... 20.03 NA 8.79 2.54 NA 31.36 090 43326 ......... ............ A Revise esophagus & stomach ..................... 19.71 NA 9.29 2.63 NA 31.63 090 43330 ......... ............ A Repair of esophagus ................................... 19.74 NA 8.54 2.51 NA 30.79 090 43331 ......... ............ A Repair of esophagus ................................... 20.10 NA 9.79 2.65 NA 32.54 090 43340 ......... ............ A Fuse esophagus & intestine ........................ 19.58 NA 8.97 2.49 NA 31.04 090 43341 ......... ............ A Fuse esophagus & intestine ........................ 20.82 NA 10.03 2.89 NA 33.74 090 43350 ......... ............ A Surgical opening, esophagus ...................... 15.76 NA 8.46 1.78 NA 26.00 090 43351 ......... ............ A Surgical opening, esophagus ...................... 18.32 NA 9.79 2.46 NA 30.57 090 43352 ......... ............ A Surgical opening, esophagus ...................... 15.24 NA 8.39 1.85 NA 25.48 090 43360 ......... ............ A Gastrointestinal repair .................................. 35.65 NA 15.07 4.26 NA 54.98 090 43361 ......... ............ A Gastrointestinal repair .................................. 40.44 NA 16.88 4.52 NA 61.84 090 43400 ......... ............ A Ligate esophagus veins ............................... 21.17 NA 9.45 2.04 NA 32.66 090 43401 ......... ............ A Esophagus surgery for veins ....................... 22.06 NA 9.49 2.61 NA 34.16 090 43405 ......... ............ A Ligate/staple esophagus .............................. 19.98 NA 9.57 2.56 NA 32.11 090 43410 ......... ............ A Repair esophagus wound ............................ 13.45 NA 7.64 1.63 NA 22.72 090 43415 ......... ............ A Repair esophagus wound ............................ 24.96 NA 11.73 3.34 NA 40.03 090 43420 ......... ............ A Repair esophagus opening .......................... 14.33 NA 7.45 1.38 NA 23.16 090 43425 ......... ............ A Repair esophagus opening .......................... 21.00 NA 9.97 2.62 NA 33.59 090 43450 ......... ............ A Dilate esophagus ......................................... 1.38 2.67 0.69 0.11 4.16 2.18 000 43453 ......... ............ A Dilate esophagus ......................................... 1.51 6.11 0.73 0.11 7.73 2.35 000 43456 ......... ............ A Dilate esophagus ......................................... 2.57 13.83 1.10 0.20 16.60 3.87 000 43458 ......... ............ A Dilate esophagus ......................................... 3.06 6.69 1.28 0.25 10.00 4.59 000 43460 ......... ............ A Pressure treatment esophagus ................... 3.79 NA 1.48 0.31 NA 5.58 000 43500 ......... ............ A Surgical opening of stomach ....................... 11.03 NA 4.98 1.39 NA 17.40 090 43501 ......... ............ A Surgical repair of stomach ........................... 20.01 NA 8.31 2.57 NA 30.89 090 43502 ......... ............ A Surgical repair of stomach ........................... 23.10 NA 9.45 2.75 NA 35.30 090 43510 ......... ............ A Surgical opening of stomach ....................... 13.06 NA 6.61 1.54 NA 21.21 090 43520 ......... ............ A Incision of pyloric muscle ............................ 9.98 NA 5.27 1.30 NA 16.55 090 43600 ......... ............ A Biopsy of stomach ....................................... 1.91 NA 0.66 0.15 NA 2.72 000 43605 ......... ............ A Biopsy of stomach ....................................... 11.96 NA 5.28 1.54 NA 18.78 090 43610 ......... ............ A Excision of stomach lesion .......................... 14.58 NA 6.16 1.88 NA 22.62 090 43611 ......... ............ A Excision of stomach lesion .......................... 17.81 NA 7.56 2.30 NA 27.67 090 43620 ......... ............ A Removal of stomach .................................... 29.99 NA 11.80 3.85 NA 45.64 090 43621 ......... ............ A Removal of stomach .................................... 30.68 NA 11.98 3.94 NA 46.60 090 43622 ......... ............ A Removal of stomach .................................... 32.48 NA 12.58 4.17 NA 49.23 090 43631 ......... ............ A Removal of stomach, partial ........................ 22.56 NA 9.15 2.90 NA 34.61 090 43632 ......... ............ A Removal of stomach, partial ........................ 22.56 NA 9.15 2.90 NA 34.61 090 43633 ......... ............ A Removal of stomach, partial ........................ 23.07 NA 9.32 2.96 NA 35.35 090 43634 ......... ............ A Removal of stomach, partial ........................ 25.08 NA 10.08 3.13 NA 38.29 090 43635 ......... ............ A Removal of stomach, partial ........................ 2.06 NA 0.70 0.27 NA 3.03 ZZZ 43638 ......... ............ A Removal of stomach, partial ........................ 28.96 NA 11.87 3.72 NA 44.55 090 43639 ......... ............ A Removal of stomach, partial ........................ 29.61 NA 11.68 3.78 NA 45.07 090 43640 ......... ............ A Vagotomy & pylorus repair .......................... 16.99 NA 7.26 2.19 NA 26.44 090 43641 ......... ............ A Vagotomy & pylorus repair .......................... 17.24 NA 7.37 2.16 NA 26.77 090 43651 ......... ............ A Laparoscopy, vagus nerve .......................... 10.13 NA 4.76 1.32 NA 16.21 090 43652 ......... ............ A Laparoscopy, vagus nerve .......................... 12.13 NA 5.75 1.51 NA 19.39 090 43653 ......... ............ A Laparoscopy, gastrostomy ........................... 7.72 NA 4.19 0.98 NA 12.89 090 43750 ......... ............ A Place gastrostomy tube ............................... 4.48 NA 2.19 0.43 NA 7.10 010 43752 ......... ............ A Nasal/orogastric w/stent .............................. 0.68 0.23 0.22 0.02 0.93 0.92 000 43760 ......... ............ A Change gastrostomy tube ........................... 1.10 2.10 0.45 0.09 3.29 1.64 000 43761 ......... ............ A Reposition gastrostomy tube ....................... 2.01 1.19 0.66 0.14 3.34 2.81 000 43800 ......... ............ A Reconstruction of pylorus ............................ 13.67 NA 5.91 1.76 NA 21.34 090 43810 ......... ............ A Fusion of stomach and bowel ..................... 14.63 NA 6.19 1.91 NA 22.73 090 43820 ......... ............ A Fusion of stomach and bowel ..................... 15.35 NA 6.42 1.96 NA 23.73 090 43825 ......... ............ A Fusion of stomach and bowel ..................... 19.19 NA 8.01 2.45 NA 29.65 090 43830 ......... ............ A Place gastrostomy tube ............................... 9.52 NA 4.85 1.18 NA 15.55 090 43831 ......... ............ A Place gastrostomy tube ............................... 7.83 NA 4.52 1.00 NA 13.35 090 43832 ......... ............ A Place gastrostomy tube ............................... 15.58 NA 6.86 1.94 NA 24.38 090 43840 ......... ............ A Repair of stomach lesion ............................. 15.54 NA 6.77 2.00 NA 24.31 090 43842 ......... ............ A Gastroplasty for obesity ............................... 18.44 NA 7.95 2.40 NA 28.79 090 43843 ......... ............ A Gastroplasty for obesity ............................... 18.62 NA 7.91 2.45 NA 28.98 090 43846 ......... ............ A Gastric bypass for obesity ........................... 24.01 NA 10.17 3.09 NA 37.27 090 43847 ......... ............ A Gastric bypass for obesity ........................... 26.88 NA 11.07 3.49 NA 41.44 090 43848 ......... ............ A Revision gastroplasty ................................... 29.35 NA 11.99 3.80 NA 45.14 090 43850 ......... ............ A Revise stomach-bowel fusion ...................... 24.68 NA 9.81 3.17 NA 37.66 090 43855 ......... ............ A Revise stomach-bowel fusion ...................... 26.12 NA 10.32 3.43 NA 39.87 090 43860 ......... ............ A Revise stomach-bowel fusion ...................... 24.96 NA 9.97 3.19 NA 38.12 090 43865 ......... ............ A Revise stomach-bowel fusion ...................... 26.48 NA 10.50 3.46 NA 40.44 090 43870 ......... ............ A Repair stomach opening .............................. 9.68 NA 4.53 1.21 NA 15.42 090 43880 ......... ............ A Repair stomach-bowel fistula ...................... 24.61 NA 9.90 3.11 NA 37.62 090 44005 ......... ............ A Freeing of bowel adhesion .......................... 16.21 NA 6.73 2.06 NA 25.00 090 44010 ......... ............ A Incision of small bowel ................................ 12.50 NA 5.46 1.60 NA 19.56 090


## 47623

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

44015 ......... ............ A Insert needle cath bowel ............................. 2.62 NA 0.88 0.33 NA 3.83 ZZZ 44020 ......... ............ A Explore small intestine ................................. 13.97 NA 5.94 1.77 NA 21.68 090 44021 ......... ............ A Decompress small bowel ............................. 14.06 NA 5.98 1.78 NA 21.82 090 44025 ......... ............ A Incision of large bowel ................................. 14.26 NA 6.03 1.81 NA 22.10 090 44050 ......... ............ A Reduce bowel obstruction ........................... 14.01 NA 5.96 1.79 NA 21.76 090 44055 ......... ............ A Correct malrotation of bowel ....................... 21.97 NA 8.73 2.81 NA 33.51 090 44100 ......... ............ A Biopsy of bowel ........................................... 2.01 NA 0.71 0.17 NA 2.89 000 44110 ......... ............ A Excise intestine lesion(s) ............................. 11.79 NA 5.24 1.48 NA 18.51 090 44111 ......... ............ A Excision of bowel lesion(s) .......................... 14.27 NA 6.12 1.80 NA 22.19 090 44120 ......... ............ A Removal of small intestine .......................... 16.97 NA 7.08 2.13 NA 26.18 090 44121 ......... ............ A Removal of small intestine .......................... 4.44 NA 1.52 0.55 NA 6.51 ZZZ 44125 ......... ............ A Removal of small intestine .......................... 17.51 NA 7.26 2.19 NA 26.96 090 44126 ......... ............ A Enterectomy w/o taper, cong ....................... 35.45 NA 14.10 4.60 NA 54.15 090 44127 ......... ............ A Enterectomy w/taper, cong .......................... 40.94 NA 15.69 5.41 NA 62.04 090 44128 ......... ............ A Enterectomy cong, add-on .......................... 4.44 NA 1.53 0.59 NA 6.56 ZZZ 44130 ......... ............ A Bowel to bowel fusion .................................. 14.47 NA 6.22 1.80 NA 22.49 090 44139 ......... ............ A Mobilization of colon .................................... 2.23 NA 0.76 0.28 NA 3.27 ZZZ 44140 ......... ............ A Partial removal of colon ............................... 20.97 NA 8.64 2.62 NA 32.23 090 44141 ......... ............ A Partial removal of colon ............................... 19.48 NA 10.04 2.42 NA 31.94 090 44143 ......... ............ A Partial removal of colon ............................... 22.96 NA 10.69 2.91 NA 36.56 090 44144 ......... ............ A Partial removal of colon ............................... 21.50 NA 9.62 2.71 NA 33.83 090 44145 ......... ............ A Partial removal of colon ............................... 26.38 NA 10.80 3.22 NA 40.40 090 44146 ......... ............ A Partial removal of colon ............................... 27.50 NA 12.85 3.35 NA 43.70 090 44147 ......... ............ A Partial removal of colon ............................... 20.68 NA 8.68 2.48 NA 31.84 090 44150 ......... ............ A Removal of colon ......................................... 23.91 NA 12.03 2.98 NA 38.92 090 44151 ......... ............ A Removal of colon/ileostomy ......................... 26.84 NA 13.39 3.39 NA 43.62 090 44152 ......... ............ A Removal of colon/ileostomy ......................... 27.79 NA 11.59 3.40 NA 42.78 090 44153 ......... ............ A Removal of colon/ileostomy ......................... 30.54 NA 14.38 3.30 NA 48.22 090 44155 ......... ............ A Removal of colon/ileostomy ......................... 27.82 NA 13.30 3.25 NA 44.37 090 44156 ......... ............ A Removal of colon/ileostomy ......................... 30.74 NA 15.03 3.95 NA 49.72 090 44160 ......... ............ A Removal of colon ......................................... 18.59 NA 7.74 2.31 NA 28.64 090 44200 ......... ............ A Laparoscopy, enterolysis ............................. 14.42 NA 6.19 1.75 NA 22.36 090 44201 ......... ............ A Laparoscopy, jejunostomy ........................... 9.77 NA 4.66 1.25 NA 15.68 090 44202 ......... ............ A Lap resect s/intestine singl .......................... 22.01 NA 8.92 2.71 NA 33.64 090 44203 ......... ............ A Lap resect s/intestine, addl .......................... 4.44 NA 1.49 0.56 NA 6.49 ZZZ 44204 ......... ............ A Laparo partial colectomy ............................. 25.04 NA 9.94 3.05 NA 38.03 090 44205 ......... ............ A Lap colectomy part w/ileum ......................... 22.20 NA 8.83 2.69 NA 33.72 090 44206 ......... ............ A Lap part colectomy w/stoma ........................ 26.96 NA 11.22 2.91 NA 41.09 090 44207 ......... ............ A L colectomy/coloproctostomy ...................... 29.96 NA 11.46 3.22 NA 44.64 090 44208 ......... ............ A L colectomy/coloproctostomy ...................... 31.95 NA 13.09 3.35 NA 48.39 090 44210 ......... ............ A Laparo total proctocolectomy ...................... 27.96 NA 11.83 2.98 NA 42.77 090 44211 ......... ............ A Laparo total proctocolectomy ...................... 34.95 NA 14.61 3.35 NA 52.91 090 44212 ......... ............ A Laparo total proctocolectomy ...................... 32.45 NA 13.59 3.25 NA 49.29 090 44300 ......... ............ A Open bowel to skin ...................................... 12.09 NA 5.49 1.55 NA 19.13 090 44310 ......... ............ A Ileostomy/jejunostomy ................................. 15.93 NA 6.69 1.94 NA 24.56 090 44312 ......... ............ A Revision of ileostomy ................................... 8.01 NA 3.99 0.90 NA 12.90 090 44314 ......... ............ A Revision of ileostomy ................................... 15.03 NA 6.55 1.73 NA 23.31 090 44316 ......... ............ A Devise bowel pouch .................................... 21.06 NA 8.54 2.41 NA 32.01 090 44320 ......... ............ A Colostomy .................................................... 17.61 NA 7.65 2.21 NA 27.47 090 44322 ......... ............ A Colostomy with biopsies .............................. 11.96 NA 8.59 1.51 NA 22.06 090 44340 ......... ............ A Revision of colostomy .................................. 7.71 NA 4.27 0.97 NA 12.95 090 44345 ......... ............ A Revision of colostomy .................................. 15.41 NA 6.88 1.92 NA 24.21 090 44346 ......... ............ A Revision of colostomy .................................. 16.96 NA 7.38 2.07 NA 26.41 090 44360 ......... ............ A Small bowel endoscopy ............................... 2.59 NA 1.10 0.19 NA 3.88 000 44361 ......... ............ A Small bowel endoscopy/biopsy ................... 2.87 NA 1.20 0.21 NA 4.28 000 44363 ......... ............ A Small bowel endoscopy ............................... 3.49 NA 1.38 0.26 NA 5.13 000 44364 ......... ............ A Small bowel endoscopy ............................... 3.73 NA 1.49 0.28 NA 5.50 000 44365 ......... ............ A Small bowel endoscopy ............................... 3.31 NA 1.36 0.25 NA 4.92 000 44366 ......... ............ A Small bowel endoscopy ............................... 4.40 NA 1.73 0.32 NA 6.45 000 44369 ......... ............ A Small bowel endoscopy ............................... 4.51 NA 1.73 0.34 NA 6.58 000 44370 ......... ............ A Small bowel endoscopy/stent ...................... 4.79 NA 1.97 0.36 NA 7.12 000 44372 ......... ............ A Small bowel endoscopy ............................... 4.40 NA 1.72 0.35 NA 6.47 000 44373 ......... ............ A Small bowel endoscopy ............................... 3.49 NA 1.42 0.26 NA 5.17 000 44376 ......... ............ A Small bowel endoscopy ............................... 5.25 NA 2.02 0.41 NA 7.68 000 44377 ......... ............ A Small bowel endoscopy/biopsy ................... 5.52 NA 2.13 0.40 NA 8.05 000 44378 ......... ............ A Small bowel endoscopy ............................... 7.12 NA 2.69 0.53 NA 10.34 000 44379 ......... ............ A S bowel endoscope w/stent ......................... 7.46 NA 2.91 0.55 NA 10.92 000 44380 ......... ............ A Small bowel endoscopy ............................... 1.05 NA 0.55 0.08 NA 1.68 000 44382 ......... ............ A Small bowel endoscopy ............................... 1.27 NA 0.63 0.12 NA 2.02 000 44383 ......... ............ A Ileoscopy w/stent ......................................... 2.94 NA 1.27 0.24 NA 4.45 000 44385 ......... ............ A Endoscopy of bowel pouch ......................... 1.82 3.35 0.75 0.15 5.32 2.72 000 44386 ......... ............ A Endoscopy, bowel pouch/biop ..................... 2.12 6.68 0.88 0.19 8.99 3.19 000 44388 ......... ............ A Colonoscopy ................................................ 2.82 5.14 1.15 0.26 8.22 4.23 000 44389 ......... ............ A Colonoscopy with biopsy ............................. 3.13 6.70 1.27 0.27 10.10 4.67 000 44390 ......... ............ A Colonoscopy for foreign body ...................... 3.82 7.19 1.49 0.30 11.31 5.61 000


## 47624

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

44391 ......... ............ A Colonoscopy for bleeding ............................ 4.31 8.84 1.69 0.34 13.49 6.34 000 44392 ......... ............ A Colonoscopy & polypectomy ....................... 3.81 6.66 1.49 0.34 10.81 5.64 000 44393 ......... ............ A Colonoscopy, lesion removal ....................... 4.83 6.99 1.86 0.41 12.23 7.10 000 44394 ......... ............ A Colonoscopy w/snare .................................. 4.42 7.90 1.72 0.39 12.71 6.53 000 44397 ......... ............ A Colonoscopy w/stent .................................... 4.70 NA 1.78 0.42 NA 6.90 000 44500 ......... ............ A Intro, gastrointestinal tube ........................... 0.49 NA 0.16 0.03 NA 0.68 000 44602 ......... ............ A Suture, small intestine ................................. 16.01 NA 6.38 2.00 NA 24.39 090 44603 ......... ............ A Suture, small intestine ................................. 18.63 NA 7.26 2.37 NA 28.26 090 44604 ......... ............ A Suture, large intestine .................................. 16.01 NA 6.45 2.02 NA 24.48 090 44605 ......... ............ A Repair of bowel lesion ................................. 19.50 NA 8.38 2.46 NA 30.34 090 44615 ......... ............ A Intestinal stricturoplasty ............................... 15.91 NA 6.67 1.99 NA 24.57 090 44620 ......... ............ A Repair bowel opening .................................. 12.18 NA 5.32 1.47 NA 18.97 090 44625 ......... ............ A Repair bowel opening .................................. 15.03 NA 6.30 1.82 NA 23.15 090 44626 ......... ............ A Repair bowel opening .................................. 25.32 NA 9.80 3.19 NA 38.31 090 44640 ......... ............ A Repair bowel-skin fistula .............................. 21.62 NA 8.57 2.71 NA 32.90 090 44650 ......... ............ A Repair bowel fistula ..................................... 22.54 NA 8.87 2.79 NA 34.20 090 44660 ......... ............ A Repair bowel-bladder fistula ........................ 21.33 NA 8.33 2.21 NA 31.87 090 44661 ......... ............ A Repair bowel-bladder fistula ........................ 24.77 NA 9.54 2.80 NA 37.11 090 44680 ......... ............ A Surgical revision, intestine ........................... 15.38 NA 6.44 1.95 NA 23.77 090 44700 ......... ............ A Suspend bowel w/prosthesis ....................... 16.09 NA 6.65 1.79 NA 24.53 090 44701 ......... ............ A Intraop colon lavage add-on ........................ 3.10 NA 1.05 0.28 NA 4.43 ZZZ 44800 ......... ............ A Excision of bowel pouch .............................. 11.21 NA 5.39 1.40 NA 18.00 090 44820 ......... ............ A Excision of mesentery lesion ....................... 12.07 NA 5.48 1.53 NA 19.08 090 44850 ......... ............ A Repair of mesentery .................................... 10.72 NA 5.00 1.35 NA 17.07 090 44900 ......... ............ A Drain app abscess, open ............................. 10.12 NA 4.70 1.29 NA 16.11 090 44901 ......... ............ A Drain app abscess, percut ........................... 3.37 28.20 1.11 0.22 31.79 4.70 000 44950 ......... ............ A Appendectomy ............................................. 9.99 NA 4.31 1.27 NA 15.57 090 44955 ......... ............ A Appendectomy add-on ................................. 1.53 NA 0.54 0.19 NA 2.26 ZZZ 44960 ......... ............ A Appendectomy ............................................. 12.32 NA 5.34 1.59 NA 19.25 090 44970 ......... ............ A Laparoscopy, appendectomy ....................... 8.69 NA 4.21 1.12 NA 14.02 090 45000 ......... ............ A Drainage of pelvic abscess ......................... 4.51 NA 2.96 0.50 NA 7.97 090 45005 ......... ............ A Drainage of rectal abscess .......................... 1.99 4.08 1.59 0.24 6.31 3.82 010 45020 ......... ............ A Drainage of rectal abscess .......................... 4.71 NA 3.28 0.53 NA 8.52 090 45100 ......... ............ A Biopsy of rectum .......................................... 3.67 NA 2.37 0.41 NA 6.45 090 45108 ......... ............ A Removal of anorectal lesion ........................ 4.75 NA 2.78 0.59 NA 8.12 090 45110 ......... ............ A Removal of rectum ...................................... 27.96 NA 12.39 3.35 NA 43.70 090 45111 ......... ............ A Partial removal of rectum ............................ 16.46 NA 7.17 2.00 NA 25.63 090 45112 ......... ............ A Removal of rectum ...................................... 30.49 NA 11.75 3.51 NA 45.75 090 45113 ......... ............ A Partial proctectomy ...................................... 30.53 NA 12.59 3.53 NA 46.65 090 45114 ......... ............ A Partial removal of rectum ............................ 27.28 NA 10.85 3.32 NA 41.45 090 45116 ......... ............ A Partial removal of rectum ............................ 24.54 NA 10.01 2.90 NA 37.45 090 45119 ......... ............ A Remove rectum w/reservoir ......................... 30.79 NA 12.44 3.30 NA 46.53 090 45120 ......... ............ A Removal of rectum ...................................... 24.56 NA 10.12 3.04 NA 37.72 090 45121 ......... ............ A Removal of rectum and colon ..................... 27.00 NA 11.10 3.37 NA 41.47 090 45123 ......... ............ A Partial proctectomy ...................................... 16.68 NA 6.85 1.85 NA 25.38 090 45126 ......... ............ A Pelvic exenteration ...................................... 45.09 NA 19.20 4.86 NA 69.15 090 45130 ......... ............ A Excision of rectal prolapse .......................... 16.42 NA 6.76 1.75 NA 24.93 090 45135 ......... ............ A Excision of rectal prolapse .......................... 19.25 NA 8.42 2.33 NA 30.00 090 45136 ......... ............ A Excise ileoanal reservior .............................. 27.26 NA 12.45 2.93 NA 42.64 090 45150 ......... ............ A Excision of rectal stricture ........................... 5.66 NA 2.97 0.58 NA 9.21 090 45160 ......... ............ A Excision of rectal lesion ............................... 15.30 NA 6.64 1.64 NA 23.58 090 45170 ......... ............ A Excision of rectal lesion ............................... 11.47 NA 5.24 1.35 NA 18.06 090 45190 ......... ............ A Destruction, rectal tumor ............................. 9.73 NA 4.66 1.13 NA 15.52 090 45300 ......... ............ A Proctosigmoidoscopy dx .............................. 0.38 1.55 0.29 0.04 1.97 0.71 000 45303 ......... ............ A Proctosigmoidoscopy dilate ......................... 0.44 18.84 0.33 0.04 19.32 0.81 000 45305 ......... ............ A Proctosigmoidoscopy w/bx .......................... 1.01 2.65 0.50 0.11 3.77 1.62 000 45307 ......... ............ A Proctosigmoidoscopy fb ............................... 0.94 3.07 0.48 0.10 4.11 1.52 000 45308 ......... ............ A Proctosigmoidoscopy removal ..................... 0.83 2.00 0.44 0.09 2.92 1.36 000 45309 ......... ............ A Proctosigmoidoscopy removal ..................... 2.01 2.83 0.84 0.22 5.06 3.07 000 45315 ......... ............ A Proctosigmoidoscopy removal ..................... 1.40 2.89 0.64 0.16 4.45 2.20 000 45317 ......... ............ A Proctosigmoidoscopy bleed ......................... 1.50 2.44 0.66 0.15 4.09 2.31 000 45320 ......... ............ A Proctosigmoidoscopy ablate ........................ 1.58 2.93 0.71 0.15 4.66 2.44 000 45321 ......... ............ A Proctosigmoidoscopy volvul ........................ 1.17 NA 0.56 0.13 NA 1.86 000 45327 ......... ............ A Proctosigmoidoscopy w/stent ...................... 1.65 NA 0.69 0.16 NA 2.50 000 45330 ......... ............ A Diagnostic sigmoidoscopy ........................... 0.96 2.30 0.50 0.08 3.34 1.54 000 45331 ......... ............ A Sigmoidoscopy and biopsy .......................... 1.15 3.11 0.59 0.09 4.35 1.83 000 45332 ......... ............ A Sigmoidoscopy w/fb removal ....................... 1.79 5.05 0.80 0.15 6.99 2.74 000 45333 ......... ............ A Sigmoidoscopy & polypectomy .................... 1.79 4.91 0.80 0.15 6.85 2.74 000 45334 ......... ............ A Sigmoidoscopy for bleeding ........................ 2.73 NA 1.14 0.21 NA 4.08 000 45335 ......... ............ A Sigmoidoscopy w/submuc inj ...................... 1.46 3.22 0.69 0.04 4.72 2.19 000 45337 ......... ............ A Sigmoidoscopy & decompress .................... 2.36 NA 1.00 0.22 NA 3.58 000 45338 ......... ............ A Sigmoidoscopy w/tumr remove ................... 2.34 5.24 1.00 0.20 7.78 3.54 000 45339 ......... ............ A Sigmoidoscopy w/ablate tumr ...................... 3.14 3.47 1.28 0.26 6.87 4.68 000 45340 ......... ............ A Sig w/balloon dilation ................................... 1.89 6.18 0.83 0.04 8.11 2.76 000 45341 ......... ............ A Sigmoidoscopy w/ultrasound ....................... 2.60 NA 1.07 0.20 NA 3.87 000


## 47625

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

45342 ......... ............ A Sigmoidoscopy w/us guide bx ..................... 4.05 NA 1.55 0.30 NA 5.90 000 45345 ......... ............ A Sigmoidoscopy w/stent ................................ 2.92 NA 1.16 0.24 NA 4.32 000 45355 ......... ............ A Surgical colonoscopy ................................... 3.51 NA 1.38 0.35 NA 5.24 000 45378 ......... ............ A Diagnostic colonoscopy ............................... 3.69 6.20 1.47 0.24 10.13 5.40 000 45378 ......... 53 ....... A Diagnostic colonoscopy ............................... 0.96 2.30 0.50 0.08 3.34 1.54 000 45379 ......... ............ A Colonoscopy w/fb removal .......................... 4.68 7.75 1.81 0.38 12.81 6.87 000 45380 ......... ............ A Colonoscopy and biopsy ............................. 4.43 7.26 1.73 0.35 12.04 6.51 000 45381 ......... ............ A Colonoscopy, submucous inj ....................... 4.19 7.17 1.65 0.31 11.67 6.15 000 45382 ......... ............ A Colonoscopy/control bleeding ...................... 5.68 10.01 2.18 0.43 16.12 8.29 000 45383 ......... ............ A Lesion removal colonoscopy ....................... 5.86 7.99 2.22 0.48 14.33 8.56 000 45384 ......... ............ A Lesion remove colonoscopy ........................ 4.69 6.85 1.82 0.38 11.92 6.89 000 45385 ......... ............ A Lesion removal colonoscopy ....................... 5.30 7.86 2.03 0.42 13.58 7.75 000 45386 ......... ............ A Colonoscopy dilate stricture ........................ 4.57 12.46 1.77 0.31 17.34 6.65 000 45387 ......... ............ A Colonoscopy w/stent .................................... 5.90 NA 2.33 0.49 NA 8.72 000 45500 ......... ............ A Repair of rectum .......................................... 7.28 NA 3.58 0.73 NA 11.59 090 45505 ......... ............ A Repair of rectum .......................................... 7.57 NA 3.86 0.83 NA 12.26 090 45520 ......... ............ A Treatment of rectal prolapse ....................... 0.55 1.65 0.37 0.05 2.25 0.97 000 45540 ......... ............ A Correct rectal prolapse ................................ 16.25 NA 6.82 1.84 NA 24.91 090 45541 ......... ............ A Correct rectal prolapse ................................ 13.38 NA 5.96 1.53 NA 20.87 090 45550 ......... ............ A Repair rectum/remove sigmoid .................... 22.97 NA 9.23 2.61 NA 34.81 090 45560 ......... ............ A Repair of rectocele ...................................... 10.56 NA 5.09 1.14 NA 16.79 090 45562 ......... ............ A Exploration/repair of rectum ........................ 15.36 NA 7.00 1.81 NA 24.17 090 45563 ......... ............ A Exploration/repair of rectum ........................ 23.43 NA 10.52 2.95 NA 36.90 090 45800 ......... ............ A Repair rect/bladder fistula ............................ 17.74 NA 7.45 1.89 NA 27.08 090 45805 ......... ............ A Repair fistula w/colostomy ........................... 20.75 NA 9.52 2.32 NA 32.59 090 45820 ......... ............ A Repair rectourethral fistula .......................... 18.45 NA 7.64 1.66 NA 27.75 090 45825 ......... ............ A Repair fistula w/colostomy ........................... 21.22 NA 9.83 2.15 NA 33.20 090 45900 ......... ............ A Reduction of rectal prolapse ........................ 2.61 NA 1.51 0.29 NA 4.41 010 45905 ......... ............ A Dilation of anal sphincter ............................. 2.30 NA 1.43 0.27 NA 4.00 010 45910 ......... ............ A Dilation of rectal narrowing .......................... 2.80 NA 1.67 0.28 NA 4.75 010 45915 ......... ............ A Remove rectal obstruction ........................... 3.14 4.36 2.10 0.30 7.80 5.54 010 46020 ......... ............ A Placement of seton ...................................... 2.90 2.35 1.86 0.35 5.60 5.11 010 46030 ......... ............ A Removal of rectal marker ............................ 1.23 1.35 0.71 0.14 2.72 2.08 010 46040 ......... ............ A Incision of rectal abscess ............................ 4.95 5.52 3.61 0.60 11.07 9.16 090 46045 ......... ............ A Incision of rectal abscess ............................ 4.31 NA 2.91 0.53 NA 7.75 090 46050 ......... ............ A Incision of anal abscess .............................. 1.19 2.56 0.85 0.14 3.89 2.18 010 46060 ......... ............ A Incision of rectal abscess ............................ 5.68 NA 3.28 0.67 NA 9.63 090 46070 ......... ............ A Incision of anal septum ................................ 2.71 NA 1.86 0.20 NA 4.77 090 46080 ......... ............ A Incision of anal sphincter ............................. 2.49 2.38 1.13 0.30 5.17 3.92 010 46083 ......... ............ A Incise external hemorrhoid .......................... 1.40 2.55 0.94 0.15 4.10 2.49 010 46200 ......... ............ A Removal of anal fissure ............................... 3.41 3.87 2.88 0.39 7.67 6.68 090 46210 ......... ............ A Removal of anal crypt .................................. 2.67 5.16 2.64 0.31 8.14 5.62 090 46211 ......... ............ A Removal of anal crypts ................................ 4.24 5.44 3.52 0.52 10.20 8.28 090 46220 ......... ............ A Removal of anal tag .................................... 1.56 2.22 0.93 0.18 3.96 2.67 010 46221 ......... ............ A Ligation of hemorrhoid(s) ............................. 2.04 2.65 1.75 0.22 4.91 4.01 010 46230 ......... ............ A Removal of anal tags ................................... 2.57 3.00 1.27 0.29 5.86 4.13 010 46250 ......... ............ A Hemorrhoidectomy ....................................... 3.88 5.34 2.62 0.46 9.68 6.96 090 46255 ......... ............ A Hemorrhoidectomy ....................................... 4.59 5.87 2.84 0.57 11.03 8.00 090 46257 ......... ............ A Remove hemorrhoids & fissure ................... 5.39 NA 2.89 0.64 NA 8.92 090 46258 ......... ............ A Remove hemorrhoids & fistula .................... 5.72 NA 3.29 0.68 NA 9.69 090 46260 ......... ............ A Hemorrhoidectomy ....................................... 6.36 NA 3.23 0.75 NA 10.34 090 46261 ......... ............ A Remove hemorrhoids & fissure ................... 7.07 NA 3.64 0.81 NA 11.52 090 46262 ......... ............ A Remove hemorrhoids & fistula .................... 7.49 NA 3.77 0.85 NA 12.11 090 46270 ......... ............ A Removal of anal fistula ................................ 3.71 5.02 2.85 0.46 9.19 7.02 090 46275 ......... ............ A Removal of anal fistula ................................ 4.55 4.65 2.98 0.51 9.71 8.04 090 46280 ......... ............ A Removal of anal fistula ................................ 5.97 NA 3.29 0.66 NA 9.92 090 46285 ......... ............ A Removal of anal fistula ................................ 4.08 3.76 2.75 0.45 8.29 7.28 090 46288 ......... ............ A Repair anal fistula ........................................ 7.12 NA 3.71 0.79 NA 11.62 090 46320 ......... ............ A Removal of hemorrhoid clot ........................ 1.61 2.14 0.86 0.17 3.92 2.64 010 46500 ......... ............ A Injection into hemorrhoid(s) ......................... 1.61 2.12 1.16 0.16 3.89 2.93 010 46600 ......... ............ A Diagnostic anoscopy .................................... 0.50 1.57 0.35 0.05 2.12 0.90 000 46604 ......... ............ A Anoscopy and dilation ................................. 1.31 9.16 0.62 0.13 10.60 2.06 000 46606 ......... ............ A Anoscopy and biopsy .................................. 0.81 3.81 0.43 0.09 4.71 1.33 000 46608 ......... ............ A Anoscopy, remove for body ......................... 1.51 4.44 0.65 0.16 6.11 2.32 000 46610 ......... ............ A Anoscopy, remove lesion ............................ 1.32 4.05 0.61 0.15 5.52 2.08 000 46611 ......... ............ A Anoscopy ..................................................... 1.81 3.36 0.78 0.19 5.36 2.78 000 46612 ......... ............ A Anoscopy, remove lesions ........................... 2.34 5.21 0.98 0.28 7.83 3.60 000 46614 ......... ............ A Anoscopy, control bleeding ......................... 2.01 2.33 0.84 0.20 4.54 3.05 000 46615 ......... ............ A Anoscopy ..................................................... 2.68 2.50 1.07 0.32 5.50 4.07 000 46700 ......... ............ A Repair of anal stricture ................................ 9.12 NA 4.23 0.93 NA 14.28 090 46705 ......... ............ A Repair of anal stricture ................................ 6.89 NA 3.72 0.91 NA 11.52 090 46706 ......... ............ A Repr of anal fistula w/glue ........................... 2.39 NA 1.25 0.51 NA 4.15 010 46715 ......... ............ A Repair of anovaginal fistula ......................... 7.19 NA 3.61 0.92 NA 11.72 090 46716 ......... ............ A Repair of anovaginal fistula ......................... 15.05 NA 7.95 1.57 NA 24.57 090 46730 ......... ............ A Construction of absent anus ........................ 26.71 NA 11.99 1.71 NA 40.41 090


## 47626

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

46735 ......... ............ A Construction of absent anus ........................ 32.12 NA 13.51 3.18 NA 48.81 090 46740 ......... ............ A Construction of absent anus ........................ 29.96 NA 13.16 2.89 NA 46.01 090 46742 ......... ............ A Repair of imperforated anus ........................ 35.75 NA 17.47 4.73 NA 57.95 090 46744 ......... ............ A Repair of cloacal anomaly ........................... 52.55 NA 21.07 3.83 NA 77.45 090 46746 ......... ............ A Repair of cloacal anomaly ........................... 58.13 NA 25.05 3.03 NA 86.21 090 46748 ......... ............ A Repair of cloacal anomaly ........................... 64.11 NA 23.66 3.34 NA 91.11 090 46750 ......... ............ A Repair of anal sphincter .............................. 10.23 NA 5.08 1.13 NA 16.44 090 46751 ......... ............ A Repair of anal sphincter .............................. 8.76 NA 5.50 0.94 NA 15.20 090 46753 ......... ............ A Reconstruction of anus ................................ 8.28 NA 3.86 0.97 NA 13.11 090 46754 ......... ............ A Removal of suture from anus ...................... 2.20 3.66 1.68 0.19 6.05 4.07 010 46760 ......... ............ A Repair of anal sphincter .............................. 14.41 NA 7.09 1.57 NA 23.07 090 46761 ......... ............ A Repair of anal sphincter .............................. 13.82 NA 6.04 1.48 NA 21.34 090 46762 ......... ............ A Implant artificial sphincter ............................ 12.69 NA 5.53 1.24 NA 19.46 090 46900 ......... ............ A Destruction, anal lesion(s) ........................... 1.91 2.59 1.28 0.18 4.68 3.37 010 46910 ......... ............ A Destruction, anal lesion(s) ........................... 1.86 2.92 1.06 0.19 4.97 3.11 010 46916 ......... ............ A Cryosurgery, anal lesion(s) .......................... 1.86 3.17 1.40 0.16 5.19 3.42 010 46917 ......... ............ A Laser surgery, anal lesions ......................... 1.86 9.19 1.12 0.21 11.26 3.19 010 46922 ......... ............ A Excision of anal lesion(s) ............................. 1.86 3.29 1.08 0.21 5.36 3.15 010 46924 ......... ............ A Destruction, anal lesion(s) ........................... 2.76 8.72 1.36 0.27 11.75 4.39 010 46934 ......... ............ A Destruction of hemorrhoids ......................... 3.50 5.10 2.97 0.31 8.91 6.78 090 46935 ......... ............ A Destruction of hemorrhoids ......................... 2.43 3.49 1.21 0.22 6.14 3.86 010 46936 ......... ............ A Destruction of hemorrhoids ......................... 3.68 4.89 2.50 0.36 8.93 6.54 090 46937 ......... ............ A Cryotherapy of rectal lesion ......................... 2.69 2.77 1.23 0.28 5.74 4.20 010 46938 ......... ............ A Cryotherapy of rectal lesion ......................... 4.65 4.00 3.06 0.58 9.23 8.29 090 46940 ......... ............ A Treatment of anal fissure ............................. 2.32 1.99 1.09 0.22 4.53 3.63 010 46942 ......... ............ A Treatment of anal fissure ............................. 2.04 1.83 1.02 0.19 4.06 3.25 010 46945 ......... ............ A Ligation of hemorrhoids ............................... 1.84 3.36 2.49 0.19 5.39 4.52 090 46946 ......... ............ A Ligation of hemorrhoids ............................... 2.58 3.79 2.40 0.26 6.63 5.24 090 47000 ......... ............ A Needle biopsy of liver .................................. 1.90 3.07 0.63 0.12 5.09 2.65 000 47001 ......... ............ A Needle biopsy, liver add-on ......................... 1.90 NA 0.65 0.24 NA 2.79 ZZZ 47010 ......... ............ A Open drainage, liver lesion .......................... 15.99 NA 8.40 1.74 NA 26.13 090 47011 ......... ............ A Percut drain, liver lesion .............................. 3.69 NA 1.20 0.23 NA 5.12 000 47015 ......... ............ A Inject/aspirate liver cyst ............................... 15.09 NA 7.49 1.78 NA 24.36 090 47100 ......... ............ A Wedge biopsy of liver .................................. 11.65 NA 6.04 1.48 NA 19.17 090 47120 ......... ............ A Partial removal of liver ................................. 35.45 NA 15.15 4.53 NA 55.13 090 47122 ......... ............ A Extensive removal of liver ........................... 55.05 NA 21.45 6.99 NA 83.49 090 47125 ......... ............ A Partial removal of liver ................................. 49.12 NA 19.51 6.23 NA 74.86 090 47130 ......... ............ A Partial removal of liver ................................. 53.27 NA 20.97 6.80 NA 81.04 090 47135 ......... ............ R Transplantation of liver ................................ 81.40 NA 31.49 9.89 NA 122.78 090 47136 ......... ............ R Transplantation of liver ................................ 68.50 NA 26.99 8.36 NA 103.85 090 47140 ......... ............ A Partial removal, donor liver .......................... 54.92 NA 22.25 4.87 NA 82.04 090 47141 ......... ............ A Partial removal, donor liver .......................... 67.40 NA 26.87 4.87 NA 99.14 090 47142 ......... ............ A Partial removal, donor liver .......................... 74.89 NA 29.43 4.87 NA 109.19 090 47300 ......... ............ A Surgery for liver lesion ................................. 15.06 NA 7.23 1.91 NA 24.20 090 47350 ......... ............ A Repair liver wound ....................................... 19.53 NA 8.86 2.48 NA 30.87 090 47360 ......... ............ A Repair liver wound ....................................... 26.88 NA 11.59 3.35 NA 41.82 090 47361 ......... ............ A Repair liver wound ....................................... 47.05 NA 18.51 5.77 NA 71.33 090 47362 ......... ............ A Repair liver wound ....................................... 18.48 NA 8.73 2.31 NA 29.52 090 47370 ......... ............ A Laparo ablate liver tumor rf ......................... 19.66 NA 8.13 2.27 NA 30.06 090 47371 ......... ............ A Laparo ablate liver cryosurg ........................ 19.66 NA 8.14 2.11 NA 29.91 090 47380 ......... ............ A Open ablate liver tumor rf ............................ 22.97 NA 9.34 2.69 NA 35.00 090 47381 ......... ............ A Open ablate liver tumor cryo ....................... 23.24 NA 9.58 2.39 NA 35.21 090 47382 ......... ............ A Percut ablate liver rf .................................... 15.17 NA 6.06 0.80 NA 22.03 010 47400 ......... ............ A Incision of liver duct ..................................... 32.44 NA 13.43 3.46 NA 49.33 090 47420 ......... ............ A Incision of bile duct ...................................... 19.85 NA 8.75 2.54 NA 31.14 090 47425 ......... ............ A Incision of bile duct ...................................... 19.80 NA 8.81 2.46 NA 31.07 090 47460 ......... ............ A Incise bile duct sphincter ............................. 18.01 NA 8.38 2.00 NA 28.39 090 47480 ......... ............ A Incision of gallbladder .................................. 10.80 NA 5.92 1.38 NA 18.10 090 47490 ......... ............ A Incision of gallbladder .................................. 7.22 NA 5.58 0.44 NA 13.24 090 47500 ......... ............ A Injection for liver x-rays ............................... 1.96 NA 0.64 0.12 NA 2.72 000 47505 ......... ............ A Injection for liver x-rays ............................... 0.76 NA 0.25 0.05 NA 1.06 000 47510 ......... ............ A Insert catheter, bile duct .............................. 7.82 NA 5.00 0.50 NA 13.32 090 47511 ......... ............ A Insert bile duct drain .................................... 10.48 NA 5.07 0.64 NA 16.19 090 47525 ......... ............ A Change bile duct catheter ........................... 5.54 12.22 2.80 0.33 18.09 8.67 010 47530 ......... ............ A Revise/reinsert bile tube .............................. 5.84 25.23 3.70 0.38 31.45 9.92 090 47550 ......... ............ A Bile duct endoscopy add-on ........................ 3.02 NA 1.02 0.39 NA 4.43 ZZZ 47552 ......... ............ A Biliary endoscopy thru skin .......................... 6.03 NA 2.40 0.44 NA 8.87 000 47553 ......... ............ A Biliary endoscopy thru skin .......................... 6.34 NA 2.06 0.41 NA 8.81 000 47554 ......... ............ A Biliary endoscopy thru skin .......................... 9.05 NA 3.38 0.96 NA 13.39 000 47555 ......... ............ A Biliary endoscopy thru skin .......................... 7.55 NA 2.45 0.46 NA 10.46 000 47556 ......... ............ A Biliary endoscopy thru skin .......................... 8.55 NA 2.77 0.51 NA 11.83 000 47560 ......... ............ A Laparoscopy w/cholangio ............................ 4.88 NA 1.66 0.59 NA 7.13 000 47561 ......... ............ A Laparo w/cholangio/biopsy .......................... 5.17 NA 1.91 0.65 NA 7.73 000 47562 ......... ............ A Laparoscopic cholecystectomy .................... 11.07 NA 4.98 1.42 NA 17.47 090 47563 ......... ............ A Laparo cholecystectomy/graph .................... 11.92 NA 5.29 1.52 NA 18.73 090


## 47627

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

47564 ......... ............ A Laparo cholecystectomy/explr ..................... 14.21 NA 5.94 1.82 NA 21.97 090 47570 ......... ............ A Laparo cholecystoenterostomy .................... 12.56 NA 5.36 1.60 NA 19.52 090 47600 ......... ............ A Removal of gallbladder ................................ 13.56 NA 6.15 1.73 NA 21.44 090 47605 ......... ............ A Removal of gallbladder ................................ 14.67 NA 6.50 1.88 NA 23.05 090 47610 ......... ............ A Removal of gallbladder ................................ 18.79 NA 7.94 2.41 NA 29.14 090 47612 ......... ............ A Removal of gallbladder ................................ 18.75 NA 7.88 2.40 NA 29.03 090 47620 ......... ............ A Removal of gallbladder ................................ 20.61 NA 8.52 2.68 NA 31.81 090 47630 ......... ............ A Remove bile duct stone ............................... 9.10 NA 4.86 0.69 NA 14.65 090 47700 ......... ............ A Exploration of bile ducts .............................. 15.60 NA 7.43 1.89 NA 24.92 090 47701 ......... ............ A Bile duct revision ......................................... 27.77 NA 11.49 3.55 NA 42.81 090 47711 ......... ............ A Excision of bile duct tumor .......................... 23.00 NA 9.92 2.93 NA 35.85 090 47712 ......... ............ A Excision of bile duct tumor .......................... 30.19 NA 12.41 3.93 NA 46.53 090 47715 ......... ............ A Excision of bile duct cyst ............................. 18.77 NA 8.42 2.38 NA 29.57 090 47716 ......... ............ A Fusion of bile duct cyst ................................ 16.42 NA 7.83 2.08 NA 26.33 090 47720 ......... ............ A Fuse gallbladder & bowel ............................ 15.89 NA 7.48 2.03 NA 25.40 090 47721 ......... ............ A Fuse upper gi structures .............................. 19.09 NA 8.57 2.46 NA 30.12 090 47740 ......... ............ A Fuse gallbladder & bowel ............................ 18.45 NA 8.38 2.43 NA 29.26 090 47741 ......... ............ A Fuse gallbladder & bowel ............................ 21.31 NA 9.28 2.63 NA 33.22 090 47760 ......... ............ A Fuse bile ducts and bowel ........................... 25.81 NA 10.84 3.32 NA 39.97 090 47765 ......... ............ A Fuse liver ducts & bowel ............................. 24.84 NA 10.80 3.21 NA 38.85 090 47780 ......... ............ A Fuse bile ducts and bowel ........................... 26.46 NA 11.20 3.43 NA 41.09 090 47785 ......... ............ A Fuse bile ducts and bowel ........................... 31.13 NA 12.91 4.04 NA 48.08 090 47800 ......... ............ A Reconstruction of bile ducts ........................ 23.27 NA 10.06 2.94 NA 36.27 090 47801 ......... ............ A Placement, bile duct support ....................... 15.15 NA 8.15 1.24 NA 24.54 090 47802 ......... ............ A Fuse liver duct & intestine ........................... 21.52 NA 9.68 2.73 NA 33.93 090 47900 ......... ............ A Suture bile duct injury .................................. 19.87 NA 8.87 2.57 NA 31.31 090 48000 ......... ............ A Drainage of abdomen .................................. 28.03 NA 11.49 3.40 NA 42.92 090 48001 ......... ............ A Placement of drain, pancreas ...................... 35.40 NA 13.87 4.47 NA 53.74 090 48005 ......... ............ A Resect/debride pancreas ............................. 42.11 NA 16.53 5.41 NA 64.05 090 48020 ......... ............ A Removal of pancreatic stone ....................... 15.68 NA 7.29 2.12 NA 25.09 090 48100 ......... ............ A Biopsy of pancreas, open ............................ 12.21 NA 5.61 1.54 NA 19.36 090 48102 ......... ............ A Needle biopsy, pancreas ............................. 4.67 7.95 1.94 0.29 12.91 6.90 010 48120 ......... ............ A Removal of pancreas lesion ........................ 15.83 NA 6.86 1.98 NA 24.67 090 48140 ......... ............ A Partial removal of pancreas ......................... 22.91 NA 9.53 2.91 NA 35.35 090 48145 ......... ............ A Partial removal of pancreas ......................... 23.98 NA 9.84 3.09 NA 36.91 090 48146 ......... ............ A Pancreatectomy ........................................... 26.36 NA 11.98 3.40 NA 41.74 090 48148 ......... ............ A Removal of pancreatic duct ......................... 17.31 NA 7.62 2.20 NA 27.13 090 48150 ......... ............ A Partial removal of pancreas ......................... 47.93 NA 19.49 6.18 NA 73.60 090 48152 ......... ............ A Pancreatectomy ........................................... 43.68 NA 18.20 5.68 NA 67.56 090 48153 ......... ............ A Pancreatectomy ........................................... 47.82 NA 19.54 6.19 NA 73.55 090 48154 ......... ............ A Pancreatectomy ........................................... 44.03 NA 18.23 5.74 NA 68.00 090 48155 ......... ............ A Removal of pancreas ................................... 24.60 NA 11.69 3.14 NA 39.43 090 48180 ......... ............ A Fuse pancreas and bowel ........................... 24.68 NA 10.16 3.22 NA 38.06 090 48400 ......... ............ A Injection, intraop add-on .............................. 1.95 NA 0.64 0.16 NA 2.75 ZZZ 48500 ......... ............ A Surgery of pancreatic cyst ........................... 15.26 NA 7.34 2.04 NA 24.64 090 48510 ......... ............ A Drain pancreatic pseudocyst ....................... 14.29 NA 7.43 1.80 NA 23.52 090 48511 ......... ............ A Drain pancreatic pseudocyst ....................... 3.99 21.20 1.30 0.25 25.44 5.54 000 48520 ......... ............ A Fuse pancreas cyst and bowel .................... 15.57 NA 6.70 1.99 NA 24.26 090 48540 ......... ............ A Fuse pancreas cyst and bowel .................... 19.69 NA 8.11 2.50 NA 30.30 090 48545 ......... ............ A Pancreatorrhaphy ........................................ 18.15 NA 7.99 2.30 NA 28.44 090 48547 ......... ............ A Duodenal exclusion ..................................... 25.79 NA 10.48 3.28 NA 39.55 090 48554 ......... ............ R Transpl allograft pancreas ........................... 34.12 NA 18.29 4.19 NA 56.60 090 48556 ......... ............ A Removal, allograft pancreas ........................ 15.69 NA 8.07 1.96 NA 25.72 090 49000 ......... ............ A Exploration of abdomen ............................... 11.66 NA 5.38 1.44 NA 18.48 090 49002 ......... ............ A Reopening of abdomen ............................... 10.47 NA 5.04 1.33 NA 16.84 090 49010 ......... ............ A Exploration behind abdomen ....................... 12.26 NA 5.91 1.49 NA 19.66 090 49020 ......... ............ A Drain abdominal abscess ............................ 22.81 NA 10.19 2.71 NA 35.71 090 49021 ......... ............ A Drain abdominal abscess ............................ 3.37 21.58 1.11 0.21 25.16 4.69 000 49040 ......... ............ A Drain, open, abdom abscess ....................... 13.50 NA 6.44 1.65 NA 21.59 090 49041 ......... ............ A Drain, percut, abdom abscess ..................... 3.99 19.76 1.31 0.25 24.00 5.55 000 49060 ......... ............ A Drain, open, retrop abscess ........................ 15.84 NA 7.44 1.64 NA 24.92 090 49061 ......... ............ A Drain, percut, retroper absc ......................... 3.69 19.95 1.21 0.22 23.86 5.12 000 49062 ......... ............ A Drain to peritoneal cavity ............................. 11.34 NA 5.46 1.40 NA 18.20 090 49080 ......... ............ A Puncture, peritoneal cavity .......................... 1.35 4.15 0.45 0.09 5.59 1.89 000 49081 ......... ............ A Removal of abdominal fluid ......................... 1.26 2.66 0.43 0.09 4.01 1.78 000 49085 ......... ............ A Remove abdomen foreign body .................. 12.12 NA 5.51 1.43 NA 19.06 090 49180 ......... ............ A Biopsy, abdominal mass .............................. 1.73 3.14 0.56 0.11 4.98 2.40 000 49200 ......... ............ A Removal of abdominal lesion ...................... 10.23 NA 5.05 1.14 NA 16.42 090 49201 ......... ............ A Remove abdom lesion, complex ................. 14.82 NA 7.06 1.77 NA 23.65 090 49215 ......... ............ A Excise sacral spine tumor ........................... 33.45 NA 14.04 4.29 NA 51.78 090 49220 ......... ............ A Multiple surgery, abdomen .......................... 14.86 NA 6.65 1.83 NA 23.34 090 49250 ......... ............ A Excision of umbilicus ................................... 8.34 NA 4.30 1.05 NA 13.69 090 49255 ......... ............ A Removal of omentum .................................. 11.12 NA 5.63 1.39 NA 18.14 090 49320 ......... ............ A Diag laparo separate proc ........................... 5.09 NA 2.63 0.63 NA 8.35 010 49321 ......... ............ A Laparoscopy, biopsy .................................... 5.39 NA 2.64 0.68 NA 8.71 010


## 47628

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

49322 ......... ............ A Laparoscopy, aspiration ............................... 5.69 NA 2.99 0.70 NA 9.38 010 49323 ......... ............ A Laparo drain lymphocele ............................. 9.47 NA 4.49 1.12 NA 15.08 090 49400 ......... ............ A Air injection into abdomen ........................... 1.88 3.16 0.62 0.16 5.20 2.66 000 49419 ......... ............ A Insrt abdom cath for chemotx ...................... 6.64 NA 3.55 0.70 NA 10.89 090 49420 ......... ............ A Insert abdom drain, temp ............................ 2.22 NA 1.09 0.21 NA 3.52 000 49421 ......... ............ A Insert abdom drain, perm ............................ 5.53 NA 3.17 0.70 NA 9.40 090 49422 ......... ............ A Remove perm cannula/catheter .................. 6.24 NA 2.89 0.80 NA 9.93 010 49423 ......... ............ A Exchange drainage catheter ........................ 1.46 14.40 0.52 0.09 15.95 2.07 000 49424 ......... ............ A Assess cyst, contrast inject ......................... 0.76 3.92 0.29 0.05 4.73 1.10 000 49425 ......... ............ A Insert abdomen-venous drain ...................... 11.35 NA 5.62 1.52 NA 18.49 090 49426 ......... ............ A Revise abdomen-venous shunt ................... 9.62 NA 4.78 1.23 NA 15.63 090 49427 ......... ............ A Injection, abdominal shunt ........................... 0.89 NA 0.30 0.06 NA 1.25 000 49428 ......... ............ A Ligation of shunt .......................................... 6.05 NA 3.92 0.84 NA 10.81 010 49429 ......... ............ A Removal of shunt ......................................... 7.39 NA 3.42 0.99 NA 11.80 010 49491 ......... ............ A Rpr hern preemie reduc .............................. 11.11 NA 5.04 1.47 NA 17.62 090 49492 ......... ............ A Rpr ing hern premie, blocked ...................... 14.01 NA 6.10 1.64 NA 21.75 090 49495 ......... ............ A Rpr ing hernia baby, reduc .......................... 5.88 NA 2.97 0.78 NA 9.63 090 49496 ......... ............ A Rpr ing hernia baby, blocked ...................... 8.78 NA 4.33 1.10 NA 14.21 090 49500 ......... ............ A Rpr ing hernia, init, reduce .......................... 5.47 NA 3.13 0.62 NA 9.22 090 49501 ......... ............ A Rpr ing hernia, init blocked .......................... 8.87 NA 4.21 1.13 NA 14.21 090 49505 ......... ............ A Prp i/hern init reduc>5 yr ............................. 7.59 NA 3.75 0.99 NA 12.33 090 49507 ......... ............ A Prp i/hern init block>5 yr ............................. 9.56 NA 4.50 1.24 NA 15.30 090 49520 ......... ............ A Rerepair ing hernia, reduce ......................... 9.62 NA 4.46 1.24 NA 15.32 090 49521 ......... ............ A Rerepair ing hernia, blocked ....................... 11.95 NA 5.25 1.56 NA 18.76 090 49525 ......... ............ A Repair ing hernia, sliding ............................. 8.56 NA 4.10 1.09 NA 13.75 090 49540 ......... ............ A Repair lumbar hernia ................................... 10.37 NA 4.77 1.34 NA 16.48 090 49550 ......... ............ A Rpr rem hernia, init, reduce ......................... 8.62 NA 4.14 1.12 NA 13.88 090 49553 ......... ............ A Rpr fem hernia, init blocked ........................ 9.43 NA 4.43 1.22 NA 15.08 090 49555 ......... ............ A Rerepair fem hernia, reduce ........................ 9.02 NA 4.29 1.17 NA 14.48 090 49557 ......... ............ A Rerepair fem hernia, blocked ...................... 11.13 NA 5.00 1.44 NA 17.57 090 49560 ......... ............ A Rpr ventral hern init, reduc .......................... 11.55 NA 5.17 1.48 NA 18.20 090 49561 ......... ............ A Rpr ventral hern init, block .......................... 14.23 NA 6.07 1.83 NA 22.13 090 49565 ......... ............ A Rerepair ventrl hern, reduce ........................ 11.55 NA 5.24 1.48 NA 18.27 090 49566 ......... ............ A Rerepair ventrl hern, block .......................... 14.38 NA 6.14 1.85 NA 22.37 090 49568 ......... ............ A Hernia repair w/mesh .................................. 4.88 NA 1.67 0.63 NA 7.18 ZZZ 49570 ......... ............ A Rpr epigastric hern, reduce ......................... 5.68 NA 3.18 0.73 NA 9.59 090 49572 ......... ............ A Rpr epigastric hern, blocked ........................ 6.72 NA 3.48 0.86 NA 11.06 090 49580 ......... ............ A Rpr umbil hern, reduc < 5 yr ....................... 4.10 NA 2.62 0.52 NA 7.24 090 49582 ......... ............ A Rpr umbil hern, block < 5 yr ........................ 6.64 NA 3.51 0.86 NA 11.01 090 49585 ......... ............ A Rpr umbil hern, reduc > 5 yr ....................... 6.22 NA 3.32 0.79 NA 10.33 090 49587 ......... ............ A Rpr umbil hern, block > 5 yr ........................ 7.55 NA 3.75 0.97 NA 12.27 090 49590 ......... ............ A Repair spigilian hernia ................................. 8.53 NA 4.11 1.09 NA 13.73 090 49600 ......... ............ A Repair umbilical lesion ................................. 10.94 NA 5.35 1.31 NA 17.60 090 49605 ......... ............ A Repair umbilical lesion ................................. 75.89 NA 28.48 9.95 NA 114.32 090 49606 ......... ............ A Repair umbilical lesion ................................. 18.57 NA 7.72 2.43 NA 28.72 090 49610 ......... ............ A Repair umbilical lesion ................................. 10.48 NA 5.24 0.57 NA 16.29 090 49611 ......... ............ A Repair umbilical lesion ................................. 8.91 NA 7.31 0.78 NA 17.00 090 49650 ......... ............ A Laparo hernia repair initial ........................... 6.26 NA 3.20 0.90 NA 10.36 090 49651 ......... ............ A Laparo hernia repair recur ........................... 8.23 NA 4.06 1.10 NA 13.39 090 49900 ......... ............ A Repair of abdominal wall ............................. 12.26 NA 6.23 1.55 NA 20.04 090 49904 ......... ............ A Omental flap, extra-abdom .......................... 19.97 NA 15.17 2.52 NA 37.66 090 49905 ......... ............ A Omental flap, intra-abdom ........................... 6.54 NA 2.29 0.79 NA 9.62 ZZZ 50010 ......... ............ A Exploration of kidney ................................... 10.96 NA 5.21 0.93 NA 17.10 090 50020 ......... ............ A Renal abscess, open drain .......................... 14.64 NA 7.73 1.27 NA 23.64 090 50021 ......... ............ A Renal abscess, percut drain ........................ 3.37 21.89 1.10 0.20 25.46 4.67 000 50040 ......... ............ A Drainage of kidney ....................................... 14.92 NA 6.80 1.03 NA 22.75 090 50045 ......... ............ A Exploration of kidney ................................... 15.44 NA 6.59 1.24 NA 23.27 090 50060 ......... ............ A Removal of kidney stone ............................. 19.27 NA 7.81 1.46 NA 28.54 090 50065 ......... ............ A Incision of kidney ......................................... 20.76 NA 6.09 1.48 NA 28.33 090 50070 ......... ............ A Incision of kidney ......................................... 20.29 NA 8.20 1.48 NA 29.97 090 50075 ......... ............ A Removal of kidney stone ............................. 25.30 NA 9.88 1.93 NA 37.11 090 50080 ......... ............ A Removal of kidney stone ............................. 14.69 NA 6.27 1.04 NA 22.00 090 50081 ......... ............ A Removal of kidney stone ............................. 21.77 NA 8.74 1.57 NA 32.08 090 50100 ......... ............ A Revise kidney blood vessels ....................... 16.07 NA 7.77 1.78 NA 25.62 090 50120 ......... ............ A Exploration of kidney ................................... 15.89 NA 6.75 1.19 NA 23.83 090 50125 ......... ............ A Explore and drain kidney ............................. 16.50 NA 6.96 1.34 NA 24.80 090 50130 ......... ............ A Removal of kidney stone ............................. 17.26 NA 7.16 1.30 NA 25.72 090 50135 ......... ............ A Exploration of kidney ................................... 19.15 NA 7.76 1.43 NA 28.34 090 50200 ......... ............ A Biopsy of kidney .......................................... 2.63 NA 1.29 0.16 NA 4.08 000 50205 ......... ............ A Biopsy of kidney .......................................... 11.29 NA 5.01 1.28 NA 17.58 090 50220 ......... ............ A Remove kidney, open .................................. 17.12 NA 7.22 1.44 NA 25.78 090 50225 ......... ............ A Removal kidney open, complex .................. 20.20 NA 8.13 1.58 NA 29.91 090 50230 ......... ............ A Removal kidney open, radical ..................... 22.04 NA 8.56 1.70 NA 32.30 090 50234 ......... ............ A Removal of kidney & ureter ......................... 22.37 NA 8.81 1.67 NA 32.85 090 50236 ......... ............ A Removal of kidney & ureter ......................... 24.82 NA 10.23 1.88 NA 36.93 090


## 47629

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

50240 ......... ............ A Partial removal of kidney ............................. 21.97 NA 8.99 1.66 NA 32.62 090 50280 ......... ............ A Removal of kidney lesion ............................ 15.65 NA 6.67 1.29 NA 23.61 090 50290 ......... ............ A Removal of kidney lesion ............................ 14.71 NA 6.45 1.22 NA 22.38 090 50320 ......... ............ A Removal of donor kidney ............................. 22.18 NA 10.66 2.33 NA 35.17 090 50340 ......... ............ A Removal of kidney ....................................... 12.13 NA 6.49 1.66 NA 20.28 090 50360 ......... ............ A Transplantation of kidney ............................ 31.48 NA 15.48 3.73 NA 50.69 090 50365 ......... ............ A Transplantation of kidney ............................ 36.75 NA 18.26 4.25 NA 59.26 090 50370 ......... ............ A Remove transplanted kidney ....................... 13.70 NA 7.15 1.55 NA 22.40 090 50380 ......... ............ A Reimplantation of kidney ............................. 20.73 NA 12.06 2.53 NA 35.32 090 50390 ......... ............ A Drainage of kidney lesion ............................ 1.96 NA 0.64 0.12 NA 2.72 000 50392 ......... ............ A Insert kidney drain ....................................... 3.37 NA 1.52 0.21 NA 5.10 000 50393 ......... ............ A Insert ureteral tube ...................................... 4.15 NA 1.77 0.26 NA 6.18 000 50394 ......... ............ A Injection for kidney x-ray ............................. 0.76 3.04 0.66 0.05 3.85 1.47 000 50395 ......... ............ A Create passage to kidney ............................ 3.37 NA 1.50 0.21 NA 5.08 000 50396 ......... ............ A Measure kidney pressure ............................ 2.09 NA 1.08 0.13 NA 3.30 000 50398 ......... ............ A Change kidney tube ..................................... 1.46 16.30 0.52 0.09 17.85 2.07 000 50400 ......... ............ A Revision of kidney/ureter ............................. 19.47 NA 7.86 1.49 NA 28.82 090 50405 ......... ............ A Revision of kidney/ureter ............................. 23.89 NA 9.01 1.79 NA 34.69 090 50500 ......... ............ A Repair of kidney wound ............................... 19.54 NA 8.39 1.96 NA 29.89 090 50520 ......... ............ A Close kidney-skin fistula .............................. 17.20 NA 7.41 1.55 NA 26.16 090 50525 ......... ............ A Repair renal-abdomen fistula ...................... 22.24 NA 8.99 2.30 NA 33.53 090 50526 ......... ............ A Repair renal-abdomen fistula ...................... 23.98 NA 9.84 4.17 NA 37.99 090 50540 ......... ............ A Revision of horseshoe kidney ..................... 19.90 NA 8.32 1.76 NA 29.98 090 50541 ......... ............ A Laparo ablate renal cyst .............................. 15.98 NA 6.47 1.22 NA 23.67 090 50542 ......... ............ A Laparo ablate renal mass ............................ 19.97 NA 8.11 1.66 NA 29.74 090 50543 ......... ............ A Laparo partial nephrectomy ......................... 25.46 NA 10.17 1.66 NA 37.29 090 50544 ......... ............ A Laparoscopy, pyeloplasty ............................ 22.37 NA 8.51 1.69 NA 32.57 090 50545 ......... ............ A Laparo radical nephrectomy ........................ 23.96 NA 9.17 1.82 NA 34.95 090 50546 ......... ............ A Laparoscopic nephrectomy .......................... 20.45 NA 8.35 1.60 NA 30.40 090 50547 ......... ............ A Laparo removal donor kidney ...................... 25.46 NA 11.10 2.80 NA 39.36 090 50548 ......... ............ A Laparo remove w/ ureter ............................. 24.36 NA 9.15 1.84 NA 35.35 090 50551 ......... ............ A Kidney endoscopy ....................................... 5.59 4.14 1.96 0.40 10.13 7.95 000 50553 ......... ............ A Kidney endoscopy ....................................... 5.98 4.35 2.16 0.39 10.72 8.53 000 50555 ......... ............ A Kidney endoscopy & biopsy ........................ 6.52 4.82 2.33 0.49 11.83 9.34 000 50557 ......... ............ A Kidney endoscopy & treatment ................... 6.61 4.57 2.29 0.48 11.66 9.38 000 50559 ......... ............ A Renal endoscopy/radiotracer ....................... 6.77 5.30 2.78 0.41 12.48 9.96 000 50561 ......... ............ A Kidney endoscopy & treatment ................... 7.58 5.08 2.64 0.55 13.21 10.77 000 50562 ......... ............ A Renal scope w/tumor resect ........................ 10.90 NA 4.27 0.48 NA 15.65 090 50570 ......... ............ A Kidney endoscopy ....................................... 9.53 NA 3.20 0.66 NA 13.39 000 50572 ......... ............ A Kidney endoscopy ....................................... 10.33 NA 3.49 0.87 NA 14.69 000 50574 ......... ............ A Kidney endoscopy & biopsy ........................ 11.00 NA 3.74 0.74 NA 15.48 000 50575 ......... ............ A Kidney endoscopy ....................................... 13.96 NA 4.62 1.00 NA 19.58 000 50576 ......... ............ A Kidney endoscopy & treatment ................... 10.97 NA 3.65 0.76 NA 15.38 000 50578 ......... ............ A Renal endoscopy/radiotracer ....................... 11.33 NA 3.79 0.81 NA 15.93 000 50580 ......... ............ A Kidney endoscopy & treatment ................... 11.84 NA 3.95 0.84 NA 16.63 000 50590 ......... ............ A Fragmenting of kidney stone ....................... 9.08 12.49 4.11 0.66 22.23 13.85 090 50600 ......... ............ A Exploration of ureter .................................... 15.82 NA 6.66 1.34 NA 23.82 090 50605 ......... ............ A Insert ureteral support ................................. 15.44 NA 6.73 1.44 NA 23.61 090 50610 ......... ............ A Removal of ureter stone .............................. 15.90 NA 6.96 1.28 NA 24.14 090 50620 ......... ............ A Removal of ureter stone .............................. 15.14 NA 6.32 1.12 NA 22.58 090 50630 ......... ............ A Removal of ureter stone .............................. 14.92 NA 6.27 1.14 NA 22.33 090 50650 ......... ............ A Removal of ureter ........................................ 17.38 NA 7.21 1.26 NA 25.85 090 50660 ......... ............ A Removal of ureter ........................................ 19.52 NA 7.94 1.55 NA 29.01 090 50684 ......... ............ A Injection for ureter x-ray .............................. 0.76 5.00 0.47 0.05 5.81 1.28 000 50686 ......... ............ A Measure ureter pressure ............................. 1.51 3.43 0.82 0.11 5.05 2.44 000 50688 ......... ............ A Change of ureter tube ................................. 1.17 NA 1.06 0.07 NA 2.30 010 50690 ......... ............ A Injection for ureter x-ray .............................. 1.16 1.80 0.72 0.08 3.04 1.96 000 50700 ......... ............ A Revision of ureter ........................................ 15.19 NA 7.10 1.25 NA 23.54 090 50715 ......... ............ A Release of ureter ......................................... 18.87 NA 8.73 2.06 NA 29.66 090 50722 ......... ............ A Release of ureter ......................................... 16.33 NA 7.80 1.88 NA 26.01 090 50725 ......... ............ A Release/revise ureter ................................... 18.46 NA 8.04 1.58 NA 28.08 090
50727 ......... ............ A Revise ureter ............................................... 8.17 NA 4.27 0.65 NA 13.09 090 50728 ......... ............ A Revise ureter ............................................... 12.00 NA 5.55 1.05 NA 18.60 090 50740 ......... ............ A Fusion of ureter & kidney ............................ 18.39 NA 7.73 1.88 NA 28.00 090 50750 ......... ............ A Fusion of ureter & kidney ............................ 19.48 NA 7.97 1.54 NA 28.99 090 50760 ......... ............ A Fusion of ureters .......................................... 18.39 NA 7.67 1.53 NA 27.59 090 50770 ......... ............ A Splicing of ureters ........................................ 19.48 NA 7.96 1.61 NA 29.05 090 50780 ......... ............ A Reimplant ureter in bladder ......................... 18.33 NA 7.58 1.59 NA 27.50 090 50782 ......... ............ A Reimplant ureter in bladder ......................... 19.51 NA 8.80 1.61 NA 29.92 090 50783 ......... ............ A Reimplant ureter in bladder ......................... 20.52 NA 8.20 1.64 NA 30.36 090 50785 ......... ............ A Reimplant ureter in bladder ......................... 20.49 NA 8.28 1.63 NA 30.40 090 50800 ......... ............ A Implant ureter in bowel ................................ 14.50 NA 6.46 1.23 NA 22.19 090 50810 ......... ............ A Fusion of ureter & bowel ............................. 20.02 NA 9.08 2.16 NA 31.26 090
50815 ......... ............ A Urine shunt to intestine ................................ 19.90 NA 8.43 1.62 NA 29.95 090 50820 ......... ............ A Construct bowel bladder .............................. 21.86 NA 8.62 1.83 NA 32.31 090


## 47630

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

50825 ......... ............ A Construct bowel bladder .............................. 28.14 NA 11.10 2.14 NA 41.38 090 50830 ......... ............ A Revise urine flow ......................................... 31.23 NA 12.15 2.58 NA 45.96 090 50840 ......... ............ A Replace ureter by bowel .............................. 19.97 NA 8.42 1.56 NA 29.95 090 50845 ......... ............ A Appendico-vesicostomy ............................... 20.86 NA 8.89 1.53 NA 31.28 090 50860 ......... ............ A Transplant ureter to skin .............................. 15.34 NA 6.61 1.21 NA 23.16 090 50900 ......... ............ A Repair of ureter ............................................ 13.60 NA 6.13 1.26 NA 20.99 090 50920 ......... ............ A Closure ureter/skin fistula ............................ 14.31 NA 6.56 1.13 NA 22.00 090 50930 ......... ............ A Closure ureter/bowel fistula ......................... 18.69 NA 7.96 1.28 NA 27.93 090 50940 ......... ............ A Release of ureter ......................................... 14.49 NA 6.39 1.40 NA 22.28 090 50945 ......... ............ A Laparoscopy ureterolithotomy ..................... 16.97 NA 7.02 1.18 NA 25.17 090 50947 ......... ............ A Laparo new ureter/bladder .......................... 24.46 NA 9.66 1.97 NA 36.09 090 50948 ......... ............ A Laparo new ureter/bladder .......................... 22.47 NA 8.67 1.60 NA 32.74 090 50951 ......... ............ A Endoscopy of ureter .................................... 5.83 4.28 2.05 0.42 10.53 8.30 000 50953 ......... ............ A Endoscopy of ureter .................................... 6.23 4.40 2.36 0.44 11.07 9.03 000 50955 ......... ............ A Ureter endoscopy & biopsy ......................... 6.74 6.66 2.68 0.46 13.86 9.88 000 50957 ......... ............ A Ureter endoscopy & treatment .................... 6.78 4.56 2.37 0.48 11.82 9.63 000 50959 ......... ............ A Ureter endoscopy & tracer .......................... 4.39 NA 1.88 0.25 NA 6.52 000 50961 ......... ............ A Ureter endoscopy & treatment .................... 6.04 4.36 2.18 0.42 10.82 8.64 000 50970 ......... ............ A Ureter endoscopy ........................................ 7.13 NA 2.45 0.50 NA 10.08 000 50972 ......... ............ A Ureter endoscopy & catheter ....................... 6.88 NA 2.46 0.50 NA 9.84 000 50974 ......... ............ A Ureter endoscopy & biopsy ......................... 9.16 NA 3.10 0.63 NA 12.89 000 50976 ......... ............ A Ureter endoscopy & treatment .................... 9.03 NA 3.06 0.64 NA 12.73 000 50978 ......... ............ A Ureter endoscopy & tracer .......................... 5.09 NA 1.83 0.36 NA 7.28 000 50980 ......... ............ A Ureter endoscopy & treatment .................... 6.84 NA 2.36 0.51 NA 9.71 000 51000 ......... ............ A Drainage of bladder ..................................... 0.78 1.97 0.24 0.06 2.81 1.08 000 51005 ......... ............ A Drainage of bladder ..................................... 1.02 4.75 0.34 0.09 5.86 1.45 000 51010 ......... ............ A Drainage of bladder ..................................... 3.52 5.59 1.87 0.28 9.39 5.67 010 51020 ......... ............ A Incise & treat bladder .................................. 6.70 NA 3.91 0.53 NA 11.14 090 51030 ......... ............ A Incise & treat bladder .................................. 6.76 NA 4.04 0.56 NA 11.36 090 51040 ......... ............ A Incise & drain bladder .................................. 4.39 NA 2.82 0.33 NA 7.54 090 51045 ......... ............ A Incise bladder/drain ureter ........................... 6.76 NA 4.00 0.58 NA 11.34 090 51050 ......... ............ A Removal of bladder stone ........................... 6.91 NA 3.69 0.50 NA 11.10 090 51060 ......... ............ A Removal of ureter stone .............................. 8.84 NA 4.56 0.68 NA 14.08 090 51065 ......... ............ A Remove ureter calculus ............................... 8.84 NA 4.40 0.67 NA 13.91 090 51080 ......... ............ A Drainage of bladder abscess ....................... 5.95 NA 3.61 0.47 NA 10.03 090 51500 ......... ............ A Removal of bladder cyst .............................. 10.12 NA 5.03 1.10 NA 16.25 090 51520 ......... ............ A Removal of bladder lesion ........................... 9.28 NA 4.72 0.72 NA 14.72 090 51525 ......... ............ A Removal of bladder lesion ........................... 13.95 NA 6.17 1.05 NA 21.17 090 51530 ......... ............ A Removal of bladder lesion ........................... 12.36 NA 5.80 1.12 NA 19.28 090 51535 ......... ............ A Repair of ureter lesion ................................. 12.55 NA 6.16 1.20 NA 19.91 090 51550 ......... ............ A Partial removal of bladder ........................... 15.64 NA 6.78 1.37 NA 23.79 090 51555 ......... ............ A Partial removal of bladder ........................... 21.20 NA 8.71 1.80 NA 31.71 090 51565 ......... ............ A Revise bladder & ureter(s) .......................... 21.59 NA 9.01 1.69 NA 32.29 090 51570 ......... ............ A Removal of bladder ..................................... 24.20 NA 9.81 1.89 NA 35.90 090 51575 ......... ............ A Removal of bladder & nodes ....................... 30.40 NA 12.10 2.27 NA 44.77 090 51580 ......... ............ A Remove bladder/revise tract ........................ 31.03 NA 12.58 2.29 NA 45.90 090 51585 ......... ............ A Removal of bladder & nodes ....................... 35.18 NA 13.77 2.80 NA 51.75 090 51590 ......... ............ A Remove bladder/revise tract ........................ 32.61 NA 12.69 2.43 NA 47.73 090 51595 ......... ............ A Remove bladder/revise tract ........................ 37.08 NA 14.19 2.74 NA 54.01 090 51596 ......... ............ A Remove bladder/create pouch .................... 39.46 NA 15.30 2.88 NA 57.64 090 51597 ......... ............ A Removal of pelvic structures ....................... 38.29 NA 14.91 2.97 NA 56.17 090 51600 ......... ............ A Injection for bladder x-ray ............................ 0.88 5.08 0.29 0.06 6.02 1.23 000 51605 ......... ............ A Preparation for bladder xray ........................ 0.64 6.03 0.35 0.04 6.71 1.03 000 51610 ......... ............ A Injection for bladder x-ray ............................ 1.05 2.33 0.60 0.07 3.45 1.72 000 51700 ......... ............ A Irrigation of bladder ...................................... 0.88 1.60 0.28 0.06 2.54 1.22 000 51701 ......... ............ A Insert bladder catheter ................................. 0.50 1.57 0.19 0.04 2.11 0.73 000 51702 ......... ............ A Insert temp bladder cath .............................. 0.50 2.08 0.24 0.04 2.62 0.78 000 51703 ......... ............ A Insert bladder cath, complex ....................... 1.47 2.72 0.56 0.08 4.27 2.11 000 51705 ......... ............ A Change of bladder tube ............................... 1.02 2.27 0.62 0.07 3.36 1.71 010 51710 ......... ............ A Change of bladder tube ............................... 1.49 3.32 0.77 0.11 4.92 2.37 010 51715 ......... ............ A Endoscopic injection/implant ....................... 3.73 3.88 1.35 0.29 7.90 5.37 000 51720 ......... ............ A Treatment of bladder lesion ......................... 1.96 1.74 0.69 0.14 3.84 2.79 000 51725 ......... ............ A Simple cystometrogram ............................... 1.51 5.58 NA 0.16 7.25 NA 000 51725 ......... 26 ....... A Simple cystometrogram ............................... 1.51 0.49 0.49 0.12 2.12 2.12 000 51725 ......... TC ...... A Simple cystometrogram ............................... 0.00 5.09 NA 0.04 5.13 NA 000 51726 ......... ............ A Complex cystometrogram ............................ 1.71 7.48 NA 0.18 9.37 NA 000 51726 ......... 26 ....... A Complex cystometrogram ............................ 1.71 0.56 0.56 0.13 2.40 2.40 000 51726 ......... TC ...... A Complex cystometrogram ............................ 0.00 6.92 NA 0.05 6.97 NA 000 51736 ......... ............ A Urine flow measurement .............................. 0.61 0.58 NA 0.06 1.25 NA 000 51736 ......... 26 ....... A Urine flow measurement .............................. 0.61 0.20 0.20 0.05 0.86 0.86 000 51736 ......... TC ...... A Urine flow measurement .............................. 0.00 0.38 NA 0.01 0.39 NA 000 51741 ......... ............ A Electro-uroflowmetry, first ............................ 1.14 0.80 NA 0.11 2.05 NA 000 51741 ......... 26 ....... A Electro-uroflowmetry, first ............................ 1.14 0.37 0.37 0.09 1.60 1.60 000 51741 ......... TC ...... A Electro-uroflowmetry, first ............................ 0.00 0.43 NA 0.02 0.45 NA 000 51772 ......... ............ A Urethra pressure profile ............................... 1.61 5.58 NA 0.19 7.38 NA 000


## 47631

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

51772 ......... 26 ....... A Urethra pressure profile ............................... 1.61 0.55 0.55 0.14 2.30 2.30 000 51772 ......... TC ...... A Urethra pressure profile ............................... 0.00 5.03 NA 0.05 5.08 NA 000 51784 ......... ............ A Anal/urinary muscle study ........................... 1.53 3.99 NA 0.16 5.68 NA 000 51784 ......... 26 ....... A Anal/urinary muscle study ........................... 1.53 0.50 0.50 0.12 2.15 2.15 000 51784 ......... TC ...... A Anal/urinary muscle study ........................... 0.00 3.48 NA 0.04 3.52 NA 000 51785 ......... ............ A Anal/urinary muscle study ........................... 1.53 4.44 NA 0.15 6.12 NA 000 51785 ......... 26 ....... A Anal/urinary muscle study ........................... 1.53 0.50 0.50 0.11 2.14 2.14 000 51785 ......... TC ...... A Anal/urinary muscle study ........................... 0.00 3.94 NA 0.04 3.98 NA 000 51792 ......... ............ A Urinary reflex study ...................................... 1.10 5.99 NA 0.20 7.29 NA 000 51792 ......... 26 ....... A Urinary reflex study ...................................... 1.10 0.41 0.41 0.07 1.58 1.58 000 51792 ......... TC ...... A Urinary reflex study ...................................... 0.00 5.57 NA 0.13 5.70 NA 000 51795 ......... ............ A Urine voiding pressure study ....................... 1.53 7.28 NA 0.22 9.03 NA 000 51795 ......... 26 ....... A Urine voiding pressure study ....................... 1.53 0.50 0.50 0.12 2.15 2.15 000 51795 ......... TC ...... A Urine voiding pressure study ....................... 0.00 6.78 NA 0.10 6.88 NA 000 51797 ......... ............ A Intraabdominal pressure test ....................... 1.60 5.76 NA 0.17 7.53 NA 000 51797 ......... 26 ....... A Intraabdominal pressure test ....................... 1.60 0.52 0.52 0.12 2.24 2.24 000 51797 ......... TC ...... A Intraabdominal pressure test ....................... 0.00 5.23 NA 0.05 5.28 NA 000 51798 ......... ............ A Us urine capacity measure .......................... 0.00 0.34 NA 0.08 0.42 NA XXX 51800 ......... ............ A Revision of bladder/urethra ......................... 17.39 NA 7.60 1.38 NA 26.37 090 51820 ......... ............ A Revision of urinary tract ............................... 17.86 NA 8.38 1.90 NA 28.14 090 51840 ......... ............ A Attach bladder/urethra ................................. 10.69 NA 5.56 1.10 NA 17.35 090 51841 ......... ............ A Attach bladder/urethra ................................. 13.01 NA 6.37 1.30 NA 20.68 090 51845 ......... ............ A Repair bladder neck .................................... 9.72 NA 4.80 0.81 NA 15.33 090 51860 ......... ............ A Repair of bladder wound ............................. 12.00 NA 5.83 1.20 NA 19.03 090 51865 ......... ............ A Repair of bladder wound ............................. 15.02 NA 6.74 1.33 NA 23.09 090 51880 ......... ............ A Repair of bladder opening ........................... 7.65 NA 4.02 0.70 NA 12.37 090 51900 ......... ............ A Repair bladder/vagina lesion ....................... 12.95 NA 6.13 1.15 NA 20.23 090 51920 ......... ............ A Close bladder-uterus fistula ......................... 11.79 NA 5.68 0.90 NA 18.37 090 51925 ......... ............ A Hysterectomy/bladder repair ........................ 15.56 NA 8.75 1.38 NA 25.69 090 51940 ......... ............ A Correction of bladder defect ........................ 28.39 NA 12.23 2.39 NA 43.01 090 51960 ......... ............ A Revision of bladder & bowel ........................ 22.98 NA 9.74 1.73 NA 34.45 090 51980 ......... ............ A Construct bladder opening .......................... 11.34 NA 5.42 0.88 NA 17.64 090 51990 ......... ............ A Laparo urethral suspension ......................... 12.48 NA 6.13 1.41 NA 20.02 090 51992 ......... ............ A Laparo sling operation ................................. 13.99 NA 6.19 1.36 NA 21.54 090 52000 ......... ............ A Cystoscopy .................................................. 2.01 3.29 0.76 0.15 5.45 2.92 000 52001 ......... ............ A Cystoscopy, removal of clots ....................... 5.44 5.06 1.86 0.17 10.67 7.47 000 52005 ......... ............ A Cystoscopy & ureter catheter ...................... 2.37 5.54 0.89 0.17 8.08 3.43 000 52007 ......... ............ A Cystoscopy and biopsy ................................ 3.02 16.43 1.15 0.22 19.67 4.39 000 52010 ......... ............ A Cystoscopy & duct catheter ......................... 3.02 10.81 1.15 0.22 14.05 4.39 000 52204 ......... ............ A Cystoscopy .................................................. 2.37 14.45 0.90 0.17 16.99 3.44 000 52214 ......... ............ A Cystoscopy and treatment ........................... 3.70 37.93 1.33 0.27 41.90 5.30 000 52224 ......... ............ A Cystoscopy and treatment ........................... 3.14 36.30 1.15 0.22 39.66 4.51 000 52234 ......... ............ A Cystoscopy and treatment ........................... 4.62 NA 1.65 0.33 NA 6.60 000 52235 ......... ............ A Cystoscopy and treatment ........................... 5.44 NA 1.93 0.39 NA 7.76 000 52240 ......... ............ A Cystoscopy and treatment ........................... 9.71 NA 3.29 0.69 NA 13.69 000 52250 ......... ............ A Cystoscopy and radiotracer ......................... 4.49 NA 1.65 0.33 NA 6.47 000 52260 ......... ............ A Cystoscopy and treatment ........................... 3.91 NA 1.42 0.29 NA 5.62 000 52265 ......... ............ A Cystoscopy and treatment ........................... 2.94 13.28 1.11 0.22 16.44 4.27 000 52270 ......... ............ A Cystoscopy & revise urethra ....................... 3.36 10.99 1.24 0.24 14.59 4.84 000 52275 ......... ............ A Cystoscopy & revise urethra ....................... 4.69 15.48 1.66 0.34 20.51 6.69 000 52276 ......... ............ A Cystoscopy and treatment ........................... 4.99 NA 1.78 0.36 NA 7.13 000 52277 ......... ............ A Cystoscopy and treatment ........................... 6.16 NA 2.22 0.45 NA 8.83 000 52281 ......... ............ A Cystoscopy and treatment ........................... 2.80 7.07 1.08 0.20 10.07 4.08 000 52282 ......... ............ A Cystoscopy, implant stent ............................ 6.39 NA 2.23 0.46 NA 9.08 000 52283 ......... ............ A Cystoscopy and treatment ........................... 3.73 3.94 1.38 0.27 7.94 5.38 000 52285 ......... ............ A Cystoscopy and treatment ........................... 3.60 4.00 1.33 0.27 7.87 5.20 000 52290 ......... ............ A Cystoscopy and treatment ........................... 4.58 NA 1.65 0.33 NA 6.56 000 52300 ......... ............ A Cystoscopy and treatment ........................... 5.30 NA 1.90 0.38 NA 7.58 000 52301 ......... ............ A Cystoscopy and treatment ........................... 5.50 NA 1.99 0.48 NA 7.97 000 52305 ......... ............ A Cystoscopy and treatment ........................... 5.30 NA 1.85 0.39 NA 7.54 000 52310 ......... ............ A Cystoscopy and treatment ........................... 2.81 4.68 1.03 0.20 7.69 4.04 000 52315 ......... ............ A Cystoscopy and treatment ........................... 5.20 8.68 1.83 0.37 14.25 7.40 000
52317 ......... ............ A Remove bladder stone ................................ 6.71 28.82 2.27 0.48 36.01 9.46 000
52318 ......... ............ A Remove bladder stone ................................ 9.18 NA 3.09 0.66 NA 12.93 000 52320 ......... ............ A Cystoscopy and treatment ........................... 4.69 NA 1.63 0.34 NA 6.66 000 52325 ......... ............ A Cystoscopy, stone removal ......................... 6.15 NA 2.10 0.44 NA 8.69 000 52327 ......... ............ A Cystoscopy, inject material .......................... 5.18 31.67 1.81 0.39 37.24 7.38 000 52330 ......... ............ A Cystoscopy and treatment ........................... 5.03 38.66 1.74 0.36 44.05 7.13 000 52332 ......... ............ A Cystoscopy and treatment ........................... 2.83 5.73 1.05 0.21 8.77 4.09 000 52334 ......... ............ A Create passage to kidney ............................ 4.82 NA 1.73 0.34 NA 6.89 000 52341 ......... ............ A Cysto w/ureter stricture tx ............................ 5.99 NA 2.21 0.43 NA 8.63 000 52342 ......... ............ A Cysto w/up stricture tx ................................. 6.49 NA 2.34 0.47 NA 9.30 000 52343 ......... ............ A Cysto w/renal stricture tx ............................. 7.19 NA 2.57 0.51 NA 10.27 000 52344 ......... ............ A Cysto/uretero, stone remove ....................... 7.69 NA 2.79 0.56 NA 11.04 000 52345 ......... ............ A Cysto/uretero w/up stricture ......................... 8.19 NA 2.95 0.58 NA 11.72 000


## 47632

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

52346 ......... ............ A Cystouretero w/renal strict ........................... 9.22 NA 3.27 0.67 NA 13.16 000 52347 ......... ............ A Cystoscopy, resect ducts ............................. 5.27 NA 1.70 0.38 NA 7.35 000 52351 ......... ............ A Cystouretero & or pyeloscope ..................... 5.85 NA 2.14 0.42 NA 8.41 000 52352 ......... ............ A Cystouretero w/stone remove ...................... 6.87 NA 2.50 0.49 NA 9.86 000 52353 ......... ............ A Cystouretero w/lithotripsy ............................ 7.96 NA 2.85 0.57 NA 11.38 000 52354 ......... ............ A Cystouretero w/biopsy ................................. 7.33 NA 2.66 0.53 NA 10.52 000 52355 ......... ............ A Cystouretero w/excise tumor ....................... 8.81 NA 3.13 0.63 NA 12.57 000 52400 ......... ............ A Cystouretero w/congen repr ........................ 9.67 NA 3.75 0.69 NA 14.11 090 52450 ......... ............ A Incision of prostate ...................................... 7.63 NA 3.68 0.55 NA 11.86 090 52500 ......... ............ A Revision of bladder neck ............................. 8.46 NA 3.92 0.60 NA 12.98 090 52510 ......... ............ A Dilation prostatic urethra .............................. 6.71 NA 3.12 0.49 NA 10.32 090 52601 ......... ............ A Prostatectomy (TURP) ................................. 12.35 NA 5.11 0.88 NA 18.34 090 52606 ......... ............ A Control postop bleeding ............................... 8.12 NA 3.55 0.58 NA 12.25 090 52612 ......... ............ A Prostatectomy, first stage ............................ 7.97 NA 3.74 0.57 NA 12.28 090 52614 ......... ............ A Prostatectomy, second stage ...................... 6.83 NA 3.35 0.49 NA 10.67 090 52620 ......... ............ A Remove residual prostate ............................ 6.60 NA 2.98 0.47 NA 10.05 090 52630 ......... ............ A Remove prostate regrowth .......................... 7.25 NA 3.19 0.52 NA 10.96 090 52640 ......... ............ A Relieve bladder contracture ......................... 6.61 NA 2.96 0.47 NA 10.04 090 52647 ......... ............ A Laser surgery of prostate ............................ 10.34 73.74 4.53 0.74 84.82 15.61 090 52648 ......... ............ A Laser surgery of prostate ............................ 11.19 NA 4.79 0.80 NA 16.78 090 52700 ......... ............ A Drainage of prostate abscess ...................... 6.79 NA 3.18 0.49 NA 10.46 090 53000 ......... ............ A Incision of urethra ........................................ 2.28 NA 1.55 0.16 NA 3.99 010 53010 ......... ............ A Incision of urethra ........................................ 3.63 NA 2.97 0.26 NA 6.86 090 53020 ......... ............ A Incision of urethra ........................................ 1.77 2.99 0.67 0.13 4.89 2.57 000 53025 ......... ............ A Incision of urethra ........................................ 1.13 3.71 0.51 0.09 4.93 1.73 000 53040 ......... ............ A Drainage of urethra abscess ....................... 6.39 NA 3.43 0.47 NA 10.29 090 53060 ......... ............ A Drainage of urethra abscess ....................... 2.63 2.09 1.37 0.27 4.99 4.27 010 53080 ......... ............ A Drainage of urinary leakage ........................ 6.28 NA 6.06 0.55 NA 12.89 090 53085 ......... ............ A Drainage of urinary leakage ........................ 10.25 NA 7.45 0.92 NA 18.62 090 53200 ......... ............ A Biopsy of urethra ......................................... 2.59 1.32 0.98 0.20 4.11 3.77 000 53210 ......... ............ A Removal of urethra ...................................... 12.55 NA 5.91 1.00 NA 19.46 090 53215 ......... ............ A Removal of urethra ...................................... 15.56 NA 6.69 1.13 NA 23.38 090 53220 ......... ............ A Treatment of urethra lesion ......................... 6.99 NA 3.79 0.54 NA 11.32 090 53230 ......... ............ A Removal of urethra lesion ........................... 9.57 NA 4.76 0.72 NA 15.05 090 53235 ......... ............ A Removal of urethra lesion ........................... 10.12 NA 4.96 0.79 NA 15.87 090 53240 ......... ............ A Surgery for urethra pouch ........................... 6.44 NA 3.59 0.54 NA 10.57 090 53250 ......... ............ A Removal of urethra gland ............................ 5.88 NA 3.35 0.50 NA 9.73 090 53260 ......... ............ A Treatment of urethra lesion ......................... 2.98 2.25 1.42 0.26 5.49 4.66 010 53265 ......... ............ A Treatment of urethra lesion ......................... 3.12 2.71 1.42 0.24 6.07 4.78 010 53270 ......... ............ A Removal of urethra gland ............................ 3.09 2.20 1.54 0.32 5.61 4.95 010 53275 ......... ............ A Repair of urethra defect ............................... 4.52 NA 2.24 0.33 NA 7.09 010 53400 ......... ............ A Revise urethra, stage 1 ............................... 12.75 NA 6.02 1.04 NA 19.81 090 53405 ......... ............ A Revise urethra, stage 2 ............................... 14.46 NA 6.37 1.22 NA 22.05 090 53410 ......... ............ A Reconstruction of urethra ............................ 16.42 NA 7.12 1.21 NA 24.75 090 53415 ......... ............ A Reconstruction of urethra ............................ 19.38 NA 7.40 1.46 NA 28.24 090 53420 ......... ............ A Reconstruct urethra, stage 1 ....................... 14.06 NA 6.43 0.98 NA 21.47 090 53425 ......... ............ A Reconstruct urethra, stage 2 ....................... 15.96 NA 6.96 1.16 NA 24.08 090 53430 ......... ............ A Reconstruction of urethra ............................ 16.32 NA 7.05 1.27 NA 24.64 090 53431 ......... ............ A Reconstruct urethra/bladder ........................ 19.86 NA 8.09 1.44 NA 29.39 090 53440 ......... ............ A Male sling procedure ................................... 13.60 NA 5.97 0.89 NA 20.46 090 53442 ......... ............ A Remove/revise male sling ........................... 11.55 NA 5.45 0.61 NA 17.61 090 53444 ......... ............ A Insert tandem cuff ........................................ 13.38 NA 5.87 0.99 NA 20.24 090 53445 ......... ............ A Insert uro/ves nck sphincter ........................ 14.04 NA 7.14 1.03 NA 22.21 090 53446 ......... ............ A Remove uro sphincter ................................. 10.21 NA 5.21 0.74 NA 16.16 090 53447 ......... ............ A Remove/replace ur sphincter ....................... 13.47 NA 6.41 0.98 NA 20.86 090 53448 ......... ............ A Remov/replc ur sphinctr comp ..................... 21.12 NA 9.03 1.51 NA 31.66 090 53449 ......... ............ A Repair uro sphincter .................................... 9.69 NA 4.77 0.65 NA 15.11 090 53450 ......... ............ A Revision of urethra ...................................... 6.13 NA 3.35 0.44 NA 9.92 090 53460 ......... ............ A Revision of urethra ...................................... 7.11 NA 3.75 0.53 NA 11.39 090 53500 ......... ............ A Urethrlys, transvag w/ scope ....................... 12.19 NA 6.19 0.91 NA 19.29 090 53502 ......... ............ A Repair of urethra injury ................................ 7.62 NA 4.06 0.63 NA 12.31 090 53505 ......... ............ A Repair of urethra injury ................................ 7.62 NA 3.92 0.55 NA 12.09 090 53510 ......... ............ A Repair of urethra injury ................................ 10.09 NA 5.23 0.74 NA 16.06 090 53515 ......... ............ A Repair of urethra injury ................................ 13.29 NA 5.98 0.95 NA 20.22 090 53520 ......... ............ A Repair of urethra defect ............................... 8.67 NA 4.53 0.64 NA 13.84 090
53600 ......... ............ A Dilate urethra stricture ................................. 1.21 1.14 0.42 0.09 2.44 1.72 000
53601 ......... ............ A Dilate urethra stricture ................................. 0.98 1.26 0.37 0.07 2.31 1.42 000
53605 ......... ............ A Dilate urethra stricture ................................. 1.28 NA 0.41 0.09 NA 1.78 000
53620 ......... ............ A Dilate urethra stricture ................................. 1.62 1.99 0.59 0.12 3.73 2.33 000
53621 ......... ............ A Dilate urethra stricture ................................. 1.35 2.06 0.49 0.10 3.51 1.94 000 53660 ......... ............ A Dilation of urethra ........................................ 0.71 1.31 0.31 0.05 2.07 1.07 000 53661 ......... ............ A Dilation of urethra ........................................ 0.72 1.30 0.29 0.05 2.07 1.06 000 53665 ......... ............ A Dilation of urethra ........................................ 0.76 NA 0.25 0.06 NA 1.07 000
53850 ......... ............ A Prostatic microwave thermotx ..................... 9.44 94.10 3.94 0.67 104.21 14.05 090 53852 ......... ............ A Prostatic rf thermotx .................................... 9.87 88.49 4.37 0.70 99.06 14.94 090


## 47633

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

53853 ......... ............ A Prostatic water thermother .......................... 5.23 55.09 2.85 0.29 60.61 8.37 090 54000 ......... ............ A Slitting of prepuce ........................................ 1.54 2.91 0.93 0.11 4.56 2.58 010 54001 ......... ............ A Slitting of prepuce ........................................ 2.19 3.18 1.11 0.16 5.53 3.46 010 54015 ......... ............ A Drain penis lesion ........................................ 5.31 NA 2.55 0.40 NA 8.26 010 54050 ......... ............ A Destruction, penis lesion(s) ......................... 1.24 1.67 1.04 0.10 3.01 2.38 010 54055 ......... ............ A Destruction, penis lesion(s) ......................... 1.22 1.57 0.80 0.09 2.88 2.11 010 54056 ......... ............ A Cryosurgery, penis lesion(s) ........................ 1.24 1.70 1.14 0.10 3.04 2.48 010 54057 ......... ............ A Laser surg, penis lesion(s) .......................... 1.24 2.22 0.83 0.09 3.55 2.16 010 54060 ......... ............ A Excision of penis lesion(s) ........................... 1.93 3.09 1.06 0.15 5.17 3.14 010 54065 ......... ............ A Destruction, penis lesion(s) ......................... 2.42 2.63 1.23 0.19 5.24 3.84 010 54100 ......... ............ A Biopsy of penis ............................................ 1.90 2.82 0.82 0.15 4.87 2.87 000 54105 ......... ............ A Biopsy of penis ............................................ 3.49 4.28 1.93 0.25 8.02 5.67 010 54110 ......... ............ A Treatment of penis lesion ............................ 10.11 NA 4.75 0.74 NA 15.60 090 54111 ......... ............ A Treat penis lesion, graft ............................... 13.55 NA 5.75 0.96 NA 20.26 090 54112 ......... ............ A Treat penis lesion, graft ............................... 15.84 NA 6.78 1.13 NA 23.75 090 54115 ......... ............ A Treatment of penis lesion ............................ 6.14 4.37 3.45 0.44 10.95 10.03 090 54120 ......... ............ A Partial removal of penis ............................... 9.96 NA 4.67 0.72 NA 15.35 090 54125 ......... ............ A Removal of penis ......................................... 13.51 NA 5.82 0.99 NA 20.32 090 54130 ......... ............ A Remove penis & nodes ............................... 20.11 NA 8.16 1.43 NA 29.70 090 54135 ......... ............ A Remove penis & nodes ............................... 26.32 NA 10.15 1.87 NA 38.34 090 54150 ......... ............ A Circumcision ................................................ 1.81 4.53 0.97 0.19 6.53 2.97 010 54152 ......... ............ A Circumcision ................................................ 2.31 NA 1.20 0.19 NA 3.70 010 54160 ......... ............ A Circumcision ................................................ 2.48 4.13 1.09 0.19 6.80 3.76 010 54161 ......... ............ A Circumcision ................................................ 3.27 NA 1.56 0.24 NA 5.07 010 54162 ......... ............ A Lysis penil circumic lesion ........................... 3.00 4.63 1.44 0.22 7.85 4.66 010 54163 ......... ............ A Repair of circumcision ................................. 3.00 NA 2.00 0.22 NA 5.22 010 54164 ......... ............ A Frenulotomy of penis ................................... 2.50 NA 1.83 0.18 NA 4.51 010 54200 ......... ............ A Treatment of penis lesion ............................ 1.06 1.79 0.98 0.08 2.93 2.12 010 54205 ......... ............ A Treatment of penis lesion ............................ 7.92 NA 4.73 0.56 NA 13.21 090 54220 ......... ............ A Treatment of penis lesion ............................ 2.42 3.83 0.95 0.18 6.43 3.55 000 54230 ......... ............ A Prepare penis study ..................................... 1.34 1.08 0.63 0.10 2.52 2.07 000 54231 ......... ............ A Dynamic cavernosometry ............................ 2.04 1.38 0.87 0.15 3.57 3.06 000 54235 ......... ............ A Penile injection ............................................. 1.19 0.96 0.58 0.09 2.24 1.86 000 54240 ......... ............ A Penis study .................................................. 1.31 1.01 NA 0.17 2.49 NA 000 54240 ......... 26 ....... A Penis study .................................................. 1.31 0.43 0.43 0.11 1.85 1.85 000 54240 ......... TC ...... A Penis study .................................................. 0.00 0.59 NA 0.06 0.65 NA 000 54250 ......... ............ A Penis study .................................................. 2.22 0.92 NA 0.19 3.33 NA 000 54250 ......... 26 ....... A Penis study .................................................. 2.22 0.71 0.71 0.17 3.10 3.10 000 54250 ......... TC ...... A Penis study .................................................. 0.00 0.21 NA 0.02 0.23 NA 000 54300 ......... ............ A Revision of penis ......................................... 10.39 NA 5.65 0.74 NA 16.78 090 54304 ......... ............ A Revision of penis ......................................... 12.47 NA 6.43 0.92 NA 19.82 090 54308 ......... ............ A Reconstruction of urethra ............................ 11.81 NA 6.05 0.84 NA 18.70 090 54312 ......... ............ A Reconstruction of urethra ............................ 13.55 NA 7.07 0.96 NA 21.58 090 54316 ......... ............ A Reconstruction of urethra ............................ 16.79 NA 8.05 1.21 NA 26.05 090 54318 ......... ............ A Reconstruction of urethra ............................ 11.23 NA 5.88 0.80 NA 17.91 090 54322 ......... ............ A Reconstruction of urethra ............................ 12.99 NA 6.53 0.99 NA 20.51 090 54324 ......... ............ A Reconstruction of urethra ............................ 16.29 NA 8.10 1.48 NA 25.87 090 54326 ......... ............ A Reconstruction of urethra ............................ 15.70 NA 7.89 1.12 NA 24.71 090 54328 ......... ............ A Revise penis/urethra .................................... 15.63 NA 7.33 1.11 NA 24.07 090 54332 ......... ............ A Revise penis/urethra .................................... 17.05 NA 7.82 1.21 NA 26.08 090 54336 ......... ............ A Revise penis/urethra .................................... 20.01 NA 10.59 1.42 NA 32.02 090 54340 ......... ............ A Secondary urethral surgery ......................... 8.90 NA 5.16 0.59 NA 14.65 090 54344 ......... ............ A Secondary urethral surgery ......................... 15.92 NA 7.86 1.13 NA 24.91 090 54348 ......... ............ A Secondary urethral surgery ......................... 17.12 NA 8.48 1.18 NA 26.78 090 54352 ......... ............ A Reconstruct urethra/penis ............................ 24.70 NA 11.36 1.81 NA 37.87 090 54360 ......... ............ A Penis plastic surgery ................................... 11.91 NA 6.08 0.86 NA 18.85 090 54380 ......... ............ A Repair penis ................................................. 13.16 NA 6.78 1.00 NA 20.94 090 54385 ......... ............ A Repair penis ................................................. 15.37 NA 8.57 1.20 NA 25.14 090 54390 ......... ............ A Repair penis and bladder ............................ 21.58 NA 9.47 1.28 NA 32.33 090 54400 ......... ............ A Insert semi-rigid prosthesis .......................... 8.98 NA 4.40 0.65 NA 14.03 090 54401 ......... ............ A Insert self-contd prosthesis .......................... 10.26 NA 5.75 0.73 NA 16.74 090 54405 ......... ............ A Insert multi-comp penis pros ....................... 13.41 NA 5.98 0.99 NA 20.38 090 54406 ......... ............ A Remove muti-comp penis pros .................... 12.08 NA 5.41 0.88 NA 18.37 090 54408 ......... ............ A Repair multi-comp penis pros ...................... 12.73 NA 5.72 0.92 NA 19.37 090 54410 ......... ............ A Remove/replace penis prosth ...................... 15.48 NA 6.61 1.13 NA 23.22 090 54411 ......... ............ A Remov/replc penis pros, comp .................... 15.98 NA 7.02 1.17 NA 24.17 090 54415 ......... ............ A Remove self-contd penis pros ..................... 8.19 NA 4.18 0.59 NA 12.96 090 54416 ......... ............ A Remv/repl penis contain pros ...................... 10.85 NA 5.36 0.79 NA 17.00 090 54417 ......... ............ A Remv/replc penis pros, compl ..................... 14.17 NA 6.15 1.01 NA 21.33 090 54420 ......... ............ A Revision of penis ......................................... 11.40 NA 5.63 0.91 NA 17.94 090 54430 ......... ............ A Revision of penis ......................................... 10.13 NA 5.16 0.73 NA 16.02 090 54435 ......... ............ A Revision of penis ......................................... 6.11 NA 3.66 0.47 NA 10.24 090 54450 ......... ............ A Preputial stretching ...................................... 1.12 0.95 0.44 0.08 2.15 1.64 000 54500 ......... ............ A Biopsy of testis ............................................ 1.31 0.60 0.56 0.11 2.02 1.98 000 54505 ......... ............ A Biopsy of testis ............................................ 3.45 NA 1.91 0.28 NA 5.64 010


## 47634

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

54512 ......... ............ A Excise lesion testis ...................................... 8.57 NA 4.12 0.65 NA 13.34 090 54520 ......... ............ A Removal of testis ......................................... 5.22 NA 2.81 0.50 NA 8.53 090 54522 ......... ............ A Orchiectomy, partial ..................................... 9.49 NA 4.85 0.91 NA 15.25 090 54530 ......... ............ A Removal of testis ......................................... 8.57 NA 4.26 0.68 NA 13.51 090 54535 ......... ............ A Extensive testis surgery ............................... 12.14 NA 5.59 1.09 NA 18.82 090 54550 ......... ............ A Exploration for testis .................................... 7.77 NA 3.84 0.63 NA 12.24 090 54560 ......... ............ A Exploration for testis .................................... 11.11 NA 5.20 0.96 NA 17.27 090 54600 ......... ............ A Reduce testis torsion ................................... 7.00 NA 3.57 0.53 NA 11.10 090 54620 ......... ............ A Suspension of testis .................................... 4.89 NA 2.43 0.42 NA 7.74 010 54640 ......... ............ A Suspension of testis .................................... 6.89 NA 3.76 0.63 NA 11.28 090 54650 ......... ............ A Orchiopexy (Fowler-Stephens) .................... 11.43 NA 5.45 1.41 NA 18.29 090 54660 ......... ............ A Revision of testis ......................................... 5.10 NA 3.01 0.40 NA 8.51 090 54670 ......... ............ A Repair testis injury ....................................... 6.40 NA 3.56 0.50 NA 10.46 090 54680 ......... ............ A Relocation of testis(es) ................................ 12.63 NA 6.22 1.23 NA 20.08 090 54690 ......... ............ A Laparoscopy, orchiectomy ........................... 10.94 NA 4.99 1.23 NA 17.16 090 54692 ......... ............ A Laparoscopy, orchiopexy ............................. 12.86 NA 5.40 1.05 NA 19.31 090 54700 ......... ............ A Drainage of scrotum .................................... 3.42 NA 1.93 0.28 NA 5.63 010 54800 ......... ............ A Biopsy of epididymis .................................... 2.33 0.94 0.89 0.22 3.49 3.44 000 54820 ......... ............ A Exploration of epididymis ............................. 5.13 NA 2.96 0.39 NA 8.48 090 54830 ......... ............ A Remove epididymis lesion ........................... 5.37 NA 3.04 0.42 NA 8.83 090 54840 ......... ............ A Remove epididymis lesion ........................... 5.19 NA 2.80 0.37 NA 8.36 090 54860 ......... ............ A Removal of epididymis ................................ 6.31 NA 3.33 0.46 NA 10.10 090 54861 ......... ............ A Removal of epididymis ................................ 8.89 NA 4.33 0.64 NA 13.86 090 54900 ......... ............ A Fusion of spermatic ducts ........................... 13.18 NA 5.80 1.62 NA 20.60 090 54901 ......... ............ A Fusion of spermatic ducts ........................... 17.91 NA 7.55 1.28 NA 26.74 090 55000 ......... ............ A Drainage of hydrocele ................................. 1.43 2.06 0.65 0.12 3.61 2.20 000 55040 ......... ............ A Removal of hydrocele .................................. 5.35 NA 2.92 0.44 NA 8.71 090 55041 ......... ............ A Removal of hydroceles ................................ 7.73 NA 3.98 0.60 NA 12.31 090 55060 ......... ............ A Repair of hydrocele ..................................... 5.51 NA 3.09 0.46 NA 9.06 090 55100 ......... ............ A Drainage of scrotum abscess ...................... 2.13 3.67 1.56 0.17 5.97 3.86 010 55110 ......... ............ A Explore scrotum ........................................... 5.69 NA 3.12 0.45 NA 9.26 090 55120 ......... ............ A Removal of scrotum lesion .......................... 5.08 NA 2.94 0.39 NA 8.41 090 55150 ......... ............ A Removal of scrotum ..................................... 7.21 NA 3.83 0.58 NA 11.62 090 55175 ......... ............ A Revision of scrotum ..................................... 5.23 NA 3.00 0.40 NA 8.63 090 55180 ......... ............ A Revision of scrotum ..................................... 10.70 NA 5.34 0.85 NA 16.89 090 55200 ......... ............ A Incision of sperm duct ................................. 4.23 12.26 2.37 0.30 16.79 6.90 090 55250 ......... ............ A Removal of sperm duct(s) ........................... 3.29 11.44 2.21 0.26 14.99 5.76 090 55300 ......... ............ A Prepare, sperm duct x-ray ........................... 3.50 NA 1.31 0.26 NA 5.07 000 55400 ......... ............ A Repair of sperm duct ................................... 8.48 NA 4.05 0.74 NA 13.27 090 55450 ......... ............ A Ligation of sperm duct ................................. 4.11 6.96 1.86 0.29 11.36 6.26 010 55500 ......... ............ A Removal of hydrocele .................................. 5.58 NA 3.11 0.55 NA 9.24 090 55520 ......... ............ A Removal of sperm cord lesion ..................... 6.02 NA 3.28 0.73 NA 10.03 090 55530 ......... ............ A Revise spermatic cord veins ....................... 5.65 NA 3.03 0.46 NA 9.14 090 55535 ......... ............ A Revise spermatic cord veins ....................... 6.55 NA 3.41 0.53 NA 10.49 090 55540 ......... ............ A Revise hernia & sperm veins ...................... 7.66 NA 3.83 0.94 NA 12.43 090 55550 ......... ............ A Laparo ligate spermatic vein ....................... 6.56 NA 3.29 0.66 NA 10.51 090 55600 ......... ............ A Incise sperm duct pouch ............................. 6.37 NA 3.35 0.59 NA 10.31 090 55605 ......... ............ A Incise sperm duct pouch ............................. 7.95 NA 4.32 0.97 NA 13.24 090 55650 ......... ............ A Remove sperm duct pouch ......................... 11.78 NA 5.29 0.95 NA 18.02 090 55680 ......... ............ A Remove sperm pouch lesion ....................... 5.18 NA 2.98 0.47 NA 8.63 090 55700 ......... ............ A Biopsy of prostate ........................................ 1.57 4.18 0.64 0.11 5.86 2.32 000 55705 ......... ............ A Biopsy of prostate ........................................ 4.56 NA 2.29 0.33 NA 7.18 010 55720 ......... ............ A Drainage of prostate abscess ...................... 7.63 NA 3.88 0.55 NA 12.06 090 55725 ......... ............ A Drainage of prostate abscess ...................... 8.67 NA 4.55 0.74 NA 13.96 090 55801 ......... ............ A Removal of prostate .................................... 17.77 NA 7.65 1.37 NA 26.79 090 55810 ......... ............ A Extensive prostate surgery .......................... 22.55 NA 8.99 1.66 NA 33.20 090 55812 ......... ............ A Extensive prostate surgery .......................... 27.47 NA 11.03 2.22 NA 40.72 090 55815 ......... ............ A Extensive prostate surgery .......................... 30.41 NA 11.94 2.39 NA 44.74 090 55821 ......... ............ A Removal of prostate .................................... 14.23 NA 6.24 1.05 NA 21.52 090 55831 ......... ............ A Removal of prostate .................................... 15.60 NA 6.69 1.16 NA 23.45 090 55840 ......... ............ A Extensive prostate surgery .......................... 22.66 NA 9.33 1.68 NA 33.67 090 55842 ......... ............ A Extensive prostate surgery .......................... 24.34 NA 9.89 1.82 NA 36.05 090 55845 ......... ............ A Extensive prostate surgery .......................... 28.51 NA 10.99 2.13 NA 41.63 090 55859 ......... ............ A Percut/needle insert, pros ............................ 12.50 NA 5.87 0.88 NA 19.25 090 55860 ......... ............ A Surgical exposure, prostate ......................... 14.43 NA 6.45 0.99 NA 21.87 090 55862 ......... ............ A Extensive prostate surgery .......................... 18.36 NA 7.88 1.31 NA 27.55 090 55865 ......... ............ A Extensive prostate surgery .......................... 22.84 NA 9.29 1.73 NA 33.86 090 55866 ......... ............ A Laparo radical prostatectomy ...................... 30.69 NA 11.68 1.68 NA 44.05 090 55870 ......... ............ A Electroejaculation ......................................... 2.58 1.53 1.08 0.17 4.28 3.83 000 55873 ......... ............ A Cryoablate prostate ..................................... 19.44 NA 8.92 1.39 NA 29.75 090 56405 ......... ............ A I & D of vulva/perineum ............................... 1.44 1.33 1.14 0.17 2.94 2.75 010 56420 ......... ............ A Drainage of gland abscess .......................... 1.39 2.28 1.05 0.15 3.82 2.59 010 56440 ......... ............ A Surgery for vulva lesion ............................... 2.84 NA 1.71 0.34 NA 4.89 010 56441 ......... ............ A Lysis of labial lesion(s) ................................ 1.97 1.81 1.42 0.19 3.97 3.58 010 56501 ......... ............ A Destroy, vulva lesions, sim .......................... 1.53 1.78 1.25 0.18 3.49 2.96 010


## 47635

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

56515 ......... ............ A Destroy vulva lesion/s compl ....................... 2.76 2.55 1.81 0.32 5.63 4.89 010 56605 ......... ............ A Biopsy of vulva/perineum ............................ 1.10 1.08 0.46 0.13 2.31 1.69 000 56606 ......... ............ A Biopsy of vulva/perineum ............................ 0.55 0.49 0.22 0.07 1.11 0.84 ZZZ 56620 ......... ............ A Partial removal of vulva ............................... 7.46 NA 4.83 0.89 NA 13.18 090 56625 ......... ............ A Complete removal of vulva .......................... 8.39 NA 5.39 1.00 NA 14.78 090 56630 ......... ............ A Extensive vulva surgery ............................... 12.34 NA 6.96 1.45 NA 20.75 090 56631 ......... ............ A Extensive vulva surgery ............................... 16.18 NA 8.98 1.92 NA 27.08 090 56632 ......... ............ A Extensive vulva surgery ............................... 20.26 NA 9.64 2.35 NA 32.25 090 56633 ......... ............ A Extensive vulva surgery ............................... 16.45 NA 8.71 1.93 NA 27.09 090 56634 ......... ............ A Extensive vulva surgery ............................... 17.85 NA 9.60 2.09 NA 29.54 090 56637 ......... ............ A Extensive vulva surgery ............................... 21.94 NA 11.24 2.56 NA 35.74 090 56640 ......... ............ A Extensive vulva surgery ............................... 22.14 NA 10.78 2.61 NA 35.53 090 56700 ......... ............ A Partial removal of hymen ............................. 2.52 NA 1.83 0.29 NA 4.64 010 56720 ......... ............ A Incision of hymen ......................................... 0.68 NA 0.51 0.08 NA 1.27 000 56740 ......... ............ A Remove vagina gland lesion ....................... 4.56 NA 2.56 0.55 NA 7.67 010 56800 ......... ............ A Repair of vagina .......................................... 3.88 NA 2.18 0.44 NA 6.50 010 56805 ......... ............ A Repair clitoris ............................................... 18.83 NA 9.38 2.08 NA 30.29 090 56810 ......... ............ A Repair of perineum ...................................... 4.12 NA 2.29 0.48 NA 6.89 010 56820 ......... ............ A Exam of vulva w/scope ................................ 1.50 1.32 0.65 0.11 2.93 2.26 000 56821 ......... ............ A Exam/biopsy of vulva w/scope .................... 2.05 1.76 0.91 0.15 3.96 3.11 000 57000 ......... ............ A Exploration of vagina ................................... 2.97 NA 1.72 0.30 NA 4.99 010 57010 ......... ............ A Drainage of pelvic abscess ......................... 6.02 NA 3.83 0.69 NA 10.54 090 57020 ......... ............ A Drainage of pelvic fluid ................................ 1.50 0.95 0.59 0.18 2.63 2.27 000 57022 ......... ............ A I & d vaginal hematoma, pp ........................ 2.56 NA 1.50 0.27 NA 4.33 010 57023 ......... ............ A I & d vag hematoma, non-ob ....................... 4.74 NA 2.57 0.55 NA 7.86 010 57061 ......... ............ A Destroy vag lesions, simple ......................... 1.25 1.66 1.12 0.15 3.06 2.52 010 57065 ......... ............ A Destroy vag lesions, complex ...................... 2.61 2.30 1.68 0.31 5.22 4.60 010 57100 ......... ............ A Biopsy of vagina .......................................... 1.20 1.09 0.48 0.14 2.43 1.82 000 57105 ......... ............ A Biopsy of vagina .......................................... 1.69 1.79 1.43 0.20 3.68 3.32 010 57106 ......... ............ A Remove vagina wall, partial ........................ 6.35 NA 4.19 0.73 NA 11.27 090 57107 ......... ............ A Remove vagina tissue, part ......................... 22.97 NA 10.45 2.67 NA 36.09 090 57109 ......... ............ A Vaginectomy partial w/nodes ....................... 26.96 NA 11.28 3.10 NA 41.34 090 57110 ......... ............ A Remove vagina wall, complete .................... 14.27 NA 7.28 1.67 NA 23.22 090 57111 ......... ............ A Remove vagina tissue, compl ..................... 26.96 NA 12.58 2.95 NA 42.49 090 57112 ......... ............ A Vaginectomy w/nodes, compl ...................... 28.96 NA 12.12 2.61 NA 43.69 090 57120 ......... ............ A Closure of vagina ......................................... 7.40 NA 4.62 0.87 NA 12.89 090 57130 ......... ............ A Remove vagina lesion ................................. 2.43 2.16 1.54 0.27 4.86 4.24 010 57135 ......... ............ A Remove vagina lesion ................................. 2.67 2.27 1.65 0.31 5.25 4.63 010 57150 ......... ............ A Treat vagina infection .................................. 0.55 1.10 0.21 0.07 1.72 0.83 000 57155 ......... ............ A Insert uteri tandems/ovoids ......................... 6.26 NA 4.61 0.45 NA 11.32 090 57160 ......... ............ A Insert pessary/other device ......................... 0.89 1.01 0.34 0.10 2.00 1.33 000 57170 ......... ............ A Fitting of diaphragm/cap .............................. 0.91 1.49 0.33 0.11 2.51 1.35 000 57180 ......... ............ A Treat vaginal bleeding ................................. 1.58 2.17 1.27 0.18 3.93 3.03 010 57200 ......... ............ A Repair of vagina .......................................... 3.93 NA 2.89 0.45 NA 7.27 090 57210 ......... ............ A Repair vagina/perineum ............................... 5.16 NA 3.43 0.61 NA 9.20 090 57220 ......... ............ A Revision of urethra ...................................... 4.30 NA 3.10 0.50 NA 7.90 090 57230 ......... ............ A Repair of urethral lesion .............................. 5.63 NA 3.40 0.57 NA 9.60 090 57240 ......... ............ A Repair bladder & vagina .............................. 6.06 NA 3.81 0.62 NA 10.49 090 57250 ......... ............ A Repair rectum & vagina ............................... 5.52 NA 3.57 0.64 NA 9.73 090 57260 ......... ............ A Repair of vagina .......................................... 8.26 NA 4.83 0.96 NA 14.05 090 57265 ......... ............ A Extensive repair of vagina ........................... 11.32 NA 6.03 1.32 NA 18.67 090 57268 ......... ............ A Repair of bowel bulge .................................. 6.75 NA 4.19 0.78 NA 11.72 090 57270 ......... ............ A Repair of bowel pouch ................................. 12.09 NA 6.24 1.39 NA 19.72 090 57280 ......... ............ A Suspension of vagina .................................. 15.02 NA 7.35 1.65 NA 24.02 090 57282 ......... ............ A Repair of vaginal prolapse ........................... 8.85 NA 5.29 1.02 NA 15.16 090 57284 ......... ............ A Repair paravaginal defect ............................ 12.68 NA 7.13 1.44 NA 21.25 090 57287 ......... ............ A Revise/remove sling repair .......................... 10.69 NA 5.46 0.91 NA 17.06 090 57288 ......... ............ A Repair bladder defect .................................. 13.00 NA 5.90 1.14 NA 20.04 090 57289 ......... ............ A Repair bladder & vagina .............................. 11.56 NA 6.03 1.17 NA 18.76 090 57291 ......... ............ A Construction of vagina ................................. 7.94 NA 4.92 0.94 NA 13.80 090 57292 ......... ............ A Construct vagina with graft .......................... 13.07 NA 6.93 1.57 NA 21.57 090 57300 ......... ............ A Repair rectum-vagina fistula ........................ 7.60 NA 4.29 0.88 NA 12.77 090 57305 ......... ............ A Repair rectum-vagina fistula ........................ 13.75 NA 6.26 1.67 NA 21.68 090 57307 ......... ............ A Fistula repair & colostomy ........................... 15.91 NA 7.02 1.96 NA 24.89 090 57308 ......... ............ A Fistula repair, transperine ............................ 9.93 NA 5.13 1.12 NA 16.18 090 57310 ......... ............ A Repair urethrovaginal lesion ........................ 6.77 NA 3.86 0.57 NA 11.20 090 57311 ......... ............ A Repair urethrovaginal lesion ........................ 7.97 NA 4.14 0.68 NA 12.79 090 57320 ......... ............ A Repair bladder-vagina lesion ....................... 8.00 NA 4.39 0.65 NA 13.04 090 57330 ......... ............ A Repair bladder-vagina lesion ....................... 12.33 NA 5.73 1.07 NA 19.13 090 57335 ......... ............ A Repair vagina ............................................... 18.70 NA 9.03 1.84 NA 29.57 090 57400 ......... ............ A Dilation of vagina ......................................... 2.27 NA 1.11 0.26 NA 3.64 000
57410 ......... ............ A Pelvic examination ....................................... 1.75 2.02 0.89 0.17 3.94 2.81 000 57415 ......... ............ A Remove vaginal foreign body ...................... 2.17 NA 1.43 0.23 NA 3.83 010 57420 ......... ............ A Exam of vagina w/scope ............................. 1.60 1.36 0.67 0.11 3.07 2.38 000 57421 ......... ............ A Exam/biopsy of vag w/scope ....................... 2.20 1.85 0.96 0.15 4.20 3.31 000


## 47636

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

57425 ......... ............ A Laparoscopy, surg, colpopexy ..................... 15.73 NA 6.63 1.74 NA 24.10 090 57452 ......... ............ A Exam of cervix w/scope ............................... 1.50 1.29 0.77 0.11 2.90 2.38 000 57454 ......... ............ A Bx/curett of cervix w/scope .......................... 2.33 1.64 1.15 0.15 4.12 3.63 000 57455 ......... ............ A Biopsy of cervix w/scope ............................. 1.99 1.72 0.87 0.15 3.86 3.01 000 57456 ......... ............ A Endocerv curettage w/scope ....................... 1.85 1.65 0.82 0.15 3.65 2.82 000 57460 ......... ............ A Bx of cervix w/scope, leep ........................... 2.83 5.85 1.37 0.33 9.01 4.53 000 57461 ......... ............ A Conz of cervix w/scope, leep ...................... 3.43 6.11 1.47 0.33 9.87 5.23 000 57500 ......... ............ A Biopsy of cervix ........................................... 0.97 2.55 0.63 0.11 3.63 1.71 000 57505 ......... ............ A Endocervical curettage ................................ 1.14 1.47 1.10 0.13 2.74 2.37 010 57510 ......... ............ A Cauterization of cervix ................................. 1.90 1.57 1.04 0.22 3.69 3.16 010 57511 ......... ............ A Cryocautery of cervix ................................... 1.90 1.83 1.38 0.22 3.95 3.50 010 57513 ......... ............ A Laser surgery of cervix ................................ 1.90 1.73 1.41 0.23 3.86 3.54 010 57520 ......... ............ A Conization of cervix ..................................... 4.03 3.93 2.88 0.48 8.44 7.39 090 57522 ......... ............ A Conization of cervix ..................................... 3.35 3.15 2.46 0.40 6.90 6.21 090
57530 ......... ............ A Removal of cervix ........................................ 4.78 NA 3.42 0.56 NA 8.76 090 57531 ......... ............ A Removal of cervix, radical ........................... 27.96 NA 13.18 3.29 NA 44.43 090
57540 ......... ............ A Removal of residual cervix .......................... 12.20 NA 6.24 1.39 NA 19.83 090 57545 ......... ............ A Remove cervix/repair pelvis ........................ 13.01 NA 6.67 1.57 NA 21.25 090 57550 ......... ............ A Removal of residual cervix .......................... 5.52 NA 3.85 0.67 NA 10.04 090 57555 ......... ............ A Remove cervix/repair vagina ....................... 8.94 NA 5.11 1.08 NA 15.13 090 57556 ......... ............ A Remove cervix, repair bowel ....................... 8.36 NA 4.87 0.95 NA 14.18 090 57700 ......... ............ A Revision of cervix ........................................ 3.54 NA 3.08 0.40 NA 7.02 090 57720 ......... ............ A Revision of cervix ........................................ 4.12 NA 3.14 0.49 NA 7.75 090 57800 ......... ............ A Dilation of cervical canal .............................. 0.77 0.76 0.47 0.09 1.62 1.33 000 57820 ......... ............ A D & c of residual cervix ............................... 1.67 1.48 1.14 0.20 3.35 3.01 010 58100 ......... ............ A Biopsy of uterus lining ................................. 1.53 1.32 0.72 0.18 3.03 2.43 000 58120 ......... ............ A Dilation and curettage .................................. 3.27 2.30 1.87 0.39 5.96 5.53 010 58140 ......... ............ A Myomectomy abdom method ...................... 14.58 NA 7.10 1.77 NA 23.45 090 58145 ......... ............ A Myomectomy vag method ........................... 8.03 NA 4.82 0.96 NA 13.81 090 58146 ......... ............ A Myomectomy abdom complex ..................... 18.97 NA 8.90 1.77 NA 29.64 090 58150 ......... ............ A Total hysterectomy ...................................... 15.22 NA 7.48 1.81 NA 24.51 090 58152 ......... ............ A Total hysterectomy ...................................... 20.57 NA 9.83 2.39 NA 32.79 090 58180 ......... ............ A Partial hysterectomy .................................... 15.27 NA 7.44 1.83 NA 24.54 090 58200 ......... ............ A Extensive hysterectomy ............................... 21.56 NA 10.00 2.52 NA 34.08 090 58210 ......... ............ A Extensive hysterectomy ............................... 28.81 NA 13.20 3.31 NA 45.32 090 58240 ......... ............ A Removal of pelvis contents ......................... 38.33 NA 17.63 4.33 NA 60.29 090 58260 ......... ............ A Vaginal hysterectomy .................................. 12.96 NA 6.68 1.54 NA 21.18 090 58262 ......... ............ A Vag hyst including t/o .................................. 14.75 NA 7.36 1.75 NA 23.86 090 58263 ......... ............ A Vag hyst w/t/o & vag repair ......................... 16.04 NA 7.86 1.90 NA 25.80 090 58267 ......... ............ A Vag hyst w/urinary repair ............................. 17.01 NA 8.36 2.01 NA 27.38 090 58270 ......... ............ A Vag hyst w/enterocele repair ....................... 14.24 NA 7.05 1.69 NA 22.98 090 58275 ......... ............ A Hysterectomy/revise vagina ......................... 15.74 NA 7.75 1.86 NA 25.35 090 58280 ......... ............ A Hysterectomy/revise vagina ......................... 16.98 NA 8.23 1.99 NA 27.20 090 58285 ......... ............ A Extensive hysterectomy ............................... 22.23 NA 9.97 2.65 NA 34.85 090 58290 ......... ............ A Vag hyst complex ........................................ 18.97 NA 9.10 1.48 NA 29.55 090 58291 ......... ............ A Vag hyst incl t/o, complex ........................... 20.76 NA 9.86 1.75 NA 32.37 090 58292 ......... ............ A Vag hyst t/o & repair, compl ........................ 22.05 NA 10.34 1.90 NA 34.29 090 58293 ......... ............ A Vag hyst w/uro repair, compl ....................... 23.03 NA 10.66 2.01 NA 35.70 090 58294 ......... ............ A Vag hyst w/enterocele, compl ..................... 20.25 NA 9.54 1.69 NA 31.48 090
58301 ......... ............ A Remove intrauterine device ......................... 1.27 1.32 0.48 0.14 2.73 1.89 000 58321 ......... ............ A Artificial insemination ................................... 0.92 1.15 0.37 0.11 2.18 1.40 000 58322 ......... ............ A Artificial insemination ................................... 1.10 1.21 0.42 0.13 2.44 1.65 000 58323 ......... ............ A Sperm washing ............................................ 0.23 0.53 0.09 0.03 0.79 0.35 000 58340 ......... ............ A Catheter for hysterography .......................... 0.88 3.16 0.65 0.09 4.13 1.62 000 58345 ......... ............ A Reopen fallopian tube .................................. 4.65 NA 2.43 0.33 NA 7.41 010 58346 ......... ............ A Insert heyman uteri capsule ........................ 6.74 NA 3.93 0.79 NA 11.46 090 58350 ......... ............ A Reopen fallopian tube .................................. 1.01 1.49 0.93 0.12 2.62 2.06 010 58353 ......... ............ A Endometr ablate, thermal ............................ 3.55 35.73 2.04 0.42 39.70 6.01 010 58400 ......... ............ A Suspension of uterus ................................... 6.35 NA 3.96 0.75 NA 11.06 090 58410 ......... ............ A Suspension of uterus ................................... 12.71 NA 6.46 1.37 NA 20.54 090 58520 ......... ............ A Repair of ruptured uterus ............................ 11.90 NA 6.04 1.32 NA 19.26 090 58540 ......... ............ A Revision of uterus ........................................ 14.62 NA 6.95 1.76 NA 23.33 090 58545 ......... ............ A Laparoscopic myomectomy ......................... 14.58 NA 7.21 1.71 NA 23.50 090 58546 ......... ............ A Laparo-myomectomy, complex .................... 18.97 NA 9.05 1.71 NA 29.73 090 58550 ......... ............ A Laparo-asst vag hysterectomy .................... 14.17 NA 7.28 1.70 NA 23.15 090 58552 ......... ............ A Laparo-vag hyst incl t/o ............................... 15.98 NA 8.00 1.70 NA 25.68 090 58553 ......... ............ A Laparo-vag hyst, complex ........................... 18.97 NA 8.93 1.54 NA 29.44 090 58554 ......... ............ A Laparo-vag hyst w/t/o, compl ...................... 21.97 NA 10.41 1.54 NA 33.92 090 58555 ......... ............ A Hysteroscopy, dx, sep proc ......................... 3.33 2.19 1.55 0.40 5.92 5.28 000 58558 ......... ............ A Hysteroscopy, biopsy ................................... 4.74 NA 2.17 0.57 NA 7.48 000 58559 ......... ............ A Hysteroscopy, lysis ...................................... 6.16 NA 2.72 0.73 NA 9.61 000 58560 ......... ............ A Hysteroscopy, resect septum ...................... 6.99 NA 3.07 0.84 NA 10.90 000 58561 ......... ............ A Hysteroscopy, remove myoma .................... 9.99 NA 4.27 1.18 NA 15.44 000 58562 ......... ............ A Hysteroscopy, remove fb ............................. 5.20 NA 2.34 0.62 NA 8.16 000


## 47637

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

58563 ......... ............ A Hysteroscopy, ablation ................................ 6.16 56.02 2.74 0.74 62.92 9.64 000 58600 ......... ............ A Division of fallopian tube ............................. 5.59 NA 3.35 0.67 NA 9.61 090 58605 ......... ............ A Division of fallopian tube ............................. 4.99 NA 3.14 0.59 NA 8.72 090 58611 ......... ............ A Ligate oviduct(s) add-on .............................. 1.45 NA 0.57 0.17 NA 2.19 ZZZ 58615 ......... ............ A Occlude fallopian tube(s) ............................. 3.89 NA 2.71 0.48 NA 7.08 010 58660 ......... ............ A Laparoscopy, lysis ....................................... 11.27 NA 5.25 1.38 NA 17.90 090 58661 ......... ............ A Laparoscopy, remove adnexa ..................... 11.03 NA 5.11 1.31 NA 17.45 010 58662 ......... ............ A Laparoscopy, excise lesions ........................ 11.77 NA 5.78 1.42 NA 18.97 090 58670 ......... ............ A Laparoscopy, tubal cautery ......................... 5.59 NA 3.27 0.66 NA 9.52 090 58671 ......... ............ A Laparoscopy, tubal block ............................. 5.59 NA 3.28 0.67 NA 9.54 090 58672 ......... ............ A Laparoscopy, fimbrioplasty .......................... 12.86 NA 6.21 1.49 NA 20.56 090 58673 ......... ............ A Laparoscopy, salpingostomy ....................... 13.72 NA 6.59 1.68 NA 21.99 090 58700 ......... ............ A Removal of fallopian tube ............................ 12.03 NA 5.99 1.47 NA 19.49 090 58720 ......... ............ A Removal of ovary/tube(s) ............................ 11.34 NA 5.79 1.36 NA 18.49 090 58740 ......... ............ A Revise fallopian tube(s) ............................... 13.98 NA 7.13 1.68 NA 22.79 090 58750 ......... ............ A Repair oviduct .............................................. 14.82 NA 7.37 1.72 NA 23.91 090 58752 ......... ............ A Revise ovarian tube(s) ................................. 14.82 NA 6.96 1.82 NA 23.60 090
58760 ......... ............ A Remove tubal obstruction ............................ 13.11 NA 6.71 1.53 NA 21.35 090 58770 ......... ............ A Create new tubal opening ........................... 13.95 NA 6.91 1.52 NA 22.38 090 58800 ......... ............ A Drainage of ovarian cyst(s) ......................... 4.13 3.64 2.90 0.47 8.24 7.50 090 58805 ......... ............ A Drainage of ovarian cyst(s) ......................... 5.87 NA 3.53 0.66 NA 10.06 090 58820 ......... ............ A Drain ovary abscess, open .......................... 4.21 NA 3.32 0.41 NA 7.94 090 58822 ......... ............ A Drain ovary abscess, percut ........................ 10.11 NA 5.22 1.23 NA 16.56 090 58823 ......... ............ A Drain pelvic abscess, percut ....................... 3.37 21.77 1.12 0.25 25.39 4.74 000 58825 ......... ............ A Transposition, ovary(s) ................................ 10.96 NA 5.80 1.33 NA 18.09 090 58900 ......... ............ A Biopsy of ovary(s) ........................................ 5.98 NA 3.59 0.70 NA 10.27 090 58920 ......... ............ A Partial removal of ovary(s) .......................... 11.34 NA 5.60 1.37 NA 18.31 090 58925 ......... ............ A Removal of ovarian cyst(s) .......................... 11.34 NA 5.69 1.39 NA 18.42 090 58940 ......... ............ A Removal of ovary(s) .................................... 7.28 NA 4.12 0.88 NA 12.28 090 58943 ......... ............ A Removal of ovary(s) .................................... 18.40 NA 8.73 2.19 NA 29.32 090 58950 ......... ............ A Resect ovarian malignancy ......................... 16.90 NA 8.48 2.01 NA 27.39 090 58951 ......... ............ A Resect ovarian malignancy ......................... 22.35 NA 10.52 2.62 NA 35.49 090 58952 ......... ............ A Resect ovarian malignancy ......................... 24.97 NA 11.83 2.96 NA 39.76 090 58953 ......... ............ A Tah, rad dissect for debulk .......................... 31.95 NA 14.54 3.77 NA 50.26 090 58954 ......... ............ A Tah rad debulk/lymph remove ..................... 34.95 NA 15.68 4.14 NA 54.77 090 58960 ......... ............ A Exploration of abdomen ............................... 14.63 NA 7.44 1.74 NA 23.81 090 58970 ......... ............ A Retrieval of oocyte ....................................... 3.52 2.31 1.49 0.29 6.12 5.30 000 58976 ......... ............ A Transfer of embryo ...................................... 3.82 2.65 1.82 0.47 6.94 6.11 000 59000 ......... ............ A Amniocentesis, diagnostic ........................... 1.30 2.08 0.67 0.31 3.69 2.28 000 59001 ......... ............ A Amniocentesis, therapeutic .......................... 3.00 NA 1.40 0.71 NA 5.11 000 59012 ......... ............ A Fetal cord puncture,prenatal ........................ 3.44 NA 1.53 0.82 NA 5.79 000 59015 ......... ............ A Chorion biopsy ............................................. 2.20 1.56 1.04 0.52 4.28 3.76 000
59020 ......... ............ A Fetal contract stress test ............................. 0.66 0.78 NA 0.26 1.70 NA 000 59020 ......... 26 ....... A Fetal contract stress test ............................. 0.66 0.26 0.26 0.16 1.08 1.08 000 59020 ......... TC ...... A Fetal contract stress test ............................. 0.00 0.52 NA 0.10 0.62 NA 000
59025 ......... ............ A Fetal non-stress test .................................... 0.53 0.44 NA 0.15 1.12 NA 000 59025 ......... 26 ....... A Fetal non-stress test .................................... 0.53 0.21 0.21 0.13 0.87 0.87 000 59025 ......... TC ...... A Fetal non-stress test .................................... 0.00 0.23 NA 0.02 0.25 NA 000 59030 ......... ............ A Fetal scalp blood sample ............................. 1.99 NA 0.77 0.47 NA 3.23 000 59050 ......... ............ A Fetal monitor w/report .................................. 0.89 NA 0.35 0.21 NA 1.45 XXX 59051 ......... ............ A Fetal monitor/interpret only .......................... 0.74 NA 0.29 0.18 NA 1.21 XXX 59070 ......... ............ A Transabdom amnioinfus w/ us .................... 5.24 5.06 2.29 0.28 10.58 7.81 000 59072 ......... ............ A Umbilical cord occlud w/ us ......................... 8.99 NA 3.11 0.16 NA 12.26 000 59074 ......... ............ A Fetal fluid drainage w/ us ............................ 5.24 4.47 2.29 0.28 9.99 7.81 000 59076 ......... ............ A Fetal shunt placement, w/ us ...................... 8.99 NA 3.11 0.16 NA 12.26 000
59100 ......... ............ A Remove uterus lesion .................................. 12.33 NA 6.46 2.93 NA 21.72 090 59120 ......... ............ A Treat ectopic pregnancy .............................. 11.47 NA 6.24 2.73 NA 20.44 090 59121 ......... ............ A Treat ectopic pregnancy .............................. 11.65 NA 6.32 2.77 NA 20.74 090 59130 ......... ............ A Treat ectopic pregnancy .............................. 14.20 NA 4.86 1.96 NA 21.02 090 59135 ......... ............ A Treat ectopic pregnancy .............................. 13.86 NA 7.22 3.00 NA 24.08 090 59136 ......... ............ A Treat ectopic pregnancy .............................. 13.16 NA 6.61 2.85 NA 22.62 090 59140 ......... ............ A Treat ectopic pregnancy .............................. 5.45 2.20 2.20 1.30 8.95 8.95 090 59150 ......... ............ A Treat ectopic pregnancy .............................. 11.65 NA 6.02 2.77 NA 20.44 090 59151 ......... ............ A Treat ectopic pregnancy .............................. 11.47 NA 6.06 2.73 NA 20.26 090 59160 ......... ............ A D & c after delivery ...................................... 2.71 3.29 2.13 0.64 6.64 5.48 010
59200 ......... ............ A Insert cervical dilator .................................... 0.79 1.19 0.30 0.19 2.17 1.28 000 59300 ......... ............ A Episiotomy or vaginal repair ........................ 2.41 2.20 0.95 0.57 5.18 3.93 000 59320 ......... ............ A Revision of cervix ........................................ 2.48 NA 1.24 0.59 NA 4.31 000 59325 ......... ............ A Revision of cervix ........................................ 4.06 NA 1.89 0.88 NA 6.83 000 59350 ......... ............ A Repair of uterus ........................................... 4.94 NA 1.86 1.18 NA 7.98 000 59400 ......... ............ A Obstetrical care ............................................ 23.03 NA 15.35 5.48 NA 43.86 MMM 59409 ......... ............ A Obstetrical care ............................................ 13.48 NA 5.29 3.21 NA 21.98 MMM 59410 ......... ............ A Obstetrical care ............................................ 14.76 NA 6.29 3.51 NA 24.56 MMM 59412 ......... ............ A Antepartum manipulation ............................. 1.71 NA 0.81 0.41 NA 2.93 MMM 59414 ......... ............ A Deliver placenta ........................................... 1.61 NA 0.64 0.38 NA 2.63 MMM


## 47638

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

59425 ......... ............ A Antepartum care only .................................. 4.80 4.22 1.85 1.14 10.16 7.79 MMM 59426 ......... ............ A Antepartum care only .................................. 8.27 7.58 3.21 1.97 17.82 13.45 MMM 59430 ......... ............ A Care after delivery ....................................... 2.13 1.23 0.93 0.51 3.87 3.57 MMM 59510 ......... ............ A Cesarean delivery ........................................ 26.18 NA 17.26 6.23 NA 49.67 MMM 59514 ......... ............ A Cesarean delivery only ................................ 15.95 NA 6.19 3.79 NA 25.93 MMM 59515 ......... ............ A Cesarean delivery ........................................ 17.34 NA 7.81 4.13 NA 29.28 MMM 59525 ......... ............ A Remove uterus after cesarean .................... 8.53 NA 3.29 2.03 NA 13.85 ZZZ 59610 ......... ............ A Vbac delivery ............................................... 24.58 NA 15.89 5.85 NA 46.32 MMM 59612 ......... ............ A Vbac delivery only ....................................... 15.04 NA 6.03 3.58 NA 24.65 MMM 59614 ......... ............ A Vbac care after delivery ............................... 16.32 NA 6.91 3.88 NA 27.11 MMM 59618 ......... ............ A Attempted vbac delivery .............................. 27.74 NA 18.29 6.60 NA 52.63 MMM 59620 ......... ............ A Attempted vbac delivery only ...................... 17.50 NA 6.74 4.17 NA 28.41 MMM 59622 ......... ............ A Attempted vbac after care ........................... 18.90 NA 8.61 4.50 NA 32.01 MMM 59812 ......... ............ A Treatment of miscarriage ............................. 4.00 NA 2.54 0.95 NA 7.49 090 59820 ......... ............ A Care of miscarriage ..................................... 4.00 4.43 3.56 0.95 9.38 8.51 090 59821 ......... ............ A Treatment of miscarriage ............................. 4.46 4.26 3.40 1.06 9.78 8.92 090 59830 ......... ............ A Treat uterus infection ................................... 6.10 NA 3.99 1.45 NA 11.54 090 59840 ......... ............ R Abortion ........................................................ 3.01 NA 2.12 0.72 NA 5.85 010 59841 ......... ............ R Abortion ........................................................ 5.23 2.56 2.56 1.25 9.04 9.04 010 59850 ......... ............ R Abortion ........................................................ 5.90 NA 3.25 1.28 NA 10.43 090 59851 ......... ............ R Abortion ........................................................ 5.92 NA 3.73 1.41 NA 11.06 090 59852 ......... ............ R Abortion ........................................................ 8.23 NA 5.05 1.79 NA 15.07 090 59855 ......... ............ R Abortion ........................................................ 6.11 NA 3.55 1.45 NA 11.11 090 59856 ......... ............ R Abortion ........................................................ 7.47 NA 4.05 1.62 NA 13.14 090 59857 ......... ............ R Abortion ........................................................ 9.28 NA 4.59 2.00 NA 15.87 090 59866 ......... ............ R Abortion (mpr) .............................................. 3.99 NA 1.82 0.87 NA 6.68 000 59870 ......... ............ A Evacuate mole of uterus .............................. 6.00 NA 4.42 1.43 NA 11.85 090 59871 ......... ............ A Remove cerclage suture .............................. 2.13 1.74 1.13 0.51 4.38 3.77 000 60000 ......... ............ A Drain thyroid/tongue cyst ............................. 1.76 1.94 1.73 0.14 3.84 3.63 010 60001 ......... ............ A Aspirate/inject thyriod cyst ........................... 0.97 1.43 0.33 0.08 2.48 1.38 000 60100 ......... ............ A Biopsy of thyroid .......................................... 1.56 1.40 0.53 0.10 3.06 2.19 000 60200 ......... ............ A Remove thyroid lesion ................................. 9.54 NA 6.08 1.01 NA 16.63 090 60210 ......... ............ A Partial thyroid excision ................................. 10.86 NA 5.72 1.24 NA 17.82 090 60212 ......... ............ A Partial thyroid excision ................................. 16.01 NA 7.75 1.59 NA 25.35 090 60220 ......... ............ A Partial removal of thyroid ............................. 11.88 NA 6.24 1.34 NA 19.46 090 60225 ......... ............ A Partial removal of thyroid ............................. 14.17 NA 7.48 1.65 NA 23.30 090 60240 ......... ............ A Removal of thyroid ....................................... 16.04 NA 7.68 1.84 NA 25.56 090 60252 ......... ............ A Removal of thyroid ....................................... 20.54 NA 10.20 2.28 NA 33.02 090 60254 ......... ............ A Extensive thyroid surgery ............................ 26.95 NA 14.28 2.75 NA 43.98 090 60260 ......... ............ A Repeat thyroid surgery ................................ 17.44 NA 8.77 1.94 NA 28.15 090 60270 ......... ............ A Removal of thyroid ....................................... 20.24 NA 10.56 2.27 NA 33.07 090 60271 ......... ............ A Removal of thyroid ....................................... 16.80 NA 8.70 1.83 NA 27.33 090 60280 ......... ............ A Remove thyroid duct lesion ......................... 5.86 NA 4.78 0.53 NA 11.17 090 60281 ......... ............ A Remove thyroid duct lesion ......................... 8.52 NA 5.94 0.80 NA 15.26 090 60500 ......... ............ A Explore parathyroid glands .......................... 16.21 NA 7.47 1.98 NA 25.66 090 60502 ......... ............ A Re-explore parathyroids .............................. 20.32 NA 9.41 2.50 NA 32.23 090 60505 ......... ............ A Explore parathyroid glands .......................... 21.46 NA 11.03 2.65 NA 35.14 090 60512 ......... ............ A Autotransplant parathyroid ........................... 4.44 NA 1.62 0.54 NA 6.60 ZZZ 60520 ......... ............ A Removal of thymus gland ............................ 16.78 NA 8.31 2.16 NA 27.25 090 60521 ......... ............ A Removal of thymus gland ............................ 18.84 NA 9.57 1.92 NA 30.33 090 60522 ......... ............ A Removal of thymus gland ............................ 23.06 NA 11.28 3.13 NA 37.47 090 60540 ......... ............ A Explore adrenal gland .................................. 17.00 NA 7.58 1.75 NA 26.33 090 60545 ......... ............ A Explore adrenal gland .................................. 19.85 NA 8.54 2.05 NA 30.44 090 60600 ......... ............ A Remove carotid body lesion ........................ 17.90 NA 10.76 2.15 NA 30.81 090 60605 ......... ............ A Remove carotid body lesion ........................ 20.21 NA 12.59 2.45 NA 35.25 090 60650 ......... ............ A Laparoscopy adrenalectomy ........................ 19.97 NA 7.95 2.32 NA 30.24 090 61000 ......... ............ A Remove cranial cavity fluid .......................... 1.58 NA 0.96 0.17 NA 2.71 000 61001 ......... ............ A Remove cranial cavity fluid .......................... 1.49 NA 1.07 0.18 NA 2.74 000 61020 ......... ............ A Remove brain cavity fluid ............................ 1.51 NA 1.35 0.30 NA 3.16 000 61026 ......... ............ A Injection into brain canal .............................. 1.69 NA 1.40 0.25 NA 3.34 000 61050 ......... ............ A Remove brain canal fluid ............................. 1.51 NA 1.27 0.12 NA 2.90 000 61055 ......... ............ A Injection into brain canal .............................. 2.10 NA 1.43 0.16 NA 3.69 000 61070 ......... ............ A Brain canal shunt procedure ....................... 0.89 NA 1.03 0.14 NA 2.06 000
61105 ......... ............ A Twist drill hole .............................................. 5.13 NA 3.93 1.26 NA 10.32 090 61107 ......... ............ A Drill skull for implantation ............................ 4.99 NA 2.52 1.24 NA 8.75 000 61108 ......... ............ A Drill skull for drainage .................................. 10.17 NA 7.13 2.53 NA 19.83 090 61120 ......... ............ A Burr hole for puncture .................................. 8.75 NA 5.99 2.04 NA 16.78 090 61140 ......... ............ A Pierce skull for biopsy ................................. 15.88 NA 9.87 3.63 NA 29.38 090 61150 ......... ............ A Pierce skull for drainage .............................. 17.54 NA 10.36 3.95 NA 31.85 090 61151 ......... ............ A Pierce skull for drainage .............................. 12.40 NA 7.81 2.97 NA 23.18 090
61154 ......... ............ A Pierce skull & remove clot ........................... 14.97 NA 9.47 3.76 NA 28.20 090 61156 ......... ............ A Pierce skull for drainage .............................. 16.30 NA 9.82 4.03 NA 30.15 090 61210 ......... ............ A Pierce skull, implant device ......................... 5.83 NA 2.91 1.45 NA 10.19 000 61215 ......... ............ A Insert brain-fluid device ............................... 4.88 NA 4.00 1.21 NA 10.09 090 61250 ......... ............ A Pierce skull & explore .................................. 10.40 NA 6.84 2.15 NA 19.39 090


## 47639

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

61253 ......... ............ A Pierce skull & explore .................................. 12.34 NA 7.72 2.01 NA 22.07 090 61304 ......... ............ A Open skull for exploration ............................ 21.93 NA 12.83 4.96 NA 39.72 090 61305 ......... ............ A Open skull for exploration ............................ 26.57 NA 15.30 6.08 NA 47.95 090 61312 ......... ............ A Open skull for drainage ............................... 24.53 NA 15.03 5.60 NA 45.16 090 61313 ......... ............ A Open skull for drainage ............................... 24.89 NA 14.79 5.79 NA 45.47 090 61314 ......... ............ A Open skull for drainage ............................... 24.19 NA 13.03 5.53 NA 42.75 090 61315 ......... ............ A Open skull for drainage ............................... 27.64 NA 16.00 6.33 NA 49.97 090 61316 ......... ............ A Implt cran bone flap to abdo ....................... 1.39 NA 0.60 0.52 NA 2.51 ZZZ 61320 ......... ............ A Open skull for drainage ............................... 25.58 NA 14.74 5.81 NA 46.13 090 61321 ......... ............ A Open skull for drainage ............................... 28.46 NA 16.11 6.55 NA 51.12 090 61322 ......... ............ A Decompressive craniotomy ......................... 29.46 NA 15.68 6.02 NA 51.16 090 61323 ......... ............ A Decompressive lobectomy ........................... 30.95 NA 16.13 6.02 NA 53.10 090 61330 ......... ............ A Decompress eye socket .............................. 23.29 NA 13.70 3.67 NA 40.66 090 61332 ......... ............ A Explore/biopsy eye socket ........................... 27.24 NA 15.57 4.76 NA 47.57 090 61333 ......... ............ A Explore orbit/remove lesion ......................... 27.91 NA 15.55 3.55 NA 47.01 090 61334 ......... ............ A Explore orbit/remove object ......................... 18.24 NA 10.62 3.15 NA 32.01 090 61340 ......... ............ A Subtemporal decompression ....................... 18.63 NA 11.12 4.26 NA 34.01 090 61343 ......... ............ A Incise skull (press relief) .............................. 29.73 NA 16.81 6.70 NA 53.24 090 61345 ......... ............ A Relieve cranial pressure .............................. 27.16 NA 15.40 5.70 NA 48.26 090 61440 ......... ............ A Incise skull for surgery ................................. 26.59 NA 14.21 6.88 NA 47.68 090 61450 ......... ............ A Incise skull for surgery ................................. 25.91 NA 14.28 5.43 NA 45.62 090 61458 ......... ............ A Incise skull for brain wound ......................... 27.25 NA 15.50 6.24 NA 48.99 090 61460 ......... ............ A Incise skull for surgery ................................. 28.35 NA 16.40 5.35 NA 50.10 090 61470 ......... ............ A Incise skull for surgery ................................. 26.02 NA 13.85 6.74 NA 46.61 090 61480 ......... ............ A Incise skull for surgery ................................. 26.45 NA 15.27 6.10 NA 47.82 090 61490 ......... ............ A Incise skull for surgery ................................. 25.62 NA 14.32 6.26 NA 46.20 090 61500 ......... ............ A Removal of skull lesion ................................ 17.89 NA 10.80 3.71 NA 32.40 090 61501 ......... ............ A Remove infected skull bone ........................ 14.82 NA 9.21 3.00 NA 27.03 090 61510 ......... ............ A Removal of brain lesion ............................... 28.41 NA 16.68 6.49 NA 51.58 090 61512 ......... ............ A Remove brain lining lesion .......................... 35.04 NA 19.66 8.06 NA 62.76 090 61514 ......... ............ A Removal of brain abscess ........................... 25.22 NA 14.42 6.01 NA 45.65 090 61516 ......... ............ A Removal of brain lesion ............................... 24.57 NA 14.27 5.43 NA 44.27 090 61517 ......... ............ A Implt brain chemotx add-on ......................... 1.38 NA 0.64 0.10 NA 2.12 ZZZ 61518 ......... ............ A Removal of brain lesion ............................... 37.26 NA 21.09 8.46 NA 66.81 090 61519 ......... ............ A Remove brain lining lesion .......................... 41.33 NA 22.64 9.61 NA 73.58 090 61520 ......... ............ A Removal of brain lesion ............................... 54.76 NA 30.31 10.02 NA 95.09 090 61521 ......... ............ A Removal of brain lesion ............................... 44.41 NA 24.21 9.76 NA 78.38 090 61522 ......... ............ A Removal of brain abscess ........................... 29.41 NA 16.42 6.78 NA 52.61 090 61524 ......... ............ A Removal of brain lesion ............................... 27.82 NA 15.67 6.02 NA 49.51 090 61526 ......... ............ A Removal of brain lesion ............................... 52.09 NA 29.46 7.10 NA 88.65 090 61530 ......... ............ A Removal of brain lesion ............................... 43.79 NA 25.06 5.67 NA 74.52 090 61531 ......... ............ A Implant brain electrodes .............................. 14.61 NA 9.13 3.60 NA 27.34 090 61533 ......... ............ A Implant brain electrodes .............................. 19.68 NA 11.54 4.43 NA 35.65 090 61534 ......... ............ A Removal of brain lesion ............................... 20.94 NA 12.10 5.32 NA 38.36 090 61535 ......... ............ A Remove brain electrodes ............................. 11.61 NA 7.43 2.81 NA 21.85 090 61536 ......... ............ A Removal of brain lesion ............................... 35.47 NA 19.78 7.56 NA 62.81 090 61537 ......... ............ A Removal of brain tissue ............................... 24.96 NA 14.72 6.05 NA 45.73 090 61538 ......... ............ A Removal of brain tissue ............................... 26.77 NA 15.31 6.05 NA 48.13 090 61539 ......... ............ A Removal of brain tissue ............................... 32.03 NA 17.77 7.41 NA 57.21 090 61540 ......... ............ A Removal of brain tissue ............................... 29.96 NA 17.23 7.41 NA 54.60 090 61541 ......... ............ A Incision of brain tissue ................................. 28.81 NA 16.20 6.10 NA 51.11 090 61542 ......... ............ A Removal of brain tissue ............................... 30.97 NA 17.82 7.83 NA 56.62 090 61543 ......... ............ A Removal of brain tissue ............................... 29.18 NA 16.39 6.58 NA 52.15 090 61544 ......... ............ A Remove & treat brain lesion ........................ 25.46 NA 13.84 5.73 NA 45.03 090 61545 ......... ............ A Excision of brain tumor ................................ 43.73 NA 24.21 10.03 NA 77.97 090 61546 ......... ............ A Removal of pituitary gland ........................... 31.25 NA 17.49 7.15 NA 55.89 090 61548 ......... ............ A Removal of pituitary gland ........................... 21.50 NA 12.79 3.31 NA 37.60 090 61550 ......... ............ A Release of skull seams ............................... 14.63 NA 6.98 1.37 NA 22.98 090 61552 ......... ............ A Release of skull seams ............................... 19.53 NA 9.14 5.06 NA 33.73 090 61556 ......... ............ A Incise skull/sutures ...................................... 22.23 NA 11.37 5.12 NA 38.72 090 61557 ......... ............ A Incise skull/sutures ...................................... 22.35 NA 13.62 5.79 NA 41.76 090 61558 ......... ............ A Excision of skull/sutures .............................. 25.54 NA 14.18 3.15 NA 42.87 090 61559 ......... ............ A Excision of skull/sutures .............................. 32.74 NA 19.30 2.01 NA 54.05 090 61563 ......... ............ A Excision of skull tumor ................................. 26.79 NA 15.25 5.75 NA 47.79 090 61564 ......... ............ A Excision of skull tumor ................................. 33.78 NA 18.27 8.28 NA 60.33 090 61566 ......... ............ A Removal of brain tissue ............................... 30.95 NA 17.75 6.05 NA 54.75 090 61567 ......... ............ A Incision of brain tissue ................................. 35.45 NA 20.66 6.49 NA 62.60 090 61570 ......... ............ A Remove foreign body, brain ........................ 24.56 NA 13.90 5.07 NA 43.53 090 61571 ......... ............ A Incise skull for brain wound ......................... 26.35 NA 15.13 5.77 NA 47.25 090 61575 ......... ............ A Skull base/brainstem surgery ...................... 34.31 NA 19.64 5.42 NA 59.37 090 61576 ......... ............ A Skull base/brainstem surgery ...................... 52.35 NA 34.69 5.80 NA 92.84 090 61580 ......... ............ A Craniofacial approach, skull ........................ 30.30 NA 25.50 3.37 NA 59.17 090 61581 ......... ............ A Craniofacial approach, skull ........................ 34.55 NA 23.42 3.30 NA 61.27 090 61582 ......... ............ A Craniofacial approach, skull ........................ 31.61 NA 27.28 6.96 NA 65.85 090 61583 ......... ............ A Craniofacial approach, skull ........................ 36.16 NA 25.08 8.12 NA 69.36 090


## 47640

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

61584 ......... ............ A Orbitocranial approach/skull ........................ 34.60 NA 24.48 7.51 NA 66.59 090 61585 ......... ............ A Orbitocranial approach/skull ........................ 38.55 NA 26.44 7.50 NA 72.49 090 61586 ......... ............ A Resect nasopharynx, skull ........................... 25.06 NA 22.52 4.95 NA 52.53 090 61590 ......... ............ A Infratemporal approach/skull ....................... 41.72 NA 28.54 5.11 NA 75.37 090 61591 ......... ............ A Infratemporal approach/skull ....................... 43.61 NA 29.45 5.64 NA 78.70 090 61592 ......... ............ A Orbitocranial approach/skull ........................ 39.58 NA 26.46 8.93 NA 74.97 090 61595 ......... ............ A Transtemporal approach/skull ..................... 29.53 NA 22.27 3.81 NA 55.61 090 61596 ......... ............ A Transcochlear approach/skull ...................... 35.58 NA 24.37 4.83 NA 64.78 090 61597 ......... ............ A Transcondylar approach/skull ...................... 37.90 NA 22.96 8.56 NA 69.42 090 61598 ......... ............ A Transpetrosal approach/skull ....................... 33.36 NA 23.18 5.50 NA 62.04 090 61600 ......... ............ A Resect/excise cranial lesion ........................ 25.81 NA 19.72 3.60 NA 49.13 090 61601 ......... ............ A Resect/excise cranial lesion ........................ 27.85 NA 20.46 6.16 NA 54.47 090 61605 ......... ............ A Resect/excise cranial lesion ........................ 29.29 NA 21.89 2.90 NA 54.08 090 61606 ......... ............ A Resect/excise cranial lesion ........................ 38.77 NA 25.10 8.22 NA 72.09 090 61607 ......... ............ A Resect/excise cranial lesion ........................ 36.22 NA 23.74 6.58 NA 66.54 090 61608 ......... ............ A Resect/excise cranial lesion ........................ 42.04 NA 26.54 9.67 NA 78.25 090 61609 ......... ............ A Transect artery, sinus .................................. 9.88 NA 4.85 1.57 NA 16.30 ZZZ 61610 ......... ............ A Transect artery, sinus .................................. 29.63 NA 13.11 4.25 NA 46.99 ZZZ 61611 ......... ............ A Transect artery, sinus .................................. 7.41 NA 3.81 1.87 NA 13.09 ZZZ 61612 ......... ............ A Transect artery, sinus .................................. 27.84 NA 13.29 2.08 NA 43.21 ZZZ 61613 ......... ............ A Remove aneurysm, sinus ............................ 40.80 NA 26.22 8.76 NA 75.78 090 61615 ......... ............ A Resect/excise lesion, skull ........................... 32.02 NA 22.66 5.07 NA 59.75 090 61616 ......... ............ A Resect/excise lesion, skull ........................... 43.27 NA 28.59 8.13 NA 79.99 090 61618 ......... ............ A Repair dura .................................................. 16.96 NA 10.46 3.42 NA 30.84 090 61619 ......... ............ A Repair dura .................................................. 20.68 NA 12.25 3.41 NA 36.34 090 61623 ......... ............ A Endovasc tempory vessel occl .................... 9.95 NA 4.07 0.60 NA 14.62 000 61624 ......... ............ A Transcath occlusion, cns ............................. 20.12 NA 6.88 1.84 NA 28.84 000 61626 ......... ............ A Transcath occlusion, non-cns ...................... 16.60 NA 5.50 1.17 NA 23.27 000 61680 ......... ............ A Intracranial vessel surgery ........................... 30.66 NA 17.44 7.03 NA 55.13 090 61682 ......... ............ A Intracranial vessel surgery ........................... 61.48 NA 32.20 14.22 NA 107.90 090 61684 ......... ............ A Intracranial vessel surgery ........................... 39.75 NA 21.99 9.24 NA 70.98 090 61686 ......... ............ A Intracranial vessel surgery ........................... 64.39 NA 34.70 14.04 NA 113.13 090 61690 ......... ............ A Intracranial vessel surgery ........................... 29.27 NA 16.72 7.58 NA 53.57 090 61692 ......... ............ A Intracranial vessel surgery ........................... 51.79 NA 27.47 11.64 NA 90.90 090 61697 ......... ............ A Brain aneurysm repr, complx ...................... 50.44 NA 27.98 12.05 NA 90.47 090 61698 ......... ............ A Brain aneurysm repr, complx ...................... 48.34 NA 26.67 11.01 NA 86.02 090 61700 ......... ............ A Brain aneurysm repr, simple ....................... 50.44 NA 27.78 11.94 NA 90.16 090 61702 ......... ............ A Inner skull vessel surgery ............................ 48.34 NA 26.02 11.56 NA 85.92 090 61703 ......... ............ A Clamp neck artery ....................................... 17.44 NA 10.48 3.72 NA 31.64 090
61705 ......... ............ A Revise circulation to head ........................... 36.15 NA 19.24 8.11 NA 63.50 090 61708 ......... ............ A Revise circulation to head ........................... 35.25 NA 15.14 2.67 NA 53.06 090 61710 ......... ............ A Revise circulation to head ........................... 29.63 NA 13.63 3.78 NA 47.04 090 61711 ......... ............ A Fusion of skull arteries ................................ 36.28 NA 19.80 8.36 NA 64.44 090 61720 ......... ............ A Incise skull/brain surgery ............................. 16.74 NA 9.98 3.55 NA 30.27 090 61735 ......... ............ A Incise skull/brain surgery ............................. 20.40 NA 12.16 3.83 NA 36.39 090 61750 ......... ............ A Incise skull/brain biopsy ............................... 18.17 NA 10.61 4.48 NA 33.26 090 61751 ......... ............ A Brain biopsy w/ct/mr guide .......................... 17.59 NA 10.82 4.34 NA 32.75 090 61760 ......... ............ A Implant brain electrodes .............................. 22.24 NA 8.73 5.49 NA 36.46 090 61770 ......... ............ A Incise skull for treatment ............................. 21.41 NA 12.26 4.44 NA 38.11 090 61790 ......... ............ A Treat trigeminal nerve .................................. 10.84 NA 5.92 2.66 NA 19.42 090 61791 ......... ............ A Treat trigeminal tract .................................... 14.59 NA 8.92 3.51 NA 27.02 090 61793 ......... ............ A Focus radiation beam .................................. 17.21 NA 10.13 4.22 NA 31.56 090 61795 ......... ............ A Brain surgery using computer ..................... 4.03 NA 2.03 0.80 NA 6.86 ZZZ 61850 ......... ............ A Implant neuroelectrodes .............................. 12.37 NA 7.68 1.98 NA 22.03 090 61860 ......... ............ A Implant neuroelectrodes .............................. 20.84 NA 12.07 4.87 NA 37.78 090 61863 ......... ............ A Implant neuroelectrode ................................ 18.97 NA 11.76 4.66 NA 35.39 090 61864 ......... ............ A Implant neuroelectrde, add-l ........................ 4.49 NA 2.27 4.66 NA 11.42 ZZZ 61867 ......... ............ A Implant neuroelectrode ................................ 31.29 NA 18.00 4.66 NA 53.95 090 61868 ......... ............ A Implant neuroelectrde, add-l ........................ 7.91 NA 4.01 4.66 NA 16.58 ZZZ 61870 ......... ............ A Implant neuroelectrodes .............................. 14.92 NA 9.73 2.05 NA 26.70 090 61875 ......... ............ A Implant neuroelectrodes .............................. 15.04 NA 8.57 2.39 NA 26.00 090 61880 ......... ............ A Revise/remove neuroelectrode .................... 6.28 NA 4.59 1.50 NA 12.37 090 61885 ......... ............ A Implant neurostim one array ........................ 5.84 NA 5.31 1.35 NA 12.50 090 61886 ......... ............ A Implant neurostim arrays ............................. 7.99 NA 6.36 1.78 NA 16.13 090 61888 ......... ............ A Revise/remove neuroreceiver ...................... 5.06 NA 3.67 1.22 NA 9.95 010 62000 ......... ............ A Treat skull fracture ....................................... 12.51 NA 5.50 1.28 NA 19.29 090 62005 ......... ............ A Treat skull fracture ....................................... 16.15 NA 8.79 3.26 NA 28.20 090 62010 ......... ............ A Treatment of head injury ............................. 19.78 NA 11.70 4.64 NA 36.12 090 62100 ......... ............ A Repair brain fluid leakage ............................ 22.00 NA 12.80 4.71 NA 39.51 090 62115 ......... ............ A Reduction of skull defect ............................. 21.63 NA 11.64 5.46 NA 38.73 090 62116 ......... ............ A Reduction of skull defect ............................. 23.55 NA 13.36 1.92 NA 38.83 090 62117 ......... ............ A Reduction of skull defect ............................. 26.56 NA 15.37 6.88 NA 48.81 090 62120 ......... ............ A Repair skull cavity lesion ............................. 23.31 NA 18.61 2.64 NA 44.56 090 62121 ......... ............ A Incise skull repair ......................................... 21.55 NA 15.41 3.49 NA 40.45 090 62140 ......... ............ A Repair of skull defect ................................... 13.49 NA 8.33 3.02 NA 24.84 090


## 47641

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

62141 ......... ............ A Repair of skull defect ................................... 14.89 NA 9.06 3.26 NA 27.21 090 62142 ......... ............ A Remove skull plate/flap ............................... 10.77 NA 7.00 2.41 NA 20.18 090 62143 ......... ............ A Replace skull plate/flap ................................ 13.03 NA 8.05 3.02 NA 24.10 090 62145 ......... ............ A Repair of skull & brain ................................. 18.79 NA 10.90 3.77 NA 33.46 090 62146 ......... ............ A Repair of skull with graft .............................. 16.10 NA 9.64 3.20 NA 28.94 090 62147 ......... ............ A Repair of skull with graft .............................. 19.31 NA 11.32 4.35 NA 34.98 090 62148 ......... ............ A Retr bone flap to fix skull ............................. 2.00 NA 0.86 0.52 NA 3.38 ZZZ 62160 ......... ............ A Neuroendoscopy add-on ............................. 3.00 NA 1.53 0.63 NA 5.16 ZZZ 62161 ......... ............ A Dissect brain w/scope .................................. 19.97 NA 12.08 4.46 NA 36.51 090 62162 ......... ............ A Remove colloid cyst w/scope ...................... 25.21 NA 15.07 6.96 NA 47.24 090 62163 ......... ............ A Neuroendoscopy w/fb removal .................... 15.48 NA 9.91 4.46 NA 29.85 090 62164 ......... ............ A Remove brain tumor w/scope ...................... 27.46 NA 14.95 6.96 NA 49.37 090 62165 ......... ............ A Remove pituit tumor w/scope ...................... 21.97 NA 13.34 4.38 NA 39.69 090 62180 ......... ............ A Establish brain cavity shunt ......................... 21.03 NA 12.29 4.55 NA 37.87 090 62190 ......... ............ A Establish brain cavity shunt ......................... 11.05 NA 7.09 2.67 NA 20.81 090 62192 ......... ............ A Establish brain cavity shunt ......................... 12.23 NA 7.63 2.79 NA 22.65 090 62194 ......... ............ A Replace/irrigate catheter .............................. 5.02 NA 2.44 0.62 NA 8.08 010 62200 ......... ............ A Establish brain cavity shunt ......................... 18.29 NA 10.85 4.45 NA 33.59 090 62201 ......... ............ A Brain cavity shunt w/scope .......................... 14.84 NA 9.45 2.88 NA 27.17 090 62220 ......... ............ A Establish brain cavity shunt ......................... 12.98 NA 8.00 2.85 NA 23.83 090 62223 ......... ............ A Establish brain cavity shunt ......................... 12.85 NA 8.25 2.83 NA 23.93 090 62225 ......... ............ A Replace/irrigate catheter .............................. 5.40 NA 4.10 1.32 NA 10.82 090 62230 ......... ............ A Replace/revise brain shunt .......................... 10.52 NA 6.49 2.40 NA 19.41 090 62252 ......... ............ A Csf shunt reprogram .................................... 0.74 1.47 NA 0.20 2.41 NA XXX 62252 ......... 26 ....... A Csf shunt reprogram .................................... 0.74 0.37 0.37 0.18 1.29 1.29 XXX 62252 ......... TC ...... A Csf shunt reprogram .................................... 0.00 1.10 NA 0.02 1.12 NA XXX 62256 ......... ............ A Remove brain cavity shunt .......................... 6.59 NA 4.71 1.57 NA 12.87 090 62258 ......... ............ A Replace brain cavity shunt .......................... 14.52 NA 8.71 3.27 NA 26.50 090 62263 ......... ............ A Epidural lysis mult sessions ........................ 6.13 12.79 3.22 0.40 19.32 9.75 010 62264 ......... ............ A Epidural lysis on single day ......................... 4.42 7.75 1.42 0.40 12.57 6.24 010 62268 ......... ............ A Drain spinal cord cyst .................................. 4.73 11.63 2.14 0.31 16.67 7.18 000 62269 ......... ............ A Needle biopsy, spinal cord .......................... 5.01 15.11 1.97 0.39 20.51 7.37 000 62270 ......... ............ A Spinal fluid tap, diagnostic ........................... 1.13 2.98 0.56 0.08 4.19 1.77 000 62272 ......... ............ A Drain cerebro spinal fluid ............................. 1.35 3.60 0.71 0.17 5.12 2.23 000 62273 ......... ............ A Treat epidural spine lesion .......................... 2.15 2.73 0.72 0.14 5.02 3.01 000 62280 ......... ............ A Treat spinal cord lesion ............................... 2.63 6.99 1.01 0.23 9.85 3.87 010 62281 ......... ............ A Treat spinal cord lesion ............................... 2.66 5.70 0.90 0.18 8.54 3.74 010 62282 ......... ............ A Treat spinal canal lesion .............................. 2.33 8.43 0.92 0.17 10.93 3.42 010 62284 ......... ............ A Injection for myelogram ............................... 1.54 5.02 0.68 0.13 6.69 2.35 000 62287 ......... ............ A Percutaneous diskectomy ............................ 8.07 NA 5.55 0.69 NA 14.31 090 62290 ......... ............ A Inject for spine disk x-ray ............................ 3.00 7.19 1.38 0.26 10.45 4.64 000 62291 ......... ............ A Inject for spine disk x-ray ............................ 2.91 5.99 1.23 0.28 9.18 4.42 000 62292 ......... ............ A Injection into disk lesion .............................. 7.85 NA 4.49 0.84 NA 13.18 090 62294 ......... ............ A Injection into spinal artery ............................ 11.81 NA 5.59 1.38 NA 18.78 090 62310 ......... ............ A Inject spine c/t .............................................. 1.91 4.85 0.65 0.12 6.88 2.68 000 62311 ......... ............ A Inject spine l/s (cd) ...................................... 1.54 4.94 0.60 0.10 6.58 2.24 000 62318 ......... ............ A Inject spine w/cath, c/t ................................. 2.04 5.76 0.65 0.13 7.93 2.82 000 62319 ......... ............ A Inject spine w/cath l/s (cd) ........................... 1.87 5.03 0.61 0.12 7.02 2.60 000 62350 ......... ............ A Implant spinal canal cath ............................. 6.86 NA 3.97 0.86 NA 11.69 090 62351 ......... ............ A Implant spinal canal cath ............................. 9.99 NA 7.12 1.88 NA 18.99 090 62355 ......... ............ A Remove spinal canal catheter ..................... 5.44 NA 3.18 0.69 NA 9.31 090 62360 ......... ............ A Insert spine infusion device ......................... 2.62 NA 2.71 0.33 NA 5.66 090 62361 ......... ............ A Implant spine infusion pump ........................ 5.41 NA 3.94 0.69 NA 10.04 090 62362 ......... ............ A Implant spine infusion pump ........................ 7.03 NA 4.37 1.08 NA 12.48 090 62365 ......... ............ A Remove spine infusion device ..................... 5.41 NA 3.59 0.77 NA 9.77 090 62367 ......... 26 ....... A Analyze spine infusion pump ....................... 0.48 0.13 0.13 0.03 0.64 0.64 XXX 62368 ......... 26 ....... A Analyze spine infusion pump ....................... 0.75 0.19 0.19 0.06 1.00 1.00 XXX 63001 ......... ............ A Removal of spinal lamina ............................ 15.80 NA 9.50 3.30 NA 28.60 090 63003 ......... ............ A Removal of spinal lamina ............................ 15.93 NA 9.85 3.41 NA 29.19 090 63005 ......... ............ A Removal of spinal lamina ............................ 14.90 NA 9.96 2.77 NA 27.63 090 63011 ......... ............ A Removal of spinal lamina ............................ 14.50 NA 8.27 3.17 NA 25.94 090 63012 ......... ............ A Removal of spinal lamina ............................ 15.38 NA 10.11 3.04 NA 28.53 090 63015 ......... ............ A Removal of spinal lamina ............................ 19.32 NA 11.86 4.14 NA 35.32 090 63016 ......... ............ A Removal of spinal lamina ............................ 19.17 NA 11.77 4.03 NA 34.97 090 63017 ......... ............ A Removal of spinal lamina ............................ 15.92 NA 10.38 3.20 NA 29.50 090 63020 ......... ............ A Neck spine disk surgery .............................. 14.79 NA 9.66 3.29 NA 27.74 090 63030 ......... ............ A Low back disk surgery ................................. 11.98 NA 8.41 2.43 NA 22.82 090 63035 ......... ............ A Spinal disk surgery add-on .......................... 3.15 NA 1.59 0.67 NA 5.41 ZZZ 63040 ......... ............ A Laminotomy, single cervical ........................ 18.78 NA 11.49 4.07 NA 34.34 090 63042 ......... ............ A Laminotomy, single lumbar .......................... 17.44 NA 11.32 3.58 NA 32.34 090 63045 ......... ............ A Removal of spinal lamina ............................ 16.48 NA 10.34 3.47 NA 30.29 090 63046 ......... ............ A Removal of spinal lamina ............................ 15.78 NA 10.17 3.17 NA 29.12 090 63047 ......... ............ A Removal of spinal lamina ............................ 14.59 NA 9.88 2.77 NA 27.24 090 63048 ......... ............ A Remove spinal lamina add-on ..................... 3.26 NA 1.66 0.63 NA 5.55 ZZZ 63055 ......... ............ A Decompress spinal cord .............................. 21.96 NA 13.12 4.73 NA 39.81 090


## 47642

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

63056 ......... ............ A Decompress spinal cord .............................. 20.33 NA 12.54 4.07 NA 36.94 090 63057 ......... ............ A Decompress spine cord add-on .................. 5.25 NA 2.63 1.11 NA 8.99 ZZZ 63064 ......... ............ A Decompress spinal cord .............................. 24.57 NA 14.41 5.05 NA 44.03 090 63066 ......... ............ A Decompress spine cord add-on .................. 3.26 NA 1.66 0.66 NA 5.58 ZZZ 63075 ......... ............ A Neck spine disk surgery .............................. 19.38 NA 12.07 3.95 NA 35.40 090 63076 ......... ............ A Neck spine disk surgery .............................. 4.04 NA 2.05 0.82 NA 6.91 ZZZ 63077 ......... ............ A Spine disk surgery, thorax ........................... 21.41 NA 12.77 3.41 NA 37.59 090 63078 ......... ............ A Spine disk surgery, thorax ........................... 3.28 NA 1.63 0.53 NA 5.44 ZZZ 63081 ......... ............ A Removal of vertebral body .......................... 23.69 NA 14.30 4.86 NA 42.85 090 63082 ......... ............ A Remove vertebral body add-on ................... 4.36 NA 2.22 0.91 NA 7.49 ZZZ 63085 ......... ............ A Removal of vertebral body .......................... 26.88 NA 15.45 4.23 NA 46.56 090 63086 ......... ............ A Remove vertebral body add-on ................... 3.19 NA 1.59 0.57 NA 5.35 ZZZ 63087 ......... ............ A Removal of vertebral body .......................... 35.52 NA 19.43 5.70 NA 60.65 090 63088 ......... ............ A Remove vertebral body add-on ................... 4.32 NA 2.17 0.72 NA 7.21 ZZZ 63090 ......... ............ A Removal of vertebral body .......................... 28.12 NA 16.01 4.09 NA 48.22 090 63091 ......... ............ A Remove vertebral body add-on ................... 3.03 NA 1.45 0.47 NA 4.95 ZZZ 63101 ......... ............ A Removal of vertebral body .......................... 31.95 NA 19.28 5.05 NA 56.28 090 63102 ......... ............ A Removal of vertebral body .......................... 31.95 NA 19.28 5.05 NA 56.28 090 63103 ......... ............ A Remove vertebral body add-on ................... 3.89 NA 2.03 0.66 NA 6.58 ZZZ 63170 ......... ............ A Incise spinal cord tract(s) ............................ 19.80 NA 12.08 4.48 NA 36.36 090 63172 ......... ............ A Drainage of spinal cyst ................................ 17.63 NA 10.90 4.06 NA 32.59 090 63173 ......... ............ A Drainage of spinal cyst ................................ 21.96 NA 13.06 4.95 NA 39.97 090 63180 ......... ............ A Revise spinal cord ligaments ....................... 18.24 NA 11.24 2.46 NA 31.94 090 63182 ......... ............ A Revise spinal cord ligaments ....................... 20.47 NA 11.18 3.47 NA 35.12 090 63185 ......... ............ A Incise spinal column/nerves ........................ 15.02 NA 8.29 2.22 NA 25.53 090 63190 ......... ............ A Incise spinal column/nerves ........................ 17.42 NA 10.34 3.35 NA 31.11 090 63191 ......... ............ A Incise spinal column/nerves ........................ 17.51 NA 10.71 4.53 NA 32.75 090 63194 ......... ............ A Incise spinal column & cord ........................ 19.16 NA 11.93 3.82 NA 34.91 090 63195 ......... ............ A Incise spinal column & cord ........................ 18.81 NA 11.26 4.37 NA 34.44 090 63196 ......... ............ A Incise spinal column & cord ........................ 22.27 NA 13.60 5.62 NA 41.49 090 63197 ......... ............ A Incise spinal column & cord ........................ 21.08 NA 12.41 4.20 NA 37.69 090 63198 ......... ............ A Incise spinal column & cord ........................ 25.34 NA 8.58 6.40 NA 40.32 090 63199 ......... ............ A Incise spinal column & cord ........................ 26.85 NA 15.23 6.78 NA 48.86 090 63200 ......... ............ A Release of spinal cord ................................. 19.15 NA 11.50 4.31 NA 34.96 090 63250 ......... ............ A Revise spinal cord vessels .......................... 40.70 NA 19.92 8.81 NA 69.43 090 63251 ......... ............ A Revise spinal cord vessels .......................... 41.14 NA 22.57 9.46 NA 73.17 090 63252 ......... ............ A Revise spinal cord vessels .......................... 41.13 NA 22.22 9.52 NA 72.87 090 63265 ......... ............ A Excise intraspinal lesion .............................. 21.53 NA 12.76 4.85 NA 39.14 090 63266 ......... ............ A Excise intraspinal lesion .............................. 22.27 NA 13.18 4.89 NA 40.34 090 63267 ......... ............ A Excise intraspinal lesion .............................. 17.92 NA 11.07 3.79 NA 32.78 090 63268 ......... ............ A Excise intraspinal lesion .............................. 18.49 NA 10.38 3.01 NA 31.88 090 63270 ......... ............ A Excise intraspinal lesion .............................. 26.76 NA 15.46 5.94 NA 48.16 090 63271 ......... ............ A Excise intraspinal lesion .............................. 26.88 NA 15.56 6.38 NA 48.82 090 63272 ......... ............ A Excise intraspinal lesion .............................. 25.28 NA 14.68 5.41 NA 45.37 090 63273 ......... ............ A Excise intraspinal lesion .............................. 24.25 NA 14.33 6.05 NA 44.63 090 63275 ......... ............ A Biopsy/excise spinal tumor .......................... 23.64 NA 13.77 5.20 NA 42.61 090 63276 ......... ............ A Biopsy/excise spinal tumor .......................... 23.41 NA 13.67 5.16 NA 42.24 090 63277 ......... ............ A Biopsy/excise spinal tumor .......................... 20.80 NA 12.51 4.32 NA 37.63 090 63278 ......... ............ A Biopsy/excise spinal tumor .......................... 20.53 NA 12.38 4.07 NA 36.98 090 63280 ......... ............ A Biopsy/excise spinal tumor .......................... 28.31 NA 16.30 6.47 NA 51.08 090 63281 ......... ............ A Biopsy/excise spinal tumor .......................... 28.01 NA 16.16 6.41 NA 50.58 090 63282 ......... ............ A Biopsy/excise spinal tumor .......................... 26.35 NA 15.32 6.03 NA 47.70 090 63283 ......... ............ A Biopsy/excise spinal tumor .......................... 24.96 NA 14.65 5.64 NA 45.25 090 63285 ......... ............ A Biopsy/excise spinal tumor .......................... 35.95 NA 19.92 9.19 NA 65.06 090 63286 ......... ............ A Biopsy/excise spinal tumor .......................... 35.58 NA 19.88 8.10 NA 63.56 090 63287 ......... ............ A Biopsy/excise spinal tumor .......................... 36.64 NA 20.41 8.00 NA 65.05 090 63290 ......... ............ A Biopsy/excise spinal tumor .......................... 37.32 NA 20.57 9.00 NA 66.89 090 63300 ......... ............ A Removal of vertebral body .......................... 24.39 NA 14.29 4.92 NA 43.60 090 63301 ......... ............ A Removal of vertebral body .......................... 27.56 NA 15.54 5.21 NA 48.31 090 63302 ......... ............ A Removal of vertebral body .......................... 27.77 NA 15.83 5.11 NA 48.71 090 63303 ......... ............ A Removal of vertebral body .......................... 30.45 NA 16.89 4.99 NA 52.33 090 63304 ......... ............ A Removal of vertebral body .......................... 30.28 NA 17.26 6.03 NA 53.57 090 63305 ......... ............ A Removal of vertebral body .......................... 31.98 NA 18.03 5.92 NA 55.93 090 63306 ......... ............ A Removal of vertebral body .......................... 32.17 NA 17.78 6.13 NA 56.08 090 63307 ......... ............ A Removal of vertebral body .......................... 31.58 NA 16.79 4.80 NA 53.17 090 63308 ......... ............ A Remove vertebral body add-on ................... 5.24 NA 2.60 1.15 NA 8.99 ZZZ 63600 ......... ............ A Remove spinal cord lesion .......................... 14.00 NA 5.41 1.29 NA 20.70 090 63610 ......... ............ A Stimulation of spinal cord ............................ 8.72 59.95 2.25 0.55 69.22 11.52 000 63615 ......... ............ A Remove lesion of spinal cord ...................... 16.26 NA 9.30 1.89 NA 27.45 090 63650 ......... ............ A Implant neuroelectrodes .............................. 6.73 NA 3.19 0.54 NA 10.46 090 63655 ......... ............ A Implant neuroelectrodes .............................. 10.27 NA 6.90 2.07 NA 19.24 090 63660 ......... ............ A Revise/remove neuroelectrode .................... 6.15 NA 3.63 0.80 NA 10.58 090 63685 ......... ............ A Implant neuroreceiver .................................. 7.03 NA 4.16 0.99 NA 12.18 090 63688 ......... ............ A Revise/remove neuroreceiver ...................... 5.38 NA 3.57 0.85 NA 9.80 090 63700 ......... ............ A Repair of spinal herniation ........................... 16.51 NA 10.29 3.14 NA 29.94 090


## 47643

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

63702 ......... ............ A Repair of spinal herniation ........................... 18.45 NA 11.05 3.43 NA 32.93 090 63704 ......... ............ A Repair of spinal herniation ........................... 21.15 NA 12.90 4.54 NA 38.59 090 63706 ......... ............ A Repair of spinal herniation ........................... 24.07 NA 13.58 5.45 NA 43.10 090 63707 ......... ............ A Repair spinal fluid leakage .......................... 11.24 NA 7.70 2.18 NA 21.12 090 63709 ......... ............ A Repair spinal fluid leakage .......................... 14.30 NA 9.39 2.77 NA 26.46 090 63710 ......... ............ A Graft repair of spine defect .......................... 14.05 NA 9.04 3.02 NA 26.11 090 63740 ......... ............ A Install spinal shunt ....................................... 11.34 NA 7.35 2.44 NA 21.13 090 63741 ......... ............ A Install spinal shunt ....................................... 8.24 NA 4.76 1.69 NA 14.69 090 63744 ......... ............ A Revision of spinal shunt .............................. 8.09 NA 5.26 1.54 NA 14.89 090 63746 ......... ............ A Removal of spinal shunt .............................. 6.42 NA 3.79 1.60 NA 11.81 090 64400 ......... ............ A N block inj, trigeminal .................................. 1.11 1.89 0.43 0.09 3.09 1.63 000 64402 ......... ............ A N block inj, facial ......................................... 1.25 1.62 0.60 0.08 2.95 1.93 000 64405 ......... ............ A N block inj, occipital ..................................... 1.32 1.46 0.46 0.09 2.87 1.87 000 64408 ......... ............ A N block inj, vagus ........................................ 1.41 1.58 0.85 0.09 3.08 2.35 000 64410 ......... ............ A N block inj, phrenic ...................................... 1.43 2.52 0.47 0.09 4.04 1.99 000 64412 ......... ............ A N block inj, spinal accessor ......................... 1.18 2.66 0.43 0.08 3.92 1.69 000 64413 ......... ............ A N block inj, cervical plexus .......................... 1.40 1.85 0.50 0.10 3.35 2.00 000 64415 ......... ............ A N block inj, brachial plexus .......................... 1.48 2.81 0.46 0.10 4.39 2.04 000 64416 ......... ............ A N block cont infuse, b plex .......................... 3.49 NA 0.79 0.10 NA 4.38 010 64417 ......... ............ A N block inj, axillary ....................................... 1.44 3.04 0.49 0.12 4.60 2.05 000 64418 ......... ............ A N block inj, suprascapular ........................... 1.32 2.63 0.44 0.08 4.03 1.84 000 64420 ......... ............ A N block inj, intercost, sng ............................ 1.18 3.98 0.42 0.08 5.24 1.68 000 64421 ......... ............ A N block inj, intercost, mlt ............................. 1.68 6.19 0.52 0.12 7.99 2.32 000 64425 ......... ............ A N block inj ilio-ing/hypogi ............................. 1.75 1.65 0.54 0.14 3.54 2.43 000 64430 ......... ............ A N block inj, pudendal ................................... 1.46 2.51 0.55 0.11 4.08 2.12 000 64435 ......... ............ A N block inj, paracervical .............................. 1.45 2.52 0.69 0.17 4.14 2.31 000 64445 ......... ............ A N block inj, sciatic, sng ................................ 1.48 2.68 0.50 0.10 4.26 2.08 000 64446 ......... ............ A N blk inj, sciatic, cont inf .............................. 3.25 NA 1.01 0.10 NA 4.36 010 64447 ......... ............ A N block inj fem, single ................................. 1.50 NA 0.43 0.10 NA 2.03 000 64448 ......... ............ A N block inj fem, cont inf ............................... 3.00 NA 0.81 0.10 NA 3.91 010 64449 ......... ............ A N block inj, lumbar plexus ........................... 3.00 NA 0.96 0.10 NA 4.06 010 64450 ......... ............ A N block, other peripheral ............................. 1.27 1.24 0.48 0.10 2.61 1.85 000 64470 ......... ............ A Inj paravertebral c/t ...................................... 1.85 7.29 0.72 0.14 9.28 2.71 000 64472 ......... ............ A Inj paravertebral c/t add-on ......................... 1.29 2.35 0.34 0.09 3.73 1.72 ZZZ 64475 ......... ............ A Inj paravertebral l/s ...................................... 1.41 6.93 0.63 0.11 8.45 2.15 000 64476 ......... ............ A Inj paravertebral l/s add-on .......................... 0.98 2.14 0.24 0.08 3.20 1.30 ZZZ 64479 ......... ............ A Inj foramen epidural c/t ................................ 2.20 7.56 0.89 0.16 9.92 3.25 000 64480 ......... ............ A Inj foramen epidural add-on ........................ 1.54 2.87 0.47 0.12 4.53 2.13 ZZZ 64483 ......... ............ A Inj foramen epidural l/s ................................ 1.90 7.95 0.83 0.12 9.97 2.85 000 64484 ......... ............ A Inj foramen epidural add-on ........................ 1.33 3.31 0.37 0.09 4.73 1.79 ZZZ 64505 ......... ............ A N block, spenopalatine gangl ...................... 1.36 1.25 0.66 0.09 2.70 2.11 000 64508 ......... ............ A N block, carotid sinus s/p ............................ 1.12 3.39 0.74 0.09 4.60 1.95 000 64510 ......... ............ A N block, stellate ganglion ............................ 1.22 3.51 0.51 0.08 4.81 1.81 000 64517 ......... ............ A N block inj, hypogas plxs ............................. 2.20 2.73 0.87 0.11 5.04 3.18 000 64520 ......... ............ A N block, lumbar/thoracic .............................. 1.35 5.21 0.55 0.09 6.65 1.99 000 64530 ......... ............ A N block inj, celiac pelus ............................... 1.58 4.49 0.66 0.10 6.17 2.34 000 64550 ......... ............ A Apply neurostimulator .................................. 0.18 0.28 0.05 0.01 0.47 0.24 000 64553 ......... ............ A Implant neuroelectrodes .............................. 2.31 2.83 1.85 0.23 5.37 4.39 010 64555 ......... ............ A Implant neuroelectrodes .............................. 2.27 3.11 1.20 0.23 5.61 3.70 010 64560 ......... ............ A Implant neuroelectrodes .............................. 2.36 2.66 1.30 0.24 5.26 3.90 010 64561 ......... ............ A Implant neuroelectrodes .............................. 6.73 30.03 2.82 0.51 37.27 10.06 010 64565 ......... ............ A Implant neuroelectrodes .............................. 1.76 3.30 1.26 0.10 5.16 3.12 010 64573 ......... ............ A Implant neuroelectrodes .............................. 7.49 NA 5.25 1.48 NA 14.22 090 64575 ......... ............ A Implant neuroelectrodes .............................. 4.34 NA 2.69 0.45 NA 7.48 090 64577 ......... ............ A Implant neuroelectrodes .............................. 4.61 NA 3.30 0.61 NA 8.52 090 64580 ......... ............ A Implant neuroelectrodes .............................. 4.11 NA 3.57 0.23 NA 7.91 090 64581 ......... ............ A Implant neuroelectrodes .............................. 13.48 NA 5.36 1.05 NA 19.89 090 64585 ......... ............ A Revise/remove neuroelectrode .................... 2.06 11.26 2.14 0.22 13.54 4.42 010 64590 ......... ............ A Implant neuroreceiver .................................. 2.40 7.15 2.28 0.23 9.78 4.91 010 64595 ......... ............ A Revise/remove neuroreceiver ...................... 1.73 10.42 1.93 0.22 12.37 3.88 010 64600 ......... ............ A Injection treatment of nerve ......................... 3.44 9.36 1.66 0.33 13.13 5.43 010 64605 ......... ............ A Injection treatment of nerve ......................... 5.60 9.58 2.19 0.92 16.10 8.71 010 64610 ......... ............ A Injection treatment of nerve ......................... 7.15 8.92 3.71 1.35 17.42 12.21 010 64612 ......... ............ A Destroy nerve, face muscle ......................... 1.96 2.48 1.32 0.12 4.56 3.40 010 64613 ......... ............ A Destroy nerve, spine muscle ....................... 1.96 2.90 1.22 0.12 4.98 3.30 010 64614 ......... ............ A Destroy nerve, extrem musc ....................... 2.20 3.21 1.31 0.12 5.53 3.63 010 64620 ......... ............ A Injection treatment of nerve ......................... 2.84 5.13 1.34 0.20 8.17 4.38 010 64622 ......... ............ A Destr paravertebrl nerve l/s ......................... 3.00 7.82 1.38 0.21 11.03 4.59 010 64623 ......... ............ A Destr paravertebral n add-on ...................... 0.99 2.98 0.22 0.07 4.04 1.28 ZZZ 64626 ......... ............ A Destr paravertebrl nerve c/t ......................... 3.28 7.84 1.98 0.22 11.34 5.48 010 64627 ......... ............ A Destr paravertebral n add-on ...................... 1.16 4.58 0.27 0.08 5.82 1.51 ZZZ 64630 ......... ............ A Injection treatment of nerve ......................... 3.00 2.73 1.42 0.23 5.96 4.65 010 64640 ......... ............ A Injection treatment of nerve ......................... 2.76 4.19 1.85 0.19 7.14 4.80 010 64680 ......... ............ A Injection treatment of nerve ......................... 2.62 6.75 1.44 0.18 9.55 4.24 010 64681 ......... ............ A Injection treatment of nerve ......................... 3.54 9.36 2.06 0.19 13.09 5.79 010


## 47644

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

64702 ......... ............ A Revise finger/toe nerve ................................ 4.22 NA 3.86 0.60 NA 8.68 090 64704 ......... ............ A Revise hand/foot nerve ................................ 4.56 NA 3.31 0.47 NA 8.34 090 64708 ......... ............ A Revise arm/leg nerve ................................... 6.11 NA 4.87 0.92 NA 11.90 090 64712 ......... ............ A Revision of sciatic nerve .............................. 7.74 NA 4.98 0.98 NA 13.70 090 64713 ......... ............ A Revision of arm nerve(s) ............................. 10.98 NA 5.88 1.68 NA 18.54 090 64714 ......... ............ A Revise low back nerve(s) ............................ 10.31 NA 4.23 1.04 NA 15.58 090 64716 ......... ............ A Revision of cranial nerve ............................. 6.30 NA 5.96 0.64 NA 12.90 090 64718 ......... ............ A Revise ulnar nerve at elbow ........................ 5.98 NA 5.98 1.03 NA 12.99 090 64719 ......... ............ A Revise ulnar nerve at wrist .......................... 4.84 NA 4.53 0.78 NA 10.15 090 64721 ......... ............ A Carpal tunnel surgery .................................. 4.28 NA 5.35 0.72 NA 10.35 090 64722 ......... ............ A Relieve pressure on nerve(s) ...................... 4.69 NA 3.06 0.45 NA 8.20 090 64726 ......... ............ A Release foot/toe nerve ................................ 4.17 NA 2.80 0.40 NA 7.37 090
64727 ......... ............ A Internal nerve revision ................................. 3.10 NA 1.50 0.49 NA 5.09 ZZZ 64732 ......... ............ A Incision of brow nerve ................................. 4.40 NA 3.52 0.81 NA 8.73 090 64734 ......... ............ A Incision of cheek nerve ................................ 4.91 NA 4.05 0.95 NA 9.91 090 64736 ......... ............ A Incision of chin nerve ................................... 4.59 NA 4.03 0.64 NA 9.26 090 64738 ......... ............ A Incision of jaw nerve .................................... 5.72 NA 4.61 1.24 NA 11.57 090 64740 ......... ............ A Incision of tongue nerve .............................. 5.58 NA 5.11 0.57 NA 11.26 090 64742 ......... ............ A Incision of facial nerve ................................. 6.21 NA 4.70 0.57 NA 11.48 090 64744 ......... ............ A Incise nerve, back of head .......................... 5.23 NA 3.78 1.03 NA 10.04 090 64746 ......... ............ A Incise diaphragm nerve ............................... 5.92 NA 4.51 0.82 NA 11.25 090 64752 ......... ............ A Incision of vagus nerve ................................ 7.05 NA 4.30 0.89 NA 12.24 090 64755 ......... ............ A Incision of stomach nerves .......................... 13.50 NA 5.65 1.63 NA 20.78 090 64760 ......... ............ A Incision of vagus nerve ................................ 6.95 NA 3.48 0.79 NA 11.22 090 64761 ......... ............ A Incision of pelvis nerve ................................ 6.40 NA 3.54 0.45 NA 10.39 090 64763 ......... ............ A Incise hip/thigh nerve ................................... 6.92 NA 5.23 0.98 NA 13.13 090 64766 ......... ............ A Incise hip/thigh nerve ................................... 8.66 NA 5.26 1.11 NA 15.03 090 64771 ......... ............ A Sever cranial nerve ...................................... 7.34 NA 5.56 1.04 NA 13.94 090 64772 ......... ............ A Incision of spinal nerve ................................ 7.20 NA 4.93 1.25 NA 13.38 090 64774 ......... ............ A Remove skin nerve lesion ........................... 5.16 NA 3.83 0.63 NA 9.62 090 64776 ......... ............ A Remove digit nerve lesion ........................... 5.11 NA 3.70 0.66 NA 9.47 090 64778 ......... ............ A Digit nerve surgery add-on .......................... 3.11 NA 1.50 0.46 NA 5.07 ZZZ 64782 ......... ............ A Remove limb nerve lesion ........................... 6.22 NA 3.77 0.71 NA 10.70 090 64783 ......... ............ A Limb nerve surgery add-on ......................... 3.71 NA 1.83 0.52 NA 6.06 ZZZ 64784 ......... ............ A Remove nerve lesion ................................... 9.81 NA 6.60 1.39 NA 17.80 090 64786 ......... ............ A Remove sciatic nerve lesion ........................ 15.44 NA 9.84 2.52 NA 27.80 090 64787 ......... ............ A Implant nerve end ........................................ 4.29 NA 2.11 0.56 NA 6.96 ZZZ 64788 ......... ............ A Remove skin nerve lesion ........................... 4.60 NA 3.48 0.64 NA 8.72 090 64790 ......... ............ A Removal of nerve lesion .............................. 11.29 NA 7.20 1.76 NA 20.25 090 64792 ......... ............ A Removal of nerve lesion .............................. 14.90 NA 8.82 2.29 NA 26.01 090 64795 ......... ............ A Biopsy of nerve ............................................ 3.01 NA 1.58 0.50 NA 5.09 000 64802 ......... ............ A Remove sympathetic nerves ....................... 9.14 NA 5.15 1.17 NA 15.46 090 64804 ......... ............ A Remove sympathetic nerves ....................... 14.62 NA 7.17 1.99 NA 23.78 090 64809 ......... ............ A Remove sympathetic nerves ....................... 13.65 NA 5.77 1.79 NA 21.21 090 64818 ......... ............ A Remove sympathetic nerves ....................... 10.28 NA 5.29 1.32 NA 16.89 090 64820 ......... ............ A Remove sympathetic nerves ....................... 10.35 NA 7.14 1.54 NA 19.03 090 64821 ......... ............ A Remove sympathetic nerves ....................... 8.74 NA 7.33 1.38 NA 17.45 090 64822 ......... ............ A Remove sympathetic nerves ....................... 8.74 NA 7.22 1.33 NA 17.29 090 64823 ......... ............ A Remove sympathetic nerves ....................... 10.35 NA 8.13 1.58 NA 20.06 090 64831 ......... ............ A Repair of digit nerve .................................... 9.43 NA 7.08 1.40 NA 17.91 090 64832 ......... ............ A Repair nerve add-on .................................... 5.65 NA 2.93 0.83 NA 9.41 ZZZ 64834 ......... ............ A Repair of hand or foot nerve ....................... 10.17 NA 7.09 1.57 NA 18.83 090 64835 ......... ............ A Repair of hand or foot nerve ....................... 10.92 NA 7.70 1.61 NA 20.23 090 64836 ......... ............ A Repair of hand or foot nerve ....................... 10.92 NA 7.67 1.63 NA 20.22 090 64837 ......... ............ A Repair nerve add-on .................................... 6.25 NA 3.22 0.95 NA 10.42 ZZZ 64840 ......... ............ A Repair of leg nerve ...................................... 13.00 NA 8.25 1.44 NA 22.69 090 64856 ......... ............ A Repair/transpose nerve ............................... 13.78 NA 9.18 2.06 NA 25.02 090 64857 ......... ............ A Repair arm/leg nerve ................................... 14.47 NA 9.63 2.22 NA 26.32 090 64858 ......... ............ A Repair sciatic nerve ..................................... 16.47 NA 10.77 2.98 NA 30.22 090 64859 ......... ............ A Nerve surgery .............................................. 4.25 NA 2.19 0.59 NA 7.03 ZZZ 64861 ......... ............ A Repair of arm nerves ................................... 19.21 NA 11.78 4.24 NA 35.23 090 64862 ......... ............ A Repair of low back nerves ........................... 19.41 NA 11.93 2.98 NA 34.32 090 64864 ......... ............ A Repair of facial nerve .................................. 12.53 NA 8.75 1.35 NA 22.63 090 64865 ......... ............ A Repair of facial nerve .................................. 15.22 NA 13.44 1.82 NA 30.48 090 64866 ......... ............ A Fusion of facial/other nerve ......................... 15.72 NA 13.10 1.63 NA 30.45 090 64868 ......... ............ A Fusion of facial/other nerve ......................... 14.02 NA 11.39 1.64 NA 27.05 090 64870 ......... ............ A Fusion of facial/other nerve ......................... 15.97 NA 8.72 0.80 NA 25.49 090 64872 ......... ............ A Subsequent repair of nerve ......................... 1.99 NA 1.08 0.28 NA 3.35 ZZZ 64874 ......... ............ A Repair & revise nerve add-on ..................... 2.98 NA 1.53 0.41 NA 4.92 ZZZ 64876 ......... ............ A Repair nerve/shorten bone .......................... 3.37 NA 1.27 0.47 NA 5.11 ZZZ 64885 ......... ............ A Nerve graft, head or neck ............................ 17.50 NA 11.59 1.69 NA 30.78 090 64886 ......... ............ A Nerve graft, head or neck ............................ 20.72 NA 13.52 2.06 NA 36.30 090 64890 ......... ............ A Nerve graft, hand or foot ............................. 15.13 NA 9.99 2.24 NA 27.36 090 64891 ......... ............ A Nerve graft, hand or foot ............................. 16.12 NA 7.60 1.38 NA 25.10 090 64892 ......... ............ A Nerve graft, arm or leg ................................ 14.63 NA 8.87 1.97 NA 25.47 090


## 47645

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

64893 ......... ............ A Nerve graft, arm or leg ................................ 15.58 NA 9.87 2.28 NA 27.73 090 64895 ......... ............ A Nerve graft, hand or foot ............................. 19.22 NA 9.65 2.43 NA 31.30 090 64896 ......... ............ A Nerve graft, hand or foot ............................. 20.46 NA 11.00 1.97 NA 33.43 090 64897 ......... ............ A Nerve graft, arm or leg ................................ 18.21 NA 10.69 2.61 NA 31.51 090 64898 ......... ............ A Nerve graft, arm or leg ................................ 19.47 NA 11.79 2.14 NA 33.40 090 64901 ......... ............ A Nerve graft add-on ....................................... 10.20 NA 5.25 1.22 NA 16.67 ZZZ 64902 ......... ............ A Nerve graft add-on ....................................... 11.81 NA 5.95 1.43 NA 19.19 ZZZ 64905 ......... ............ A Nerve pedicle transfer ................................. 14.00 NA 8.50 1.53 NA 24.03 090 64907 ......... ............ A Nerve pedicle transfer ................................. 18.80 NA 12.50 2.16 NA 33.46 090 65091 ......... ............ A Revise eye ................................................... 6.45 NA 8.37 0.34 NA 15.16 090 65093 ......... ............ A Revise eye with implant ............................... 6.86 NA 8.73 0.36 NA 15.95 090 65101 ......... ............ A Removal of eye ............................................ 7.02 NA 9.55 0.37 NA 16.94 090 65103 ......... ............ A Remove eye/insert implant .......................... 7.56 NA 9.75 0.39 NA 17.70 090 65105 ......... ............ A Remove eye/attach implant ......................... 8.48 NA 10.48 0.44 NA 19.40 090 65110 ......... ............ A Removal of eye ............................................ 13.93 NA 13.66 0.86 NA 28.45 090 65112 ......... ............ A Remove eye/revise socket .......................... 16.36 NA 16.08 0.98 NA 33.42 090 65114 ......... ............ A Remove eye/revise socket .......................... 17.50 NA 16.31 1.07 NA 34.88 090 65125 ......... ............ A Revise ocular implant .................................. 3.12 8.84 3.59 0.18 12.14 6.89 090 65130 ......... ............ A Insert ocular implant .................................... 7.14 NA 9.18 0.38 NA 16.70 090 65135 ......... ............ A Insert ocular implant .................................... 7.32 NA 9.32 0.38 NA 17.02 090 65140 ......... ............ A Attach ocular implant ................................... 8.01 NA 9.88 0.43 NA 18.32 090 65150 ......... ............ A Revise ocular implant .................................. 6.25 NA 7.99 0.35 NA 14.59 090 65155 ......... ............ A Reinsert ocular implant ................................ 8.65 NA 10.48 0.50 NA 19.63 090 65175 ......... ............ A Removal of ocular implant ........................... 6.27 NA 8.49 0.34 NA 15.10 090 65205 ......... ............ A Remove foreign body from eye ................... 0.71 0.64 0.30 0.04 1.39 1.05 000 65210 ......... ............ A Remove foreign body from eye ................... 0.84 0.81 0.38 0.04 1.69 1.26 000 65220 ......... ............ A Remove foreign body from eye ................... 0.71 0.65 0.29 0.05 1.41 1.05 000 65222 ......... ............ A Remove foreign body from eye ................... 0.93 0.89 0.38 0.05 1.87 1.36 000 65235 ......... ............ A Remove foreign body from eye ................... 7.56 NA 6.74 0.38 NA 14.68 090 65260 ......... ............ A Remove foreign body from eye ................... 10.94 NA 9.65 0.56 NA 21.15 090 65265 ......... ............ A Remove foreign body from eye ................... 12.57 NA 10.63 0.66 NA 23.86 090 65270 ......... ............ A Repair of eye wound ................................... 1.90 5.24 1.39 0.10 7.24 3.39 010 65272 ......... ............ A Repair of eye wound ................................... 3.81 7.73 3.29 0.20 11.74 7.30 090 65273 ......... ............ A Repair of eye wound ................................... 4.35 NA 3.57 0.25 NA 8.17 090 65275 ......... ............ A Repair of eye wound ................................... 5.33 6.33 3.95 0.30 11.96 9.58 090 65280 ......... ............ A Repair of eye wound ................................... 7.65 NA 6.23 0.39 NA 14.27 090 65285 ......... ............ A Repair of eye wound ................................... 12.88 NA 9.20 0.65 NA 22.73 090 65286 ......... ............ A Repair of eye wound ................................... 5.50 11.17 4.62 0.28 16.95 10.40 090 65290 ......... ............ A Repair of eye socket wound ........................ 5.40 NA 4.73 0.36 NA 10.49 090 65400 ......... ............ A Removal of eye lesion ................................. 6.05 8.33 6.12 0.30 14.68 12.47 090 65410 ......... ............ A Biopsy of cornea .......................................... 1.47 2.11 0.97 0.07 3.65 2.51 000 65420 ......... ............ A Removal of eye lesion ................................. 4.16 8.86 4.44 0.21 13.23 8.81 090 65426 ......... ............ A Removal of eye lesion ................................. 5.24 10.19 4.92 0.26 15.69 10.42 090 65430 ......... ............ A Corneal smear ............................................. 1.47 1.29 0.98 0.07 2.83 2.52 000 65435 ......... ............ A Curette/treat cornea ..................................... 0.92 1.00 0.71 0.05 1.97 1.68 000 65436 ......... ............ A Curette/treat cornea ..................................... 4.18 4.10 3.67 0.21 8.49 8.06 090 65450 ......... ............ A Treatment of corneal lesion ......................... 3.27 4.03 3.86 0.17 7.47 7.30 090 65600 ......... ............ A Revision of cornea ....................................... 3.39 5.49 3.03 0.17 9.05 6.59 090 65710 ......... ............ A Corneal transplant ....................................... 12.33 NA 11.43 0.62 NA 24.38 090 65730 ......... ............ A Corneal transplant ....................................... 14.23 NA 11.83 0.71 NA 26.77 090 65750 ......... ............ A Corneal transplant ....................................... 14.98 NA 12.29 0.75 NA 28.02 090 65755 ......... ............ A Corneal transplant ....................................... 14.87 NA 12.22 0.74 NA 27.83 090 65770 ......... ............ A Revise cornea with implant ......................... 17.53 NA 13.20 0.87 NA 31.60 090 65772 ......... ............ A Correction of astigmatism ............................ 4.28 5.53 4.13 0.21 10.02 8.62 090 65775 ......... ............ A Correction of astigmatism ............................ 5.78 NA 6.25 0.29 NA 12.32 090 65780 ......... ............ A Ocular reconst, transplant ........................... 10.23 NA 10.30 0.45 NA 20.98 090 65781 ......... ............ A Ocular reconst, transplant ........................... 17.64 NA 13.67 0.45 NA 31.76 090 65782 ......... ............ A Ocular reconst, transplant ........................... 14.98 NA 11.99 0.45 NA 27.42 090 65800 ......... ............ A Drainage of eye ........................................... 1.91 1.79 1.18 0.10 3.80 3.19 000 65805 ......... ............ A Drainage of eye ........................................... 1.91 2.17 1.18 0.10 4.18 3.19 000 65810 ......... ............ A Drainage of eye ........................................... 4.86 NA 4.70 0.25 NA 9.81 090 65815 ......... ............ A Drainage of eye ........................................... 5.04 10.02 4.81 0.26 15.32 10.11 090 65820 ......... ............ A Relieve inner eye pressure .......................... 8.12 NA 9.06 0.42 NA 17.60 090 65850 ......... ............ A Incision of eye .............................................. 10.50 NA 8.44 0.52 NA 19.46 090 65855 ......... ............ A Laser surgery of eye .................................... 3.84 4.32 3.10 0.19 8.35 7.13 010 65860 ......... ............ A Incise inner eye adhesions .......................... 3.54 4.05 2.50 0.18 7.77 6.22 090 65865 ......... ............ A Incise inner eye adhesions .......................... 5.59 NA 5.63 0.28 NA 11.50 090 65870 ......... ............ A Incise inner eye adhesions .......................... 6.26 NA 6.41 0.31 NA 12.98 090 65875 ......... ............ A Incise inner eye adhesions .......................... 6.53 NA 6.80 0.33 NA 13.66 090 65880 ......... ............ A Incise inner eye adhesions .......................... 7.08 NA 7.04 0.35 NA 14.47 090 65900 ......... ............ A Remove eye lesion ...................................... 10.91 NA 10.42 0.56 NA 21.89 090 65920 ......... ............ A Remove implant of eye ................................ 8.39 NA 8.17 0.42 NA 16.98 090 65930 ......... ............ A Remove blood clot from eye ....................... 7.43 NA 6.84 0.37 NA 14.64 090 66020 ......... ............ A Injection treatment of eye ............................ 1.59 3.13 1.43 0.08 4.80 3.10 010 66030 ......... ............ A Injection treatment of eye ............................ 1.25 2.97 1.28 0.06 4.28 2.59 010


## 47646

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

66130 ......... ............ A Remove eye lesion ...................................... 7.68 9.64 5.60 0.39 17.71 13.67 090 66150 ......... ............ A Glaucoma surgery ....................................... 8.29 NA 9.41 0.44 NA 18.14 090 66155 ......... ............ A Glaucoma surgery ....................................... 8.28 NA 9.37 0.43 NA 18.08 090 66160 ......... ............ A Glaucoma surgery ....................................... 10.15 NA 10.20 0.52 NA 20.87 090 66165 ......... ............ A Glaucoma surgery ....................................... 8.00 NA 9.24 0.42 NA 17.66 090 66170 ......... ............ A Glaucoma surgery ....................................... 12.14 NA 12.23 0.61 NA 24.98 090 66172 ......... ............ A Incision of eye .............................................. 15.02 NA 15.21 0.75 NA 30.98 090 66180 ......... ............ A Implant eye shunt ........................................ 14.53 NA 10.76 0.73 NA 26.02 090 66185 ......... ............ A Revise eye shunt ......................................... 8.13 NA 7.38 0.41 NA 15.92 090 66220 ......... ............ A Repair eye lesion ......................................... 7.76 NA 7.11 0.41 NA 15.28 090 66225 ......... ............ A Repair/graft eye lesion ................................. 11.03 NA 8.73 0.55 NA 20.31 090 66250 ......... ............ A Follow-up surgery of eye ............................. 5.97 11.71 5.48 0.30 17.98 11.75 090 66500 ......... ............ A Incision of iris ............................................... 3.70 NA 4.65 0.19 NA 8.54 090 66505 ......... ............ A Incision of iris ............................................... 4.07 NA 4.99 0.20 NA 9.26 090 66600 ......... ............ A Remove iris and lesion ................................ 8.67 NA 8.23 0.44 NA 17.34 090 66605 ......... ............ A Removal of iris ............................................. 12.77 NA 10.02 0.79 NA 23.58 090 66625 ......... ............ A Removal of iris ............................................. 5.12 NA 4.73 0.27 NA 10.12 090 66630 ......... ............ A Removal of iris ............................................. 6.15 NA 5.70 0.31 NA 12.16 090 66635 ......... ............ A Removal of iris ............................................. 6.24 NA 5.74 0.32 NA 12.30 090 66680 ......... ............ A Repair iris & ciliary body .............................. 5.43 NA 5.27 0.27 NA 10.97 090 66682 ......... ............ A Repair iris & ciliary body .............................. 6.20 NA 6.61 0.31 NA 13.12 090 66700 ......... ............ A Destruction, ciliary body .............................. 4.77 5.25 3.93 0.25 10.27 8.95 090 66710 ......... ............ A Destruction, ciliary body .............................. 4.77 5.17 3.84 0.24 10.18 8.85 090 66720 ......... ............ A Destruction, ciliary body .............................. 4.77 5.82 4.71 0.26 10.85 9.74 090 66740 ......... ............ A Destruction, ciliary body .............................. 4.77 5.09 3.97 0.24 10.10 8.98 090 66761 ......... ............ A Revision of iris ............................................. 4.06 5.59 4.31 0.21 9.86 8.58 090 66762 ......... ............ A Revision of iris ............................................. 4.57 5.66 4.28 0.23 10.46 9.08 090 66770 ......... ............ A Removal of inner eye lesion ........................ 5.17 6.09 4.80 0.26 11.52 10.23 090 66820 ......... ............ A Incision, secondary cataract ........................ 3.88 NA 5.83 0.19 NA 9.90 090 66821 ......... ............ A After cataract laser surgery ......................... 2.35 3.81 3.63 0.11 6.27 6.09 090 66825 ......... ............ A Reposition intraocular lens .......................... 8.22 NA 9.07 0.40 NA 17.69 090 66830 ......... ............ A Removal of lens lesion ................................ 8.19 NA 6.95 0.40 NA 15.54 090 66840 ......... ............ A Removal of lens material ............................. 7.90 NA 6.86 0.39 NA 15.15 090 66850 ......... ............ A Removal of lens material ............................. 9.10 NA 7.64 0.45 NA 17.19 090 66852 ......... ............ A Removal of lens material ............................. 9.96 NA 8.10 0.50 NA 18.56 090 66920 ......... ............ A Extraction of lens ......................................... 8.85 NA 7.30 0.44 NA 16.59 090 66930 ......... ............ A Extraction of lens ......................................... 10.16 NA 8.14 0.51 NA 18.81 090 66940 ......... ............ A Extraction of lens ......................................... 8.92 NA 7.67 0.44 NA 17.03 090 66982 ......... ............ A Cataract surgery, complex ........................... 13.48 NA 9.86 0.63 NA 23.97 090 66983 ......... ............ A Cataract surg w/iol, 1 stage ......................... 8.98 NA 6.11 0.21 NA 15.30 090 66984 ......... ............ A Cataract surg w/iol, 1 stage ......................... 10.21 NA 7.41 0.42 NA 18.04 090 66985 ......... ............ A Insert lens prosthesis ................................... 8.38 NA 7.45 0.39 NA 16.22 090 66986 ......... ............ A Exchange lens prosthesis ............................ 12.26 NA 9.17 0.60 NA 22.03 090 66990 ......... ............ A Ophthalmic endoscope add-on .................... 1.51 NA 0.69 0.07 NA 2.27 ZZZ 67005 ......... ............ A Partial removal of eye fluid .......................... 5.69 NA 4.37 0.29 NA 10.35 090 67010 ......... ............ A Partial removal of eye fluid .......................... 6.86 NA 4.91 0.34 NA 12.11 090 67015 ......... ............ A Release of eye fluid ..................................... 6.91 NA 6.46 0.35 NA 13.72 090 67025 ......... ............ A Replace eye fluid ......................................... 6.83 9.24 6.22 0.34 16.41 13.39 090 67027 ......... ............ A Implant eye drug system ............................. 10.83 NA 8.00 0.55 NA 19.38 090 67028 ......... ............ A Injection eye drug ........................................ 2.52 2.70 1.45 0.13 5.35 4.10 000 67030 ......... ............ A Incise inner eye strands .............................. 4.83 NA 5.85 0.25 NA 10.93 090 67031 ......... ............ A Laser surgery, eye strands .......................... 3.66 4.61 3.64 0.18 8.45 7.48 090 67036 ......... ............ A Removal of inner eye fluid ........................... 11.87 NA 9.12 0.60 NA 21.59 090 67038 ......... ............ A Strip retinal membrane ................................ 21.21 NA 15.49 1.07 NA 37.77 090 67039 ......... ............ A Laser treatment of retina ............................. 14.50 NA 12.18 0.73 NA 27.41 090 67040 ......... ............ A Laser treatment of retina ............................. 17.20 NA 13.68 0.87 NA 31.75 090 67101 ......... ............ A Repair detached retina ................................ 7.52 9.13 6.53 0.38 17.03 14.43 090 67105 ......... ............ A Repair detached retina ................................ 7.40 8.09 6.15 0.37 15.86 13.92 090 67107 ......... ............ A Repair detached retina ................................ 14.82 NA 11.30 0.74 NA 26.86 090 67108 ......... ............ A Repair detached retina ................................ 20.79 NA 14.41 1.05 NA 36.25 090 67110 ......... ............ A Repair detached retina ................................ 8.80 10.24 7.39 0.44 19.48 16.63 090 67112 ......... ............ A Rerepair detached retina ............................. 16.83 NA 11.81 0.85 NA 29.49 090 67115 ......... ............ A Release encircling material ......................... 4.98 NA 5.08 0.25 NA 10.31 090 67120 ......... ............ A Remove eye implant material ...................... 5.97 8.59 5.52 0.30 14.86 11.79 090 67121 ......... ............ A Remove eye implant material ...................... 10.65 NA 8.53 0.53 NA 19.71 090 67141 ......... ............ A Treatment of retina ...................................... 5.19 5.85 4.86 0.26 11.30 10.31 090 67145 ......... ............ A Treatment of retina ...................................... 5.36 5.72 4.93 0.27 11.35 10.56 090 67208 ......... ............ A Treatment of retinal lesion ........................... 6.69 6.12 5.51 0.34 13.15 12.54 090 67210 ......... ............ A Treatment of retinal lesion ........................... 8.81 6.58 5.87 0.44 15.83 15.12 090 67218 ......... ............ A Treatment of retinal lesion ........................... 18.50 NA 12.15 0.93 NA 31.58 090 67220 ......... ............ A Treatment of choroid lesion ......................... 13.11 10.43 9.01 0.66 24.20 22.78 090 67221 ......... ............ R Ocular photodynamic ther ........................... 4.00 4.34 1.80 0.20 8.54 6.00 000 67225 ......... ............ A Eye photodynamic ther add-on ................... 0.47 0.25 0.21 0.02 0.74 0.70 ZZZ 67227 ......... ............ A Treatment of retinal lesion ........................... 6.57 6.58 5.52 0.33 13.48 12.42 090 67228 ......... ............ A Treatment of retinal lesion ........................... 12.72 11.49 8.54 0.64 24.85 21.90 090


## 47647

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

67250 ......... ............ A Reinforce eye wall ....................................... 8.65 NA 9.18 0.43 NA 18.26 090 67255 ......... ............ A Reinforce/graft eye wall ............................... 8.89 NA 9.91 0.45 NA 19.25 090 67311 ......... ............ A Revise eye muscle ...................................... 6.64 NA 6.02 0.37 NA 13.03 090 67312 ......... ............ A Revise two eye muscles .............................. 8.53 NA 6.75 0.44 NA 15.72 090 67314 ......... ............ A Revise eye muscle ...................................... 7.51 NA 6.55 0.40 NA 14.46 090 67316 ......... ............ A Revise two eye muscles .............................. 9.65 NA 7.50 0.51 NA 17.66 090 67318 ......... ............ A Revise eye muscle(s) .................................. 7.84 NA 6.93 0.41 NA 15.18 090 67320 ......... ............ A Revise eye muscle(s) add-on ...................... 4.32 NA 1.95 0.23 NA 6.50 ZZZ 67331 ......... ............ A Eye surgery follow-up add-on ...................... 4.05 NA 1.82 0.21 NA 6.08 ZZZ 67332 ......... ............ A Rerevise eye muscles add-on ..................... 4.48 NA 2.02 0.24 NA 6.74 ZZZ 67334 ......... ............ A Revise eye muscle w/suture ........................ 3.97 NA 1.79 0.20 NA 5.96 ZZZ 67335 ......... ............ A Eye suture during surgery ........................... 2.49 NA 1.12 0.13 NA 3.74 ZZZ 67340 ......... ............ A Revise eye muscle add-on .......................... 4.92 NA 2.20 0.26 NA 7.38 ZZZ 67343 ......... ............ A Release eye tissue ...................................... 7.34 NA 6.50 0.42 NA 14.26 090 67345 ......... ............ A Destroy nerve of eye muscle ....................... 2.96 2.58 2.01 0.18 5.72 5.15 010 67350 ......... ............ A Biopsy eye muscle ....................................... 2.87 NA 1.86 0.15 NA 4.88 000 67400 ......... ............ A Explore/biopsy eye socket ........................... 9.75 NA 11.27 0.58 NA 21.60 090 67405 ......... ............ A Explore/drain eye socket ............................. 7.92 NA 9.78 0.49 NA 18.19 090 67412 ......... ............ A Explore/treat eye socket .............................. 9.49 NA 10.95 0.53 NA 20.97 090 67413 ......... ............ A Explore/treat eye socket .............................. 9.99 NA 10.78 0.56 NA 21.33 090 67414 ......... ............ A Explr/decompress eye socket ...................... 11.11 NA 12.06 0.66 NA 23.83 090 67415 ......... ............ A Aspiration, orbital contents .......................... 1.76 NA 0.76 0.09 NA 2.61 000 67420 ......... ............ A Explore/treat eye socket .............................. 20.03 NA 17.39 1.21 NA 38.63 090 67430 ......... ............ A Explore/treat eye socket .............................. 13.37 NA 15.08 0.84 NA 29.29 090 67440 ......... ............ A Explore/drain eye socket ............................. 13.07 NA 14.27 0.76 NA 28.10 090 67445 ......... ............ A Explr/decompress eye socket ...................... 14.40 NA 13.93 0.92 NA 29.25 090 67450 ......... ............ A Explore/biopsy eye socket ........................... 13.49 NA 14.71 0.75 NA 28.95 090 67500 ......... ............ A Inject/treat eye socket .................................. 0.79 0.67 0.29 0.05 1.51 1.13 000 67505 ......... ............ A Inject/treat eye socket .................................. 0.82 0.69 0.31 0.05 1.56 1.18 000 67515 ......... ............ A Inject/treat eye socket .................................. 0.61 0.59 0.38 0.03 1.23 1.02 000 67550 ......... ............ A Insert eye socket implant ............................. 10.17 NA 11.29 0.66 NA 22.12 090 67560 ......... ............ A Revise eye socket implant ........................... 10.58 NA 11.37 0.70 NA 22.65 090 67570 ......... ............ A Decompress optic nerve .............................. 13.56 NA 13.60 0.82 NA 27.98 090 67700 ......... ............ A Drainage of eyelid abscess ......................... 1.35 6.05 1.27 0.07 7.47 2.69 010 67710 ......... ............ A Incision of eyelid .......................................... 1.02 5.40 1.20 0.05 6.47 2.27 010 67715 ......... ............ A Incision of eyelid fold ................................... 1.22 5.39 1.29 0.06 6.67 2.57 010 67800 ......... ............ A Remove eyelid lesion .................................. 1.38 1.62 1.03 0.07 3.07 2.48 010 67801 ......... ............ A Remove eyelid lesions ................................. 1.88 1.96 1.26 0.10 3.94 3.24 010 67805 ......... ............ A Remove eyelid lesions ................................. 2.22 2.52 1.64 0.12 4.86 3.98 010 67808 ......... ............ A Remove eyelid lesion(s) .............................. 3.79 NA 3.77 0.21 NA 7.77 090 67810 ......... ............ A Biopsy of eyelid ........................................... 1.48 3.34 0.67 0.11 4.93 2.26 000 67820 ......... ............ A Revise eyelashes ......................................... 0.89 0.60 0.56 0.04 1.53 1.49 000 67825 ......... ............ A Revise eyelashes ......................................... 1.38 1.73 1.41 0.07 3.18 2.86 010 67830 ......... ............ A Revise eyelashes ......................................... 1.70 5.55 1.50 0.09 7.34 3.29 010 67835 ......... ............ A Revise eyelashes ......................................... 5.55 NA 4.61 0.29 NA 10.45 090 67840 ......... ............ A Remove eyelid lesion .................................. 2.04 5.49 1.65 0.11 7.64 3.80 010 67850 ......... ............ A Treat eyelid lesion ....................................... 1.69 3.37 1.46 0.11 5.17 3.26 010 67875 ......... ............ A Closure of eyelid by suture .......................... 1.35 3.31 0.94 0.08 4.74 2.37 000 67880 ......... ............ A Revision of eyelid ........................................ 3.79 6.63 3.79 0.20 10.62 7.78 090 67882 ......... ............ A Revision of eyelid ........................................ 5.06 7.65 4.80 0.27 12.98 10.13 090 67900 ......... ............ A Repair brow defect ...................................... 6.13 9.05 5.23 0.39 15.57 11.75 090 67901 ......... ............ A Repair eyelid defect ..................................... 6.96 NA 5.38 0.53 NA 12.87 090 67902 ......... ............ A Repair eyelid defect ..................................... 7.02 NA 5.44 0.46 NA 12.92 090 67903 ......... ............ A Repair eyelid defect ..................................... 6.36 9.58 5.47 0.44 16.38 12.27 090 67904 ......... ............ A Repair eyelid defect ..................................... 6.25 9.69 5.22 0.41 16.35 11.88 090 67906 ......... ............ A Repair eyelid defect ..................................... 6.78 5.39 5.02 0.44 12.61 12.24 090 67908 ......... ............ A Repair eyelid defect ..................................... 5.12 7.04 5.24 0.30 12.46 10.66 090 67909 ......... ............ A Revise eyelid defect .................................... 5.39 8.03 4.93 0.32 13.74 10.64 090 67911 ......... ............ A Revise eyelid defect .................................... 5.26 NA 4.77 0.31 NA 10.34 090 67912 ......... ............ A Correction eyelid w/ implant ........................ 5.67 18.69 5.46 0.28 24.64 11.41 090 67914 ......... ............ A Repair eyelid defect ..................................... 3.67 6.35 3.04 0.21 10.23 6.92 090 67915 ......... ............ A Repair eyelid defect ..................................... 3.18 6.00 2.80 0.17 9.35 6.15 090 67916 ......... ............ A Repair eyelid defect ..................................... 5.30 8.06 4.76 0.30 13.66 10.36 090 67917 ......... ............ A Repair eyelid defect ..................................... 6.01 8.47 5.07 0.37 14.85 11.45 090 67921 ......... ............ A Repair eyelid defect ..................................... 3.39 6.21 2.89 0.18 9.78 6.46 090 67922 ......... ............ A Repair eyelid defect ..................................... 3.06 5.93 2.75 0.16 9.15 5.97 090 67923 ......... ............ A Repair eyelid defect ..................................... 5.87 8.14 4.97 0.32 14.33 11.16 090 67924 ......... ............ A Repair eyelid defect ..................................... 5.78 8.94 4.68 0.32 15.04 10.78 090 67930 ......... ............ A Repair eyelid wound .................................... 3.60 5.74 2.17 0.20 9.54 5.97 010 67935 ......... ............ A Repair eyelid wound .................................... 6.21 8.53 4.40 0.39 15.13 11.00 090 67938 ......... ............ A Remove eyelid foreign body ........................ 1.33 5.40 1.27 0.07 6.80 2.67 010 67950 ......... ............ A Revision of eyelid ........................................ 5.81 8.63 5.19 0.36 14.80 11.36 090 67961 ......... ............ A Revision of eyelid ........................................ 5.68 8.68 5.01 0.33 14.69 11.02 090 67966 ......... ............ A Revision of eyelid ........................................ 6.56 9.13 5.53 0.39 16.08 12.48 090 67971 ......... ............ A Reconstruction of eyelid .............................. 9.78 NA 7.27 0.54 NA 17.59 090


## 47648

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

67973 ......... ............ A Reconstruction of eyelid .............................. 12.85 NA 9.29 0.73 NA 22.87 090 67974 ......... ............ A Reconstruction of eyelid .............................. 12.82 NA 9.21 0.70 NA 22.73 090 67975 ......... ............ A Reconstruction of eyelid .............................. 9.12 NA 6.94 0.49 NA 16.55 090 68020 ......... ............ A Incise/drain eyelid lining .............................. 1.37 1.41 1.21 0.07 2.85 2.65 010 68040 ......... ............ A Treatment of eyelid lesions ......................... 0.85 0.71 0.43 0.04 1.60 1.32 000 68100 ......... ............ A Biopsy of eyelid lining .................................. 1.35 3.25 0.95 0.07 4.67 2.37 000 68110 ......... ............ A Remove eyelid lining lesion ......................... 1.77 4.10 1.64 0.09 5.96 3.50 010 68115 ......... ............ A Remove eyelid lining lesion ......................... 2.36 5.97 1.91 0.12 8.45 4.39 010 68130 ......... ............ A Remove eyelid lining lesion ......................... 4.92 8.72 4.59 0.25 13.89 9.76 090 68135 ......... ............ A Remove eyelid lining lesion ......................... 1.84 1.81 1.65 0.09 3.74 3.58 010 68200 ......... ............ A Treat eyelid by injection ............................... 0.49 0.54 0.33 0.02 1.05 0.84 000 68320 ......... ............ A Revise/graft eyelid lining .............................. 5.36 11.29 5.52 0.29 16.94 11.17 090 68325 ......... ............ A Revise/graft eyelid lining .............................. 7.35 NA 6.53 0.41 NA 14.29 090 68326 ......... ............ A Revise/graft eyelid lining .............................. 7.14 NA 6.40 0.38 NA 13.92 090 68328 ......... ............ A Revise/graft eyelid lining .............................. 8.17 NA 7.26 0.55 NA 15.98 090 68330 ......... ............ A Revise eyelid lining ...................................... 4.82 9.41 4.71 0.25 14.48 9.78 090 68335 ......... ............ A Revise/graft eyelid lining .............................. 7.18 NA 6.37 0.36 NA 13.91 090 68340 ......... ............ A Separate eyelid adhesions .......................... 4.16 8.89 4.10 0.21 13.26 8.47 090 68360 ......... ............ A Revise eyelid lining ...................................... 4.36 8.05 4.18 0.22 12.63 8.76 090 68362 ......... ............ A Revise eyelid lining ...................................... 7.33 NA 6.40 0.37 NA 14.10 090 68371 ......... ............ A Harvest eye tissue, alograft ......................... 4.89 NA 4.73 0.45 NA 10.07 010 68400 ......... ............ A Incise/drain tear gland ................................. 1.69 5.92 1.83 0.09 7.70 3.61 010 68420 ......... ............ A Incise/drain tear sac .................................... 2.30 6.22 2.11 0.12 8.64 4.53 010 68440 ......... ............ A Incise tear duct opening .............................. 0.94 2.09 1.27 0.05 3.08 2.26 010 68500 ......... ............ A Removal of tear gland ................................. 11.00 NA 9.73 0.63 NA 21.36 090 68505 ......... ............ A Partial removal, tear gland .......................... 10.92 NA 10.59 0.61 NA 22.12 090 68510 ......... ............ A Biopsy of tear gland ..................................... 4.60 7.35 2.09 0.24 12.19 6.93 000 68520 ......... ............ A Removal of tear sac .................................... 7.50 NA 7.41 0.39 NA 15.30 090 68525 ......... ............ A Biopsy of tear sac ........................................ 4.42 NA 2.01 0.24 NA 6.67 000 68530 ......... ............ A Clearance of tear duct ................................. 3.65 8.19 2.64 0.20 12.04 6.49 010 68540 ......... ............ A Remove tear gland lesion ............................ 10.58 NA 9.38 0.53 NA 20.49 090 68550 ......... ............ A Remove tear gland lesion ............................ 13.24 NA 11.33 0.66 NA 25.23 090 68700 ......... ............ A Repair tear ducts ......................................... 6.59 NA 5.97 0.35 NA 12.91 090 68705 ......... ............ A Revise tear duct opening ............................. 2.06 4.19 1.78 0.10 6.35 3.94 010 68720 ......... ............ A Create tear sac drain ................................... 8.95 NA 7.86 0.50 NA 17.31 090 68745 ......... ............ A Create tear duct drain .................................. 8.62 NA 7.86 0.43 NA 16.91 090 68750 ......... ............ A Create tear duct drain .................................. 8.65 NA 8.27 0.46 NA 17.38 090 68760 ......... ............ A Close tear duct opening .............................. 1.73 3.55 1.63 0.09 5.37 3.45 010 68761 ......... ............ A Close tear duct opening .............................. 1.36 2.27 1.32 0.07 3.70 2.75 010 68770 ......... ............ A Close tear system fistula ............................. 7.01 3.17 3.17 0.36 10.54 10.54 090 68801 ......... ............ A Dilate tear duct opening .............................. 0.94 1.95 1.48 0.05 2.94 2.47 010 68810 ......... ............ A Probe nasolacrimal duct .............................. 1.90 3.66 2.67 0.11 5.67 4.68 010 68811 ......... ............ A Probe nasolacrimal duct .............................. 2.35 NA 2.40 0.14 NA 4.89 010 68815 ......... ............ A Probe nasolacrimal duct .............................. 3.20 8.27 2.81 0.18 11.65 6.19 010 68840 ......... ............ A Explore/irrigate tear ducts ............................ 1.25 1.61 1.12 0.06 2.92 2.43 010 68850 ......... ............ A Injection for tear sac x-ray ........................... 0.80 0.88 0.67 0.04 1.72 1.51 000 69000 ......... ............ A Drain external ear lesion ............................. 1.45 2.89 1.38 0.12 4.46 2.95 010 69005 ......... ............ A Drain external ear lesion ............................. 2.11 2.93 1.83 0.18 5.22 4.12 010 69020 ......... ............ A Drain outer ear canal lesion ........................ 1.48 3.97 2.07 0.12 5.57 3.67 010 69100 ......... ............ A Biopsy of external ear .................................. 0.81 1.71 0.39 0.07 2.59 1.27 000 69105 ......... ............ A Biopsy of external ear canal ........................ 0.85 2.32 0.77 0.07 3.24 1.69 000 69110 ......... ............ A Remove external ear, partial ....................... 3.43 6.73 4.46 0.34 10.50 8.23 090 69120 ......... ............ A Removal of external ear .............................. 4.04 NA 6.16 0.39 NA 10.59 090 69140 ......... ............ A Remove ear canal lesion(s) ......................... 7.96 NA 13.21 0.67 NA 21.84 090 69145 ......... ............ A Remove ear canal lesion(s) ......................... 2.62 5.73 3.28 0.22 8.57 6.12 090 69150 ......... ............ A Extensive ear canal surgery ........................ 13.41 NA 13.32 1.27 NA 28.00 090 69155 ......... ............ A Extensive ear/neck surgery ......................... 20.77 NA 19.43 1.84 NA 42.04 090 69200 ......... ............ A Clear outer ear canal ................................... 0.77 2.38 0.56 0.06 3.21 1.39 000 69205 ......... ............ A Clear outer ear canal ................................... 1.20 NA 1.35 0.10 NA 2.65 010 69210 ......... ............ A Remove impacted ear wax .......................... 0.61 0.63 0.23 0.05 1.29 0.89 000 69220 ......... ............ A Clean out mastoid cavity ............................. 0.83 2.35 0.74 0.07 3.25 1.64 000 69222 ......... ............ A Clean out mastoid cavity ............................. 1.40 3.82 2.05 0.12 5.34 3.57 010
69300 ......... ............ R Revise external ear ...................................... 6.35 NA 4.21 0.75 NA 11.31 YYY
69310 ......... ............ A Rebuild outer ear canal ............................... 10.77 NA 16.18 0.89 NA 27.84 090
69320 ......... ............ A Rebuild outer ear canal ............................... 16.93 NA 21.71 1.45 NA 40.09 090 69400 ......... ............ A Inflate middle ear canal ............................... 0.83 2.16 0.67 0.07 3.06 1.57 000 69401 ......... ............ A Inflate middle ear canal ............................... 0.63 1.24 0.65 0.05 1.92 1.33 000 69405 ......... ............ A Catheterize middle ear canal ....................... 2.63 3.46 2.29 0.21 6.30 5.13 010 69410 ......... ............ A Inset middle ear (baffle) ............................... 0.33 2.12 0.48 0.03 2.48 0.84 000 69420 ......... ............ A Incision of eardrum ...................................... 1.33 3.12 1.58 0.11 4.56 3.02 010 69421 ......... ............ A Incision of eardrum ...................................... 1.73 NA 2.15 0.16 NA 4.04 010 69424 ......... ............ A Remove ventilating tube .............................. 0.85 2.17 0.68 0.07 3.09 1.60 000 69433 ......... ............ A Create eardrum opening .............................. 1.52 3.09 1.64 0.13 4.74 3.29 010 69436 ......... ............ A Create eardrum opening .............................. 1.96 NA 2.27 0.19 NA 4.42 010 69440 ......... ............ A Exploration of middle ear ............................. 7.56 NA 8.71 0.62 NA 16.89 090


## 47649

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

69450 ......... ............ A Eardrum revision .......................................... 5.56 NA 6.99 0.45 NA 13.00 090 69501 ......... ............ A Mastoidectomy ............................................. 9.06 NA 8.96 0.76 NA 18.78 090 69502 ......... ............ A Mastoidectomy ............................................. 12.36 NA 11.54 1.03 NA 24.93 090 69505 ......... ............ A Remove mastoid structures ......................... 12.97 NA 17.11 1.08 NA 31.16 090 69511 ......... ............ A Extensive mastoid surgery .......................... 13.50 NA 17.39 1.09 NA 31.98 090 69530 ......... ............ A Extensive mastoid surgery .......................... 19.16 NA 21.52 1.44 NA 42.12 090 69535 ......... ............ A Remove part of temporal bone .................... 36.09 NA 31.85 2.98 NA 70.92 090 69540 ......... ............ A Remove ear lesion ....................................... 1.20 3.71 1.95 0.10 5.01 3.25 010 69550 ......... ............ A Remove ear lesion ....................................... 10.97 NA 14.79 0.90 NA 26.66 090 69552 ......... ............ A Remove ear lesion ....................................... 19.43 NA 20.60 1.55 NA 41.58 090 69554 ......... ............ A Remove ear lesion ....................................... 33.11 NA 30.18 2.94 NA 66.23 090 69601 ......... ............ A Mastoid surgery revision .............................. 13.22 NA 12.60 1.07 NA 26.89 090 69602 ......... ............ A Mastoid surgery revision .............................. 13.56 NA 13.16 1.05 NA 27.77 090 69603 ......... ............ A Mastoid surgery revision .............................. 14.00 NA 18.26 1.14 NA 33.40 090 69604 ......... ............ A Mastoid surgery revision .............................. 14.00 NA 13.63 0.92 NA 28.55 090 69605 ......... ............ A Mastoid surgery revision .............................. 18.46 NA 20.85 1.51 NA 40.82 090 69610 ......... ............ A Repair of eardrum ........................................ 4.42 5.50 3.26 0.36 10.28 8.04 010 69620 ......... ............ A Repair of eardrum ........................................ 5.88 11.03 6.25 0.48 17.39 12.61 090 69631 ......... ............ A Repair eardrum structures ........................... 9.85 NA 11.13 0.81 NA 21.79 090 69632 ......... ............ A Rebuild eardrum structures ......................... 12.73 NA 13.39 1.04 NA 27.16 090 69633 ......... ............ A Rebuild eardrum structures ......................... 12.08 NA 12.97 0.99 NA 26.04 090 69635 ......... ............ A Repair eardrum structures ........................... 13.31 NA 16.66 1.08 NA 31.05 090 69636 ......... ............ A Rebuild eardrum structures ......................... 15.20 NA 19.18 1.23 NA 35.61 090 69637 ......... ............ A Rebuild eardrum structures ......................... 15.09 NA 19.11 1.25 NA 35.45 090 69641 ......... ............ A Revise middle ear & mastoid ...................... 12.69 NA 12.70 1.04 NA 26.43 090 69642 ......... ............ A Revise middle ear & mastoid ...................... 16.81 NA 16.19 1.37 NA 34.37 090 69643 ......... ............ A Revise middle ear & mastoid ...................... 15.30 NA 14.73 1.26 NA 31.29 090 69644 ......... ............ A Revise middle ear & mastoid ...................... 16.94 NA 20.30 1.38 NA 38.62 090 69645 ......... ............ A Revise middle ear & mastoid ...................... 16.36 NA 19.92 1.35 NA 37.63 090 69646 ......... ............ A Revise middle ear & mastoid ...................... 17.96 NA 20.65 1.48 NA 40.09 090 69650 ......... ............ A Release middle ear bone ............................ 9.65 NA 9.85 0.78 NA 20.28 090 69660 ......... ............ A Revise middle ear bone ............................... 11.88 NA 11.13 0.95 NA 23.96 090 69661 ......... ............ A Revise middle ear bone ............................... 15.72 NA 14.62 1.29 NA 31.63 090 69662 ......... ............ A Revise middle ear bone ............................... 15.42 NA 13.68 1.26 NA 30.36 090 69666 ......... ............ A Repair middle ear structures ....................... 9.74 NA 9.91 0.79 NA 20.44 090 69667 ......... ............ A Repair middle ear structures ....................... 9.75 NA 9.92 0.79 NA 20.46 090 69670 ......... ............ A Remove mastoid air cells ............................ 11.49 NA 11.65 0.96 NA 24.10 090 69676 ......... ............ A Remove middle ear nerve ........................... 9.51 NA 10.67 0.84 NA 21.02 090 69700 ......... ............ A Close mastoid fistula ................................... 8.22 NA 9.20 0.66 NA 18.08 090 69711 ......... ............ A Remove/repair hearing aid .......................... 10.42 NA 10.74 0.85 NA 22.01 090 69714 ......... ............ A Implant temple bone w/stimul ...................... 13.98 NA 12.61 1.21 NA 27.80 090 69715 ......... ............ A Temple bne implnt w/stimulat ...................... 18.22 NA 14.96 1.49 NA 34.67 090 69717 ......... ............ A Temple bone implant revision ..................... 14.96 NA 14.46 1.35 NA 30.77 090 69718 ......... ............ A Revise temple bone implant ........................ 18.47 NA 15.26 1.62 NA 35.35 090 69720 ......... ............ A Release facial nerve .................................... 14.36 NA 14.43 1.24 NA 30.03 090 69725 ......... ............ A Release facial nerve .................................... 25.34 NA 20.02 2.29 NA 47.65 090 69740 ......... ............ A Repair facial nerve ....................................... 15.94 NA 13.37 1.58 NA 30.89 090 69745 ......... ............ A Repair facial nerve ....................................... 16.66 NA 14.91 1.36 NA 32.93 090 69801 ......... ............ A Incise inner ear ............................................ 8.55 NA 9.41 0.70 NA 18.66 090 69802 ......... ............ A Incise inner ear ............................................ 13.08 NA 12.25 1.07 NA 26.40 090 69805 ......... ............ A Explore inner ear ......................................... 13.80 NA 11.82 1.16 NA 26.78 090 69806 ......... ............ A Explore inner ear ......................................... 12.33 NA 10.99 1.04 NA 24.36 090 69820 ......... ............ A Establish inner ear window .......................... 10.32 NA 11.19 0.82 NA 22.33 090 69840 ......... ............ A Revise inner ear window ............................. 10.24 NA 13.15 0.74 NA 24.13 090 69905 ......... ............ A Remove inner ear ........................................ 11.08 NA 11.29 0.90 NA 23.27 090 69910 ......... ............ A Remove inner ear & mastoid ....................... 13.61 NA 11.88 1.10 NA 26.59 090 69915 ......... ............ A Incise inner ear nerve .................................. 21.20 NA 16.39 1.70 NA 39.29 090 69930 ......... ............ A Implant cochlear device ............................... 16.78 NA 14.68 1.38 NA 32.84 090 69950 ......... ............ A Incise inner ear nerve .................................. 25.60 NA 18.82 3.07 NA 47.49 090 69955 ......... ............ A Release facial nerve .................................... 27.00 NA 21.29 2.77 NA 51.06 090 69960 ......... ............ A Release inner ear canal .............................. 27.00 NA 19.98 2.69 NA 49.67 090 69970 ......... ............ A Remove inner ear lesion ............................. 29.99 NA 23.17 2.73 NA 55.89 090 69990 ......... ............ R Microsurgery add-on .................................... 3.46 NA 1.78 0.81 NA 6.05 ZZZ 70010 ......... ............ A Contrast x-ray of brain ................................. 1.19 4.72 NA 0.28 6.19 NA XXX 70010 ......... 26 ....... A Contrast x-ray of brain ................................. 1.19 0.39 0.39 0.06 1.64 1.64 XXX 70010 ......... TC ...... A Contrast x-ray of brain ................................. 0.00 4.32 NA 0.22 4.54 NA XXX 70015 ......... ............ A Contrast x-ray of brain ................................. 1.19 1.74 NA 0.14 3.07 NA XXX 70015 ......... 26 ....... A Contrast x-ray of brain ................................. 1.19 0.39 0.39 0.06 1.64 1.64 XXX 70015 ......... TC ...... A Contrast x-ray of brain ................................. 0.00 1.35 NA 0.08 1.43 NA XXX 70030 ......... ............ A X-ray eye for foreign body ........................... 0.17 0.47 NA 0.03 0.67 NA XXX 70030 ......... 26 ....... A X-ray eye for foreign body ........................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 70030 ......... TC ...... A X-ray eye for foreign body ........................... 0.00 0.42 NA 0.02 0.44 NA XXX 70100 ......... ............ A X-ray exam of jaw ........................................ 0.18 0.58 NA 0.03 0.79 NA XXX 70100 ......... 26 ....... A X-ray exam of jaw ........................................ 0.18 0.06 0.06 0.01 0.25 0.25 XXX 70100 ......... TC ...... A X-ray exam of jaw ........................................ 0.00 0.52 NA 0.02 0.54 NA XXX


## 47650

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

70110 ......... ............ A X-ray exam of jaw ........................................ 0.25 0.70 NA 0.05 1.00 NA XXX 70110 ......... 26 ....... A X-ray exam of jaw ........................................ 0.25 0.08 0.08 0.01 0.34 0.34 XXX 70110 ......... TC ...... A X-ray exam of jaw ........................................ 0.00 0.62 NA 0.04 0.66 NA XXX 70120 ......... ............ A X-ray exam of mastoids ............................... 0.18 0.68 NA 0.05 0.91 NA XXX 70120 ......... 26 ....... A X-ray exam of mastoids ............................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX 70120 ......... TC ...... A X-ray exam of mastoids ............................... 0.00 0.62 NA 0.04 0.66 NA XXX 70130 ......... ............ A X-ray exam of mastoids ............................... 0.34 0.89 NA 0.07 1.30 NA XXX 70130 ......... 26 ....... A X-ray exam of mastoids ............................... 0.34 0.11 0.11 0.02 0.47 0.47 XXX 70130 ......... TC ...... A X-ray exam of mastoids ............................... 0.00 0.78 NA 0.05 0.83 NA XXX 70134 ......... ............ A X-ray exam of middle ear ............................ 0.34 0.85 NA 0.07 1.26 NA XXX 70134 ......... 26 ....... A X-ray exam of middle ear ............................ 0.34 0.11 0.11 0.02 0.47 0.47 XXX 70134 ......... TC ...... A X-ray exam of middle ear ............................ 0.00 0.73 NA 0.05 0.78 NA XXX 70140 ......... ............ A X-ray exam of facial bones .......................... 0.19 0.68 NA 0.05 0.92 NA XXX 70140 ......... 26 ....... A X-ray exam of facial bones .......................... 0.19 0.06 0.06 0.01 0.26 0.26 XXX 70140 ......... TC ...... A X-ray exam of facial bones .......................... 0.00 0.62 NA 0.04 0.66 NA XXX 70150 ......... ............ A X-ray exam of facial bones .......................... 0.26 0.87 NA 0.06 1.19 NA XXX 70150 ......... 26 ....... A X-ray exam of facial bones .......................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 70150 ......... TC ...... A X-ray exam of facial bones .......................... 0.00 0.78 NA 0.05 0.83 NA XXX 70160 ......... ............ A X-ray exam of nasal bones ......................... 0.17 0.58 NA 0.03 0.78 NA XXX 70160 ......... 26 ....... A X-ray exam of nasal bones ......................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 70160 ......... TC ...... A X-ray exam of nasal bones ......................... 0.00 0.52 NA 0.02 0.54 NA XXX 70170 ......... ............ A X-ray exam of tear duct ............................... 0.30 1.04 NA 0.07 1.41 NA XXX 70170 ......... 26 ....... A X-ray exam of tear duct ............................... 0.30 0.10 0.10 0.01 0.41 0.41 XXX 70170 ......... TC ...... A X-ray exam of tear duct ............................... 0.00 0.95 NA 0.06 1.01 NA XXX 70190 ......... ............ A X-ray exam of eye sockets .......................... 0.21 0.69 NA 0.05 0.95 NA XXX 70190 ......... 26 ....... A X-ray exam of eye sockets .......................... 0.21 0.07 0.07 0.01 0.29 0.29 XXX 70190 ......... TC ...... A X-ray exam of eye sockets .......................... 0.00 0.62 NA 0.04 0.66 NA XXX 70200 ......... ............ A X-ray exam of eye sockets .......................... 0.28 0.87 NA 0.06 1.21 NA XXX 70200 ......... 26 ....... A X-ray exam of eye sockets .......................... 0.28 0.09 0.09 0.01 0.38 0.38 XXX 70200 ......... TC ...... A X-ray exam of eye sockets .......................... 0.00 0.78 NA 0.05 0.83 NA XXX 70210 ......... ............ A X-ray exam of sinuses ................................. 0.17 0.67 NA 0.05 0.89 NA XXX 70210 ......... 26 ....... A X-ray exam of sinuses ................................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX 70210 ......... TC ...... A X-ray exam of sinuses ................................. 0.00 0.62 NA 0.04 0.66 NA XXX 70220 ......... ............ A X-ray exam of sinuses ................................. 0.25 0.86 NA 0.06 1.17 NA XXX 70220 ......... 26 ....... A X-ray exam of sinuses ................................. 0.25 0.08 0.08 0.01 0.34 0.34 XXX 70220 ......... TC ...... A X-ray exam of sinuses ................................. 0.00 0.78 NA 0.05 0.83 NA XXX 70240 ......... ............ A X-ray exam, pituitary saddle ........................ 0.19 0.48 NA 0.03 0.70 NA XXX 70240 ......... 26 ....... A X-ray exam, pituitary saddle ........................ 0.19 0.06 0.06 0.01 0.26 0.26 XXX 70240 ......... TC ...... A X-ray exam, pituitary saddle ........................ 0.00 0.42 NA 0.02 0.44 NA XXX 70250 ......... ............ A X-ray exam of skull ...................................... 0.24 0.70 NA 0.05 0.99 NA XXX 70250 ......... 26 ....... A X-ray exam of skull ...................................... 0.24 0.08 0.08 0.01 0.33 0.33 XXX 70250 ......... TC ...... A X-ray exam of skull ...................................... 0.00 0.62 NA 0.04 0.66 NA XXX 70260 ......... ............ A X-ray exam of skull ...................................... 0.34 1.00 NA 0.08 1.42 NA XXX 70260 ......... 26 ....... A X-ray exam of skull ...................................... 0.34 0.11 0.11 0.02 0.47 0.47 XXX 70260 ......... TC ...... A X-ray exam of skull ...................................... 0.00 0.89 NA 0.06 0.95 NA XXX 70300 ......... ............ A X-ray exam of teeth ..................................... 0.10 0.31 NA 0.03 0.44 NA XXX 70300 ......... 26 ....... A X-ray exam of teeth ..................................... 0.10 0.05 0.05 0.01 0.16 0.16 XXX 70300 ......... TC ...... A X-ray exam of teeth ..................................... 0.00 0.26 NA 0.02 0.28 NA XXX 70310 ......... ............ A X-ray exam of teeth ..................................... 0.16 0.49 NA 0.03 0.68 NA XXX 70310 ......... 26 ....... A X-ray exam of teeth ..................................... 0.16 0.08 0.08 0.01 0.25 0.25 XXX 70310 ......... TC ...... A X-ray exam of teeth ..................................... 0.00 0.42 NA 0.02 0.44 NA XXX 70320 ......... ............ A Full mouth x-ray of teeth ............................. 0.22 0.86 NA 0.06 1.14 NA XXX 70320 ......... 26 ....... A Full mouth x-ray of teeth ............................. 0.22 0.08 0.08 0.01 0.31 0.31 XXX 70320 ......... TC ...... A Full mouth x-ray of teeth ............................. 0.00 0.78 NA 0.05 0.83 NA XXX 70328 ......... ............ A X-ray exam of jaw joint ................................ 0.18 0.55 NA 0.03 0.76 NA XXX 70328 ......... 26 ....... A X-ray exam of jaw joint ................................ 0.18 0.06 0.06 0.01 0.25 0.25 XXX 70328 ......... TC ...... A X-ray exam of jaw joint ................................ 0.00 0.49 NA 0.02 0.51 NA XXX 70330 ......... ............ A X-ray exam of jaw joints .............................. 0.24 0.92 NA 0.06 1.22 NA XXX 70330 ......... 26 ....... A X-ray exam of jaw joints .............................. 0.24 0.08 0.08 0.01 0.33 0.33 XXX 70330 ......... TC ...... A X-ray exam of jaw joints .............................. 0.00 0.84 NA 0.05 0.89 NA XXX 70332 ......... ............ A X-ray exam of jaw joint ................................ 0.54 2.29 NA 0.15 2.98 NA XXX 70332 ......... 26 ....... A X-ray exam of jaw joint ................................ 0.54 0.20 0.20 0.03 0.77 0.77 XXX 70332 ......... TC ...... A X-ray exam of jaw joint ................................ 0.00 2.09 NA 0.12 2.21 NA XXX 70336 ......... ............ A Magnetic image, jaw joint ............................ 1.48 11.67 NA 0.66 13.81 NA XXX 70336 ......... 26 ....... A Magnetic image, jaw joint ............................ 1.48 0.49 0.49 0.07 2.04 2.04 XXX 70336 ......... TC ...... A Magnetic image, jaw joint ............................ 0.00 11.19 NA 0.59 11.78 NA XXX 70350 ......... ............ A X-ray head for orthodontia ........................... 0.17 0.45 NA 0.03 0.65 NA XXX 70350 ......... 26 ....... A X-ray head for orthodontia ........................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 70350 ......... TC ...... A X-ray head for orthodontia ........................... 0.00 0.38 NA 0.02 0.40 NA XXX 70355 ......... ............ A Panoramic x-ray of jaws .............................. 0.20 0.64 NA 0.05 0.89 NA XXX 70355 ......... 26 ....... A Panoramic x-ray of jaws .............................. 0.20 0.07 0.07 0.01 0.28 0.28 XXX 70355 ......... TC ...... A Panoramic x-ray of jaws .............................. 0.00 0.57 NA 0.04 0.61 NA XXX 70360 ......... ............ A X-ray exam of neck ..................................... 0.17 0.47 NA 0.03 0.67 NA XXX 70360 ......... 26 ....... A X-ray exam of neck ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 70360 ......... TC ...... A X-ray exam of neck ..................................... 0.00 0.42 NA 0.02 0.44 NA XXX


## 47651

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

70370 ......... ............ A Throat x-ray & fluoroscopy .......................... 0.32 1.41 NA 0.08 1.81 NA XXX 70370 ......... 26 ....... A Throat x-ray & fluoroscopy .......................... 0.32 0.10 0.10 0.01 0.43 0.43 XXX 70370 ......... TC ...... A Throat x-ray & fluoroscopy .......................... 0.00 1.30 NA 0.07 1.37 NA XXX 70371 ......... ............ A Speech evaluation, complex ........................ 0.84 2.37 NA 0.16 3.37 NA XXX 70371 ......... 26 ....... A Speech evaluation, complex ........................ 0.84 0.27 0.27 0.04 1.15 1.15 XXX 70371 ......... TC ...... A Speech evaluation, complex ........................ 0.00 2.09 NA 0.12 2.21 NA XXX 70373 ......... ............ A Contrast x-ray of larynx ............................... 0.44 1.92 NA 0.13 2.49 NA XXX 70373 ......... 26 ....... A Contrast x-ray of larynx ............................... 0.44 0.14 0.14 0.02 0.60 0.60 XXX 70373 ......... TC ...... A Contrast x-ray of larynx ............................... 0.00 1.78 NA 0.11 1.89 NA XXX 70380 ......... ............ A X-ray exam of salivary gland ....................... 0.17 0.72 NA 0.05 0.94 NA XXX 70380 ......... 26 ....... A X-ray exam of salivary gland ....................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 70380 ......... TC ...... A X-ray exam of salivary gland ....................... 0.00 0.67 NA 0.04 0.71 NA XXX 70390 ......... ............ A X-ray exam of salivary duct ......................... 0.38 1.90 NA 0.13 2.41 NA XXX 70390 ......... 26 ....... A X-ray exam of salivary duct ......................... 0.38 0.12 0.12 0.02 0.52 0.52 XXX 70390 ......... TC ...... A X-ray exam of salivary duct ......................... 0.00 1.78 NA 0.11 1.89 NA XXX 70450 ......... ............ A Ct head/brain w/o dye ................................. 0.85 4.99 NA 0.29 6.13 NA XXX 70450 ......... 26 ....... A Ct head/brain w/o dye ................................. 0.85 0.28 0.28 0.04 1.17 1.17 XXX 70450 ......... TC ...... A Ct head/brain w/o dye ................................. 0.00 4.71 NA 0.25 4.96 NA XXX 70460 ......... ............ A Ct head/brain w/dye ..................................... 1.13 6.02 NA 0.35 7.50 NA XXX 70460 ......... 26 ....... A Ct head/brain w/dye ..................................... 1.13 0.37 0.37 0.05 1.55 1.55 XXX 70460 ......... TC ...... A Ct head/brain w/dye ..................................... 0.00 5.65 NA 0.30 5.95 NA XXX 70470 ......... ............ A Ct head/brain w/o & w/ dye ......................... 1.27 7.47 NA 0.43 9.17 NA XXX 70470 ......... 26 ....... A Ct head/brain w/o & w/ dye ......................... 1.27 0.42 0.42 0.06 1.75 1.75 XXX 70470 ......... TC ...... A Ct head/brain w/o & w/ dye ......................... 0.00 7.06 NA 0.37 7.43 NA XXX 70480 ......... ............ A Ct orbit/ear/fossa w/o dye ............................ 1.28 5.13 NA 0.31 6.72 NA XXX 70480 ......... 26 ....... A Ct orbit/ear/fossa w/o dye ............................ 1.28 0.42 0.42 0.06 1.76 1.76 XXX 70480 ......... TC ...... A Ct orbit/ear/fossa w/o dye ............................ 0.00 4.71 NA 0.25 4.96 NA XXX 70481 ......... ............ A Ct orbit/ear/fossa w/dye ............................... 1.38 6.10 NA 0.36 7.84 NA XXX 70481 ......... 26 ....... A Ct orbit/ear/fossa w/dye ............................... 1.38 0.45 0.45 0.06 1.89 1.89 XXX 70481 ......... TC ...... A Ct orbit/ear/fossa w/dye ............................... 0.00 5.65 NA 0.30 5.95 NA XXX 70482 ......... ............ A Ct orbit/ear/fossa w/o&w dye ....................... 1.45 7.53 NA 0.44 9.42 NA XXX 70482 ......... 26 ....... A Ct orbit/ear/fossa w/o&w dye ....................... 1.45 0.47 0.47 0.07 1.99 1.99 XXX 70482 ......... TC ...... A Ct orbit/ear/fossa w/o&w dye ....................... 0.00 7.06 NA 0.37 7.43 NA XXX 70486 ......... ............ A Ct maxillofacial w/o dye ............................... 1.14 5.08 NA 0.30 6.52 NA XXX 70486 ......... 26 ....... A Ct maxillofacial w/o dye ............................... 1.14 0.37 0.37 0.05 1.56 1.56 XXX 70486 ......... TC ...... A Ct maxillofacial w/o dye ............................... 0.00 4.71 NA 0.25 4.96 NA XXX 70487 ......... ............ A Ct maxillofacial w/dye .................................. 1.30 6.07 NA 0.36 7.73 NA XXX 70487 ......... 26 ....... A Ct maxillofacial w/dye .................................. 1.30 0.43 0.43 0.06 1.79 1.79 XXX 70487 ......... TC ...... A Ct maxillofacial w/dye .................................. 0.00 5.65 NA 0.30 5.95 NA XXX 70488 ......... ............ A Ct maxillofacial w/o & w dye ....................... 1.42 7.52 NA 0.43 9.37 NA XXX 70488 ......... 26 ....... A Ct maxillofacial w/o & w dye ....................... 1.42 0.46 0.46 0.06 1.94 1.94 XXX 70488 ......... TC ...... A Ct maxillofacial w/o & w dye ....................... 0.00 7.06 NA 0.37 7.43 NA XXX 70490 ......... ............ A Ct soft tissue neck w/o dye ......................... 1.28 5.13 NA 0.31 6.72 NA XXX 70490 ......... 26 ....... A Ct soft tissue neck w/o dye ......................... 1.28 0.42 0.42 0.06 1.76 1.76 XXX 70490 ......... TC ...... A Ct soft tissue neck w/o dye ......................... 0.00 4.71 NA 0.25 4.96 NA XXX 70491 ......... ............ A Ct soft tissue neck w/dye ............................ 1.38 6.10 NA 0.36 7.84 NA XXX 70491 ......... 26 ....... A Ct soft tissue neck w/dye ............................ 1.38 0.45 0.45 0.06 1.89 1.89 XXX 70491 ......... TC ...... A Ct soft tissue neck w/dye ............................ 0.00 5.65 NA 0.30 5.95 NA XXX 70492 ......... ............ A Ct sft tsue nck w/o & w/dye ......................... 1.45 7.53 NA 0.44 9.42 NA XXX 70492 ......... 26 ....... A Ct sft tsue nck w/o & w/dye ......................... 1.45 0.47 0.47 0.07 1.99 1.99 XXX 70492 ......... TC ...... A Ct sft tsue nck w/o & w/dye ......................... 0.00 7.06 NA 0.37 7.43 NA XXX 70496 ......... ............ A Ct angiography, head .................................. 1.75 11.16 NA 0.66 13.57 NA XXX 70496 ......... 26 ....... A Ct angiography, head .................................. 1.75 0.57 0.57 0.08 2.40 2.40 XXX 70496 ......... TC ...... A Ct angiography, head .................................. 0.00 10.59 NA 0.58 11.17 NA XXX 70498 ......... ............ A Ct angiography, neck ................................... 1.75 11.16 NA 0.66 13.57 NA XXX 70498 ......... 26 ....... A Ct angiography, neck ................................... 1.75 0.57 0.57 0.08 2.40 2.40 XXX 70498 ......... TC ...... A Ct angiography, neck ................................... 0.00 10.59 NA 0.58 11.17 NA XXX 70540 ......... ............ A Mri orbit/face/neck w/o dye .......................... 1.35 11.63 NA 0.45 13.43 NA XXX 70540 ......... 26 ....... A Mri orbit/face/neck w/o dye .......................... 1.35 0.44 0.44 0.06 1.85 1.85 XXX 70540 ......... TC ...... A Mri orbit/face/neck w/o dye .......................... 0.00 11.19 NA 0.39 11.58 NA XXX 70542 ......... ............ A Mri orbit/face/neck w/dye ............................. 1.62 13.95 NA 0.54 16.11 NA XXX 70542 ......... 26 ....... A Mri orbit/face/neck w/dye ............................. 1.62 0.53 0.53 0.07 2.22 2.22 XXX 70542 ......... TC ...... A Mri orbit/face/neck w/dye ............................. 0.00 13.42 NA 0.47 13.89 NA XXX 70543 ......... ............ A Mri orbt/fac/nck w/o & w dye ....................... 2.15 25.55 NA 0.94 28.64 NA XXX 70543 ......... 26 ....... A Mri orbt/fac/nck w/o & w dye ....................... 2.15 0.71 0.71 0.10 2.96 2.96 XXX 70543 ......... TC ...... A Mri orbt/fac/nck w/o & w dye ....................... 0.00 24.84 NA 0.84 25.68 NA XXX 70544 ......... ............ A Mr angiography head w/o dye ..................... 1.20 11.58 NA 0.64 13.42 NA XXX 70544 ......... 26 ....... A Mr angiography head w/o dye ..................... 1.20 0.39 0.39 0.05 1.64 1.64 XXX 70544 ......... TC ...... A Mr angiography head w/o dye ..................... 0.00 11.19 NA 0.59 11.78 NA XXX 70545 ......... ............ A Mr angiography head w/dye ........................ 1.20 11.58 NA 0.65 13.43 NA XXX 70545 ......... 26 ....... A Mr angiography head w/dye ........................ 1.20 0.39 0.39 0.06 1.65 1.65 XXX 70545 ......... TC ...... A Mr angiography head w/dye ........................ 0.00 11.19 NA 0.59 11.78 NA XXX 70546 ......... ............ A Mr angiograph head w/o&w dye .................. 1.80 22.96 NA 0.67 25.43 NA XXX 70546 ......... 26 ....... A Mr angiograph head w/o&w dye .................. 1.80 0.59 0.59 0.08 2.47 2.47 XXX 70546 ......... TC ...... A Mr angiograph head w/o&w dye .................. 0.00 22.37 NA 0.59 22.96 NA XXX


## 47652

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

70547 ......... ............ A Mr angiography neck w/o dye ..................... 1.20 11.58 NA 0.64 13.42 NA XXX 70547 ......... 26 ....... A Mr angiography neck w/o dye ..................... 1.20 0.39 0.39 0.05 1.64 1.64 XXX 70547 ......... TC ...... A Mr angiography neck w/o dye ..................... 0.00 11.19 NA 0.59 11.78 NA XXX 70548 ......... ............ A Mr angiography neck w/dye ........................ 1.20 11.58 NA 0.64 13.42 NA XXX 70548 ......... 26 ....... A Mr angiography neck w/dye ........................ 1.20 0.39 0.39 0.05 1.64 1.64 XXX 70548 ......... TC ...... A Mr angiography neck w/dye ........................ 0.00 11.19 NA 0.59 11.78 NA XXX 70549 ......... ............ A Mr angiograph neck w/o&w dye .................. 1.80 22.97 NA 0.67 25.44 NA XXX 70549 ......... 26 ....... A Mr angiograph neck w/o&w dye .................. 1.80 0.59 0.59 0.08 2.47 2.47 XXX 70549 ......... TC ...... A Mr angiograph neck w/o&w dye .................. 0.00 22.37 NA 0.59 22.96 NA XXX 70551 ......... ............ A Mri brain w/o dye ......................................... 1.48 11.67 NA 0.66 13.81 NA XXX 70551 ......... 26 ....... A Mri brain w/o dye ......................................... 1.48 0.49 0.49 0.07 2.04 2.04 XXX 70551 ......... TC ...... A Mri brain w/o dye ......................................... 0.00 11.19 NA 0.59 11.78 NA XXX 70552 ......... ............ A Mri brain w/ dye ........................................... 1.78 14.01 NA 0.79 16.58 NA XXX 70552 ......... 26 ....... A Mri brain w/ dye ........................................... 1.78 0.59 0.59 0.09 2.46 2.46 XXX 70552 ......... TC ...... A Mri brain w/ dye ........................................... 0.00 13.42 NA 0.70 14.12 NA XXX 70553 ......... ............ A Mri brain w/o & w/ dye ................................. 2.36 25.62 NA 1.42 29.40 NA XXX 70553 ......... 26 ....... A Mri brain w/o & w/ dye ................................. 2.36 0.77 0.77 0.11 3.24 3.24 XXX 70553 ......... TC ...... A Mri brain w/o & w/ dye ................................. 0.00 24.84 NA 1.31 26.15 NA XXX 70557 ......... 26 ....... A Mri brain w/o dye ......................................... 2.90 1.12 1.12 0.08 4.10 4.10 XXX 70558 ......... 26 ....... A Mri brain w/ dye ........................................... 3.20 1.23 1.23 0.10 4.53 4.53 XXX 70559 ......... 26 ....... A Mri brain w/o & w/ dye ................................. 3.20 1.23 1.23 0.12 4.55 4.55 XXX 71010 ......... ............ A Chest x-ray .................................................. 0.18 0.53 NA 0.03 0.74 NA XXX 71010 ......... 26 ....... A Chest x-ray .................................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 71010 ......... TC ...... A Chest x-ray .................................................. 0.00 0.47 NA 0.02 0.49 NA XXX 71015 ......... ............ A Chest x-ray .................................................. 0.21 0.59 NA 0.03 0.83 NA XXX 71015 ......... 26 ....... A Chest x-ray .................................................. 0.21 0.07 0.07 0.01 0.29 0.29 XXX 71015 ......... TC ...... A Chest x-ray .................................................. 0.00 0.52 NA 0.02 0.54 NA XXX 71020 ......... ............ A Chest x-ray .................................................. 0.22 0.69 NA 0.05 0.96 NA XXX 71020 ......... 26 ....... A Chest x-ray .................................................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX 71020 ......... TC ...... A Chest x-ray .................................................. 0.00 0.62 NA 0.04 0.66 NA XXX 71021 ......... ............ A Chest x-ray .................................................. 0.27 0.82 NA 0.06 1.15 NA XXX 71021 ......... 26 ....... A Chest x-ray .................................................. 0.27 0.09 0.09 0.01 0.37 0.37 XXX 71021 ......... TC ...... A Chest x-ray .................................................. 0.00 0.73 NA 0.05 0.78 NA XXX 71022 ......... ............ A Chest x-ray .................................................. 0.31 0.83 NA 0.06 1.20 NA XXX 71022 ......... 26 ....... A Chest x-ray .................................................. 0.31 0.10 0.10 0.01 0.42 0.42 XXX 71022 ......... TC ...... A Chest x-ray .................................................. 0.00 0.73 NA 0.05 0.78 NA XXX 71023 ......... ............ A Chest x-ray and fluoroscopy ........................ 0.38 0.91 NA 0.07 1.36 NA XXX 71023 ......... 26 ....... A Chest x-ray and fluoroscopy ........................ 0.38 0.13 0.13 0.02 0.53 0.53 XXX 71023 ......... TC ...... A Chest x-ray and fluoroscopy ........................ 0.00 0.78 NA 0.05 0.83 NA XXX 71030 ......... ............ A Chest x-ray .................................................. 0.31 0.88 NA 0.06 1.25 NA XXX 71030 ......... 26 ....... A Chest x-ray .................................................. 0.31 0.10 0.10 0.01 0.42 0.42 XXX 71030 ......... TC ...... A Chest x-ray .................................................. 0.00 0.78 NA 0.05 0.83 NA XXX 71034 ......... ............ A Chest x-ray and fluoroscopy ........................ 0.46 1.60 NA 0.10 2.16 NA XXX 71034 ......... 26 ....... A Chest x-ray and fluoroscopy ........................ 0.46 0.16 0.16 0.02 0.64 0.64 XXX 71034 ......... TC ...... A Chest x-ray and fluoroscopy ........................ 0.00 1.44 NA 0.08 1.52 NA XXX 71035 ......... ............ A Chest x-ray .................................................. 0.18 0.58 NA 0.03 0.79 NA XXX 71035 ......... 26 ....... A Chest x-ray .................................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 71035 ......... TC ...... A Chest x-ray .................................................. 0.00 0.52 NA 0.02 0.54 NA XXX 71040 ......... ............ A Contrast x-ray of bronchi ............................. 0.58 1.65 NA 0.11 2.34 NA XXX 71040 ......... 26 ....... A Contrast x-ray of bronchi ............................. 0.58 0.19 0.19 0.03 0.80 0.80 XXX 71040 ......... TC ...... A Contrast x-ray of bronchi ............................. 0.00 1.46 NA 0.08 1.54 NA XXX 71060 ......... ............ A Contrast x-ray of bronchi ............................. 0.74 2.44 NA 0.17 3.35 NA XXX 71060 ......... 26 ....... A Contrast x-ray of bronchi ............................. 0.74 0.24 0.24 0.04 1.02 1.02 XXX 71060 ......... TC ...... A Contrast x-ray of bronchi ............................. 0.00 2.20 NA 0.13 2.33 NA XXX 71090 ......... ............ A X-ray & pacemaker insertion ....................... 0.54 1.89 NA 0.13 2.56 NA XXX 71090 ......... 26 ....... A X-ray & pacemaker insertion ....................... 0.54 0.21 0.21 0.02 0.77 0.77 XXX 71090 ......... TC ...... A X-ray & pacemaker insertion ....................... 0.00 1.68 NA 0.11 1.79 NA XXX 71100 ......... ............ A X-ray exam of ribs ....................................... 0.22 0.64 NA 0.05 0.91 NA XXX 71100 ......... 26 ....... A X-ray exam of ribs ....................................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 71100 ......... TC ...... A X-ray exam of ribs ....................................... 0.00 0.57 NA 0.04 0.61 NA XXX 71101 ......... ............ A X-ray exam of ribs/chest .............................. 0.27 0.75 NA 0.05 1.07 NA XXX 71101 ......... 26 ....... A X-ray exam of ribs/chest .............................. 0.27 0.09 0.09 0.01 0.37 0.37 XXX 71101 ......... TC ...... A X-ray exam of ribs/chest .............................. 0.00 0.67 NA 0.04 0.71 NA XXX 71110 ......... ............ A X-ray exam of ribs ....................................... 0.27 0.87 NA 0.06 1.20 NA XXX 71110 ......... 26 ....... A X-ray exam of ribs ....................................... 0.27 0.09 0.09 0.01 0.37 0.37 XXX 71110 ......... TC ...... A X-ray exam of ribs ....................................... 0.00 0.78 NA 0.05 0.83 NA XXX 71111 ......... ............ A X-ray exam of ribs/ chest ............................ 0.32 0.99 NA 0.07 1.38 NA XXX 71111 ......... 26 ....... A X-ray exam of ribs/ chest ............................ 0.32 0.10 0.10 0.01 0.43 0.43 XXX 71111 ......... TC ...... A X-ray exam of ribs/ chest ............................ 0.00 0.89 NA 0.06 0.95 NA XXX 71120 ......... ............ A X-ray exam of breastbone ........................... 0.20 0.71 NA 0.05 0.96 NA XXX 71120 ......... 26 ....... A X-ray exam of breastbone ........................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX 71120 ......... TC ...... A X-ray exam of breastbone ........................... 0.00 0.65 NA 0.04 0.69 NA XXX 71130 ......... ............ A X-ray exam of breastbone ........................... 0.22 0.78 NA 0.05 1.05 NA XXX 71130 ......... 26 ....... A X-ray exam of breastbone ........................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 71130 ......... TC ...... A X-ray exam of breastbone ........................... 0.00 0.70 NA 0.04 0.74 NA XXX


## 47653

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

71250 ......... ............ A Ct thorax w/o dye ........................................ 1.16 6.28 NA 0.36 7.80 NA XXX 71250 ......... 26 ....... A Ct thorax w/o dye ........................................ 1.16 0.38 0.38 0.05 1.59 1.59 XXX 71250 ......... TC ...... A Ct thorax w/o dye ........................................ 0.00 5.90 NA 0.31 6.21 NA XXX 71260 ......... ............ A Ct thorax w/dye ............................................ 1.24 7.46 NA 0.43 9.13 NA XXX 71260 ......... 26 ....... A Ct thorax w/dye ............................................ 1.24 0.40 0.40 0.06 1.70 1.70 XXX 71260 ......... TC ...... A Ct thorax w/dye ............................................ 0.00 7.06 NA 0.37 7.43 NA XXX 71270 ......... ............ A Ct thorax w/o & w/ dye ................................ 1.38 9.28 NA 0.52 11.18 NA XXX 71270 ......... 26 ....... A Ct thorax w/o & w/ dye ................................ 1.38 0.45 0.45 0.06 1.89 1.89 XXX 71270 ......... TC ...... A Ct thorax w/o & w/ dye ................................ 0.00 8.83 NA 0.46 9.29 NA XXX 71275 ......... ............ A Ct angiography, chest .................................. 1.92 12.99 NA 0.48 15.39 NA XXX 71275 ......... 26 ....... A Ct angiography, chest .................................. 1.92 0.63 0.63 0.09 2.64 2.64 XXX 71275 ......... TC ...... A Ct angiography, chest .................................. 0.00 12.36 NA 0.39 12.75 NA XXX 71550 ......... ............ A Mri chest w/o dye ........................................ 1.46 11.66 NA 0.52 13.64 NA XXX 71550 ......... 26 ....... A Mri chest w/o dye ........................................ 1.46 0.48 0.48 0.07 2.01 2.01 XXX 71550 ......... TC ...... A Mri chest w/o dye ........................................ 0.00 11.19 NA 0.45 11.64 NA XXX 71551 ......... ............ A Mri chest w/dye ............................................ 1.73 13.98 NA 0.60 16.31 NA XXX 71551 ......... 26 ....... A Mri chest w/dye ............................................ 1.73 0.56 0.56 0.08 2.37 2.37 XXX 71551 ......... TC ...... A Mri chest w/dye ............................................ 0.00 13.42 NA 0.52 13.94 NA XXX 71552 ......... ............ A Mri chest w/o & w/dye ................................. 2.26 25.58 NA 0.78 28.62 NA XXX 71552 ......... 26 ....... A Mri chest w/o & w/dye ................................. 2.26 0.74 0.74 0.10 3.10 3.10 XXX 71552 ......... TC ...... A Mri chest w/o & w/dye ................................. 0.00 24.84 NA 0.68 25.52 NA XXX 71555 ......... ............ R Mri angio chest w or w/o dye ...................... 1.81 11.78 NA 0.67 14.26 NA XXX 71555 ......... 26 ....... R Mri angio chest w or w/o dye ...................... 1.81 0.60 0.60 0.08 2.49 2.49 XXX 71555 ......... TC ...... R Mri angio chest w or w/o dye ...................... 0.00 11.19 NA 0.59 11.78 NA XXX 72010 ......... ............ A X-ray exam of spine .................................... 0.45 1.17 NA 0.08 1.70 NA XXX 72010 ......... 26 ....... A X-ray exam of spine .................................... 0.45 0.15 0.15 0.02 0.62 0.62 XXX 72010 ......... TC ...... A X-ray exam of spine .................................... 0.00 1.02 NA 0.06 1.08 NA XXX 72020 ......... ............ A X-ray exam of spine .................................... 0.15 0.46 NA 0.03 0.64 NA XXX 72020 ......... 26 ....... A X-ray exam of spine .................................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX 72020 ......... TC ...... A X-ray exam of spine .................................... 0.00 0.42 NA 0.02 0.44 NA XXX 72040 ......... ............ A X-ray exam of neck spine ............................ 0.22 0.67 NA 0.05 0.94 NA XXX 72040 ......... 26 ....... A X-ray exam of neck spine ............................ 0.22 0.07 0.07 0.01 0.30 0.30 XXX 72040 ......... TC ...... A X-ray exam of neck spine ............................ 0.00 0.60 NA 0.04 0.64 NA XXX 72050 ......... ............ A X-ray exam of neck spine ............................ 0.31 0.99 NA 0.07 1.37 NA XXX 72050 ......... 26 ....... A X-ray exam of neck spine ............................ 0.31 0.10 0.10 0.01 0.42 0.42 XXX 72050 ......... TC ...... A X-ray exam of neck spine ............................ 0.00 0.89 NA 0.06 0.95 NA XXX 72052 ......... ............ A X-ray exam of neck spine ............................ 0.36 1.25 NA 0.08 1.69 NA XXX 72052 ......... 26 ....... A X-ray exam of neck spine ............................ 0.36 0.12 0.12 0.02 0.50 0.50 XXX 72052 ......... TC ...... A X-ray exam of neck spine ............................ 0.00 1.13 NA 0.06 1.19 NA XXX 72069 ......... ............ A X-ray exam of trunk spine ........................... 0.22 0.57 NA 0.03 0.82 NA XXX 72069 ......... 26 ....... A X-ray exam of trunk spine ........................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 72069 ......... TC ...... A X-ray exam of trunk spine ........................... 0.00 0.49 NA 0.02 0.51 NA XXX 72070 ......... ............ A X-ray exam of thoracic spine ....................... 0.22 0.72 NA 0.05 0.99 NA XXX 72070 ......... 26 ....... A X-ray exam of thoracic spine ....................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 72070 ......... TC ...... A X-ray exam of thoracic spine ....................... 0.00 0.65 NA 0.04 0.69 NA XXX 72072 ......... ............ A X-ray exam of thoracic spine ....................... 0.22 0.81 NA 0.06 1.09 NA XXX 72072 ......... 26 ....... A X-ray exam of thoracic spine ....................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 72072 ......... TC ...... A X-ray exam of thoracic spine ....................... 0.00 0.73 NA 0.05 0.78 NA XXX 72074 ......... ............ A X-ray exam of thoracic spine ....................... 0.22 0.98 NA 0.07 1.27 NA XXX 72074 ......... 26 ....... A X-ray exam of thoracic spine ....................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 72074 ......... TC ...... A X-ray exam of thoracic spine ....................... 0.00 0.91 NA 0.06 0.97 NA XXX 72080 ......... ............ A X-ray exam of trunk spine ........................... 0.22 0.74 NA 0.05 1.01 NA XXX 72080 ......... 26 ....... A X-ray exam of trunk spine ........................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 72080 ......... TC ...... A X-ray exam of trunk spine ........................... 0.00 0.67 NA 0.04 0.71 NA XXX 72090 ......... ............ A X-ray exam of trunk spine ........................... 0.28 0.76 NA 0.05 1.09 NA XXX 72090 ......... 26 ....... A X-ray exam of trunk spine ........................... 0.28 0.09 0.09 0.01 0.38 0.38 XXX 72090 ......... TC ...... A X-ray exam of trunk spine ........................... 0.00 0.67 NA 0.04 0.71 NA XXX 72100 ......... ............ A X-ray exam of lower spine ........................... 0.22 0.74 NA 0.05 1.01 NA XXX 72100 ......... 26 ....... A X-ray exam of lower spine ........................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 72100 ......... TC ...... A X-ray exam of lower spine ........................... 0.00 0.67 NA 0.04 0.71 NA XXX 72110 ......... ............ A X-ray exam of lower spine ........................... 0.31 1.01 NA 0.07 1.39 NA XXX 72110 ......... 26 ....... A X-ray exam of lower spine ........................... 0.31 0.10 0.10 0.01 0.42 0.42 XXX 72110 ......... TC ...... A X-ray exam of lower spine ........................... 0.00 0.91 NA 0.06 0.97 NA XXX 72114 ......... ............ A X-ray exam of lower spine ........................... 0.36 1.31 NA 0.08 1.75 NA XXX 72114 ......... 26 ....... A X-ray exam of lower spine ........................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX 72114 ......... TC ...... A X-ray exam of lower spine ........................... 0.00 1.19 NA 0.06 1.25 NA XXX 72120 ......... ............ A X-ray exam of lower spine ........................... 0.22 0.96 NA 0.07 1.25 NA XXX 72120 ......... 26 ....... A X-ray exam of lower spine ........................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 72120 ......... TC ...... A X-ray exam of lower spine ........................... 0.00 0.89 NA 0.06 0.95 NA XXX 72125 ......... ............ A Ct neck spine w/o dye ................................. 1.16 6.28 NA 0.36 7.80 NA XXX 72125 ......... 26 ....... A Ct neck spine w/o dye ................................. 1.16 0.38 0.38 0.05 1.59 1.59 XXX 72125 ......... TC ...... A Ct neck spine w/o dye ................................. 0.00 5.90 NA 0.31 6.21 NA XXX 72126 ......... ............ A Ct neck spine w/dye .................................... 1.22 7.45 NA 0.43 9.10 NA XXX 72126 ......... 26 ....... A Ct neck spine w/dye .................................... 1.22 0.40 0.40 0.06 1.68 1.68 XXX 72126 ......... TC ...... A Ct neck spine w/dye .................................... 0.00 7.06 NA 0.37 7.43 NA XXX


## 47654

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

72127 ......... ............ A Ct neck spine w/o & w/dye .......................... 1.27 9.25 NA 0.52 11.04 NA XXX 72127 ......... 26 ....... A Ct neck spine w/o & w/dye .......................... 1.27 0.42 0.42 0.06 1.75 1.75 XXX 72127 ......... TC ...... A Ct neck spine w/o & w/dye .......................... 0.00 8.83 NA 0.46 9.29 NA XXX 72128 ......... ............ A Ct chest spine w/o dye ................................ 1.16 6.28 NA 0.36 7.80 NA XXX 72128 ......... 26 ....... A Ct chest spine w/o dye ................................ 1.16 0.38 0.38 0.05 1.59 1.59 XXX 72128 ......... TC ...... A Ct chest spine w/o dye ................................ 0.00 5.90 NA 0.31 6.21 NA XXX 72129 ......... ............ A Ct chest spine w/dye ................................... 1.22 7.45 NA 0.43 9.10 NA XXX 72129 ......... 26 ....... A Ct chest spine w/dye ................................... 1.22 0.40 0.40 0.06 1.68 1.68 XXX 72129 ......... TC ...... A Ct chest spine w/dye ................................... 0.00 7.06 NA 0.37 7.43 NA XXX 72130 ......... ............ A Ct chest spine w/o & w/dye ......................... 1.27 9.25 NA 0.52 11.04 NA XXX 72130 ......... 26 ....... A Ct chest spine w/o & w/dye ......................... 1.27 0.42 0.42 0.06 1.75 1.75 XXX 72130 ......... TC ...... A Ct chest spine w/o & w/dye ......................... 0.00 8.83 NA 0.46 9.29 NA XXX 72131 ......... ............ A Ct lumbar spine w/o dye .............................. 1.16 6.28 NA 0.36 7.80 NA XXX 72131 ......... 26 ....... A Ct lumbar spine w/o dye .............................. 1.16 0.38 0.38 0.05 1.59 1.59 XXX 72131 ......... TC ...... A Ct lumbar spine w/o dye .............................. 0.00 5.90 NA 0.31 6.21 NA XXX 72132 ......... ............ A Ct lumbar spine w/dye ................................. 1.22 7.45 NA 0.43 9.10 NA XXX 72132 ......... 26 ....... A Ct lumbar spine w/dye ................................. 1.22 0.40 0.40 0.06 1.68 1.68 XXX 72132 ......... TC ...... A Ct lumbar spine w/dye ................................. 0.00 7.06 NA 0.37 7.43 NA XXX 72133 ......... ............ A Ct lumbar spine w/o & w/dye ...................... 1.27 9.25 NA 0.52 11.04 NA XXX 72133 ......... 26 ....... A Ct lumbar spine w/o & w/dye ...................... 1.27 0.42 0.42 0.06 1.75 1.75 XXX 72133 ......... TC ...... A Ct lumbar spine w/o & w/dye ...................... 0.00 8.83 NA 0.46 9.29 NA XXX 72141 ......... ............ A Mri neck spine w/o dye ................................ 1.60 11.71 NA 0.66 13.97 NA XXX 72141 ......... 26 ....... A Mri neck spine w/o dye ................................ 1.60 0.53 0.53 0.07 2.20 2.20 XXX 72141 ......... TC ...... A Mri neck spine w/o dye ................................ 0.00 11.19 NA 0.59 11.78 NA XXX 72142 ......... ............ A Mri neck spine w/dye ................................... 1.92 14.06 NA 0.79 16.77 NA XXX 72142 ......... 26 ....... A Mri neck spine w/dye ................................... 1.92 0.64 0.64 0.09 2.65 2.65 XXX 72142 ......... TC ...... A Mri neck spine w/dye ................................... 0.00 13.42 NA 0.70 14.12 NA XXX 72146 ......... ............ A Mri chest spine w/o dye ............................... 1.60 12.95 NA 0.71 15.26 NA XXX 72146 ......... 26 ....... A Mri chest spine w/o dye ............................... 1.60 0.52 0.52 0.07 2.19 2.19 XXX 72146 ......... TC ...... A Mri chest spine w/o dye ............................... 0.00 12.42 NA 0.64 13.06 NA XXX 72147 ......... ............ A Mri chest spine w/dye .................................. 1.92 14.05 NA 0.79 16.76 NA XXX 72147 ......... 26 ....... A Mri chest spine w/dye .................................. 1.92 0.63 0.63 0.09 2.64 2.64 XXX 72147 ......... TC ...... A Mri chest spine w/dye .................................. 0.00 13.42 NA 0.70 14.12 NA XXX 72148 ......... ............ A Mri lumbar spine w/o dye ............................ 1.48 12.91 NA 0.71 15.10 NA XXX 72148 ......... 26 ....... A Mri lumbar spine w/o dye ............................ 1.48 0.49 0.49 0.07 2.04 2.04 XXX 72148 ......... TC ...... A Mri lumbar spine w/o dye ............................ 0.00 12.42 NA 0.64 13.06 NA XXX 72149 ......... ............ A Mri lumbar spine w/dye ............................... 1.78 14.01 NA 0.79 16.58 NA XXX 72149 ......... 26 ....... A Mri lumbar spine w/dye ............................... 1.78 0.59 0.59 0.09 2.46 2.46 XXX 72149 ......... TC ...... A Mri lumbar spine w/dye ............................... 0.00 13.42 NA 0.70 14.12 NA XXX 72156 ......... ............ A Mri neck spine w/o & w/dye ........................ 2.57 25.69 NA 1.43 29.69 NA XXX 72156 ......... 26 ....... A Mri neck spine w/o & w/dye ........................ 2.57 0.85 0.85 0.12 3.54 3.54 XXX 72156 ......... TC ...... A Mri neck spine w/o & w/dye ........................ 0.00 24.84 NA 1.31 26.15 NA XXX 72157 ......... ............ A Mri chest spine w/o & w/dye ....................... 2.57 25.68 NA 1.43 29.68 NA XXX 72157 ......... 26 ....... A Mri chest spine w/o & w/dye ....................... 2.57 0.84 0.84 0.12 3.53 3.53 XXX 72157 ......... TC ...... A Mri chest spine w/o & w/dye ....................... 0.00 24.84 NA 1.31 26.15 NA XXX 72158 ......... ............ A Mri lumbar spine w/o & w/dye ..................... 2.36 25.62 NA 1.42 29.40 NA XXX 72158 ......... 26 ....... A Mri lumbar spine w/o & w/dye ..................... 2.36 0.77 0.77 0.11 3.24 3.24 XXX 72158 ......... TC ...... A Mri lumbar spine w/o & w/dye ..................... 0.00 24.84 NA 1.31 26.15 NA XXX 72170 ......... ............ A X-ray exam of pelvis .................................... 0.17 0.58 NA 0.03 0.78 NA XXX 72170 ......... 26 ....... A X-ray exam of pelvis .................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 72170 ......... TC ...... A X-ray exam of pelvis .................................... 0.00 0.52 NA 0.02 0.54 NA XXX 72190 ......... ............ A X-ray exam of pelvis .................................... 0.21 0.74 NA 0.05 1.00 NA XXX 72190 ......... 26 ....... A X-ray exam of pelvis .................................... 0.21 0.07 0.07 0.01 0.29 0.29 XXX 72190 ......... TC ...... A X-ray exam of pelvis .................................... 0.00 0.67 NA 0.04 0.71 NA XXX 72191 ......... ............ A Ct angiograph pelv w/o&w/dye .................... 1.81 12.60 NA 0.47 14.88 NA XXX 72191 ......... 26 ....... A Ct angiograph pelv w/o&w/dye .................... 1.81 0.60 0.60 0.08 2.49 2.49 XXX 72191 ......... TC ...... A Ct angiograph pelv w/o&w/dye .................... 0.00 12.01 NA 0.39 12.40 NA XXX 72192 ......... ............ A Ct pelvis w/o dye ......................................... 1.09 6.25 NA 0.36 7.70 NA XXX 72192 ......... 26 ....... A Ct pelvis w/o dye ......................................... 1.09 0.36 0.36 0.05 1.50 1.50 XXX 72192 ......... TC ...... A Ct pelvis w/o dye ......................................... 0.00 5.90 NA 0.31 6.21 NA XXX 72193 ......... ............ A Ct pelvis w/dye ............................................ 1.16 7.21 NA 0.41 8.78 NA XXX 72193 ......... 26 ....... A Ct pelvis w/dye ............................................ 1.16 0.38 0.38 0.05 1.59 1.59 XXX 72193 ......... TC ...... A Ct pelvis w/dye ............................................ 0.00 6.83 NA 0.36 7.19 NA XXX 72194 ......... ............ A Ct pelvis w/o & w/dye .................................. 1.22 8.87 NA 0.48 10.57 NA XXX 72194 ......... 26 ....... A Ct pelvis w/o & w/dye .................................. 1.22 0.40 0.40 0.05 1.67 1.67 XXX 72194 ......... TC ...... A Ct pelvis w/o & w/dye .................................. 0.00 8.47 NA 0.43 8.90 NA XXX 72195 ......... ............ A Mri pelvis w/o dye ........................................ 1.46 11.66 NA 0.52 13.64 NA XXX 72195 ......... 26 ....... A Mri pelvis w/o dye ........................................ 1.46 0.48 0.48 0.07 2.01 2.01 XXX 72195 ......... TC ...... A Mri pelvis w/o dye ........................................ 0.00 11.19 NA 0.45 11.64 NA XXX 72196 ......... ............ A Mri pelvis w/dye ........................................... 1.73 13.98 NA 0.60 16.31 NA XXX 72196 ......... 26 ....... A Mri pelvis w/dye ........................................... 1.73 0.56 0.56 0.08 2.37 2.37 XXX 72196 ......... TC ...... A Mri pelvis w/dye ........................................... 0.00 13.42 NA 0.52 13.94 NA XXX 72197 ......... ............ A Mri pelvis w/o & w/dye ................................. 2.26 25.58 NA 1.02 28.86 NA XXX 72197 ......... 26 ....... A Mri pelvis w/o & w/dye ................................. 2.26 0.74 0.74 0.10 3.10 3.10 XXX 72197 ......... TC ...... A Mri pelvis w/o & w/dye ................................. 0.00 24.84 NA 0.92 25.76 NA XXX


## 47655

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

72198 ......... ............ A Mr angio pelvis w/o & w/dye ....................... 1.80 11.77 NA 0.69 14.26 NA XXX 72198 ......... 26 ....... A Mr angio pelvis w/o & w/dye ....................... 1.80 0.59 0.59 0.10 2.49 2.49 XXX 72198 ......... TC ...... A Mr angio pelvis w/o & w/dye ....................... 0.00 11.19 NA 0.59 11.78 NA XXX 72200 ......... ............ A X-ray exam sacroiliac joints ......................... 0.17 0.58 NA 0.03 0.78 NA XXX 72200 ......... 26 ....... A X-ray exam sacroiliac joints ......................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 72200 ......... TC ...... A X-ray exam sacroiliac joints ......................... 0.00 0.52 NA 0.02 0.54 NA XXX 72202 ......... ............ A X-ray exam sacroiliac joints ......................... 0.19 0.68 NA 0.05 0.92 NA XXX 72202 ......... 26 ....... A X-ray exam sacroiliac joints ......................... 0.19 0.06 0.06 0.01 0.26 0.26 XXX 72202 ......... TC ...... A X-ray exam sacroiliac joints ......................... 0.00 0.62 NA 0.04 0.66 NA XXX 72220 ......... ............ A X-ray exam of tailbone ................................ 0.17 0.63 NA 0.05 0.85 NA XXX 72220 ......... 26 ....... A X-ray exam of tailbone ................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX 72220 ......... TC ...... A X-ray exam of tailbone ................................ 0.00 0.57 NA 0.04 0.61 NA XXX 72240 ......... ............ A Contrast x-ray of neck spine ....................... 0.91 5.03 NA 0.29 6.23 NA XXX 72240 ......... 26 ....... A Contrast x-ray of neck spine ....................... 0.91 0.29 0.29 0.04 1.24 1.24 XXX 72240 ......... TC ...... A Contrast x-ray of neck spine ....................... 0.00 4.74 NA 0.25 4.99 NA XXX 72255 ......... ............ A Contrast x-ray, thorax spine ........................ 0.91 4.59 NA 0.26 5.76 NA XXX 72255 ......... 26 ....... A Contrast x-ray, thorax spine ........................ 0.91 0.27 0.27 0.04 1.22 1.22 XXX 72255 ......... TC ...... A Contrast x-ray, thorax spine ........................ 0.00 4.32 NA 0.22 4.54 NA XXX 72265 ......... ............ A Contrast x-ray, lower spine .......................... 0.83 4.32 NA 0.26 5.41 NA XXX 72265 ......... 26 ....... A Contrast x-ray, lower spine .......................... 0.83 0.25 0.25 0.04 1.12 1.12 XXX 72265 ......... TC ...... A Contrast x-ray, lower spine .......................... 0.00 4.06 NA 0.22 4.28 NA XXX 72270 ......... ............ A Contrast x-ray, spine ................................... 1.33 6.51 NA 0.40 8.24 NA XXX 72270 ......... 26 ....... A Contrast x-ray, spine ................................... 1.33 0.42 0.42 0.07 1.82 1.82 XXX 72270 ......... TC ...... A Contrast x-ray, spine ................................... 0.00 6.09 NA 0.33 6.42 NA XXX 72275 ......... ............ A Epidurography .............................................. 0.76 2.29 NA 0.27 3.32 NA XXX 72275 ......... 26 ....... A Epidurography .............................................. 0.76 0.20 0.20 0.05 1.01 1.01 XXX 72275 ......... TC ...... A Epidurography .............................................. 0.00 2.09 NA 0.22 2.31 NA XXX 72285 ......... ............ A X-ray c/t spine disk ...................................... 1.16 8.72 NA 0.50 10.38 NA XXX 72285 ......... 26 ....... A X-ray c/t spine disk ...................................... 1.16 0.35 0.35 0.07 1.58 1.58 XXX 72285 ......... TC ...... A X-ray c/t spine disk ...................................... 0.00 8.37 NA 0.43 8.80 NA XXX 72295 ......... ............ A X-ray of lower spine disk ............................. 0.83 8.11 NA 0.46 9.40 NA XXX 72295 ......... 26 ....... A X-ray of lower spine disk ............................. 0.83 0.27 0.27 0.06 1.16 1.16 XXX 72295 ......... TC ...... A X-ray of lower spine disk ............................. 0.00 7.85 NA 0.40 8.25 NA XXX 73000 ......... ............ A X-ray exam of collar bone ........................... 0.16 0.57 NA 0.03 0.76 NA XXX 73000 ......... 26 ....... A X-ray exam of collar bone ........................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 73000 ......... TC ...... A X-ray exam of collar bone ........................... 0.00 0.52 NA 0.02 0.54 NA XXX 73010 ......... ............ A X-ray exam of shoulder blade ..................... 0.17 0.58 NA 0.03 0.78 NA XXX 73010 ......... 26 ....... A X-ray exam of shoulder blade ..................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 73010 ......... TC ...... A X-ray exam of shoulder blade ..................... 0.00 0.52 NA 0.02 0.54 NA XXX 73020 ......... ............ A X-ray exam of shoulder ............................... 0.15 0.52 NA 0.03 0.70 NA XXX 73020 ......... 26 ....... A X-ray exam of shoulder ............................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX 73020 ......... TC ...... A X-ray exam of shoulder ............................... 0.00 0.47 NA 0.02 0.49 NA XXX 73030 ......... ............ A X-ray exam of shoulder ............................... 0.18 0.63 NA 0.05 0.86 NA XXX 73030 ......... 26 ....... A X-ray exam of shoulder ............................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX 73030 ......... TC ...... A X-ray exam of shoulder ............................... 0.00 0.57 NA 0.04 0.61 NA XXX 73040 ......... ............ A Contrast x-ray of shoulder ........................... 0.54 2.27 NA 0.14 2.95 NA XXX 73040 ......... 26 ....... A Contrast x-ray of shoulder ........................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 73040 ......... TC ...... A Contrast x-ray of shoulder ........................... 0.00 2.09 NA 0.12 2.21 NA XXX 73050 ......... ............ A X-ray exam of shoulders ............................. 0.20 0.73 NA 0.05 0.98 NA XXX 73050 ......... 26 ....... A X-ray exam of shoulders ............................. 0.20 0.07 0.07 0.01 0.28 0.28 XXX 73050 ......... TC ...... A X-ray exam of shoulders ............................. 0.00 0.67 NA 0.04 0.71 NA XXX 73060 ......... ............ A X-ray exam of humerus ............................... 0.17 0.63 NA 0.05 0.85 NA XXX 73060 ......... 26 ....... A X-ray exam of humerus ............................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 73060 ......... TC ...... A X-ray exam of humerus ............................... 0.00 0.57 NA 0.04 0.61 NA XXX 73070 ......... ............ A X-ray exam of elbow .................................... 0.15 0.57 NA 0.03 0.75 NA XXX 73070 ......... 26 ....... A X-ray exam of elbow .................................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX 73070 ......... TC ...... A X-ray exam of elbow .................................... 0.00 0.52 NA 0.02 0.54 NA XXX 73080 ......... ............ A X-ray exam of elbow .................................... 0.17 0.63 NA 0.05 0.85 NA XXX 73080 ......... 26 ....... A X-ray exam of elbow .................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 73080 ......... TC ...... A X-ray exam of elbow .................................... 0.00 0.57 NA 0.04 0.61 NA XXX 73085 ......... ............ A Contrast x-ray of elbow ............................... 0.54 2.28 NA 0.15 2.97 NA XXX 73085 ......... 26 ....... A Contrast x-ray of elbow ............................... 0.54 0.18 0.18 0.03 0.75 0.75 XXX 73085 ......... TC ...... A Contrast x-ray of elbow ............................... 0.00 2.09 NA 0.12 2.21 NA XXX 73090 ......... ............ A X-ray exam of forearm ................................. 0.16 0.57 NA 0.03 0.76 NA XXX 73090 ......... 26 ....... A X-ray exam of forearm ................................. 0.16 0.05 0.05 0.01 0.22 0.22 XXX 73090 ......... TC ...... A X-ray exam of forearm ................................. 0.00 0.52 NA 0.02 0.54 NA XXX 73092 ......... ............ A X-ray exam of arm, infant ............................ 0.16 0.54 NA 0.03 0.73 NA XXX 73092 ......... 26 ....... A X-ray exam of arm, infant ............................ 0.16 0.05 0.05 0.01 0.22 0.22 XXX 73092 ......... TC ...... A X-ray exam of arm, infant ............................ 0.00 0.49 NA 0.02 0.51 NA XXX 73100 ......... ............ A X-ray exam of wrist ...................................... 0.16 0.55 NA 0.03 0.74 NA XXX 73100 ......... 26 ....... A X-ray exam of wrist ...................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 73100 ......... TC ...... A X-ray exam of wrist ...................................... 0.00 0.49 NA 0.02 0.51 NA XXX 73110 ......... ............ A X-ray exam of wrist ...................................... 0.17 0.59 NA 0.03 0.79 NA XXX 73110 ......... 26 ....... A X-ray exam of wrist ...................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 73110 ......... TC ...... A X-ray exam of wrist ...................................... 0.00 0.53 NA 0.02 0.55 NA XXX


## 47656

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

73115 ......... ............ A Contrast x-ray of wrist ................................. 0.54 1.76 NA 0.13 2.43 NA XXX 73115 ......... 26 ....... A Contrast x-ray of wrist ................................. 0.54 0.18 0.18 0.03 0.75 0.75 XXX 73115 ......... TC ...... A Contrast x-ray of wrist ................................. 0.00 1.57 NA 0.10 1.67 NA XXX 73120 ......... ............ A X-ray exam of hand ..................................... 0.16 0.55 NA 0.03 0.74 NA XXX 73120 ......... 26 ....... A X-ray exam of hand ..................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 73120 ......... TC ...... A X-ray exam of hand ..................................... 0.00 0.49 NA 0.02 0.51 NA XXX 73130 ......... ............ A X-ray exam of hand ..................................... 0.17 0.59 NA 0.03 0.79 NA XXX 73130 ......... 26 ....... A X-ray exam of hand ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 73130 ......... TC ...... A X-ray exam of hand ..................................... 0.00 0.53 NA 0.02 0.55 NA XXX 73140 ......... ............ A X-ray exam of finger(s) ................................ 0.13 0.46 NA 0.03 0.62 NA XXX 73140 ......... 26 ....... A X-ray exam of finger(s) ................................ 0.13 0.04 0.04 0.01 0.18 0.18 XXX 73140 ......... TC ...... A X-ray exam of finger(s) ................................ 0.00 0.42 NA 0.02 0.44 NA XXX 73200 ......... ............ A Ct upper extremity w/o dye ......................... 1.09 5.31 NA 0.30 6.70 NA XXX 73200 ......... 26 ....... A Ct upper extremity w/o dye ......................... 1.09 0.36 0.36 0.05 1.50 1.50 XXX 73200 ......... TC ...... A Ct upper extremity w/o dye ......................... 0.00 4.95 NA 0.25 5.20 NA XXX 73201 ......... ............ A Ct upper extremity w/dye ............................. 1.16 6.28 NA 0.36 7.80 NA XXX 73201 ......... 26 ....... A Ct upper extremity w/dye ............................. 1.16 0.38 0.38 0.05 1.59 1.59 XXX 73201 ......... TC ...... A Ct upper extremity w/dye ............................. 0.00 5.90 NA 0.31 6.21 NA XXX 73202 ......... ............ A Ct uppr extremity w/o&w/dye ....................... 1.22 7.81 NA 0.44 9.47 NA XXX 73202 ......... 26 ....... A Ct uppr extremity w/o&w/dye ....................... 1.22 0.40 0.40 0.05 1.67 1.67 XXX 73202 ......... TC ...... A Ct uppr extremity w/o&w/dye ....................... 0.00 7.41 NA 0.39 7.80 NA XXX 73206 ......... ............ A Ct angio upr extrm w/o&w/dye .................... 1.81 11.54 NA 0.47 13.82 NA XXX 73206 ......... 26 ....... A Ct angio upr extrm w/o&w/dye .................... 1.81 0.59 0.59 0.08 2.48 2.48 XXX 73206 ......... TC ...... A Ct angio upr extrm w/o&w/dye .................... 0.00 10.94 NA 0.39 11.33 NA XXX 73218 ......... ............ A Mri upper extremity w/o dye ........................ 1.35 11.63 NA 0.45 13.43 NA XXX 73218 ......... 26 ....... A Mri upper extremity w/o dye ........................ 1.35 0.44 0.44 0.06 1.85 1.85 XXX 73218 ......... TC ...... A Mri upper extremity w/o dye ........................ 0.00 11.19 NA 0.39 11.58 NA XXX 73219 ......... ............ A Mri upper extremity w/dye ........................... 1.62 13.95 NA 0.54 16.11 NA XXX 73219 ......... 26 ....... A Mri upper extremity w/dye ........................... 1.62 0.53 0.53 0.07 2.22 2.22 XXX 73219 ......... TC ...... A Mri upper extremity w/dye ........................... 0.00 13.42 NA 0.47 13.89 NA XXX 73220 ......... ............ A Mri uppr extremity w/o&w/dye ..................... 2.15 25.55 NA 0.94 28.64 NA XXX 73220 ......... 26 ....... A Mri uppr extremity w/o&w/dye ..................... 2.15 0.71 0.71 0.10 2.96 2.96 XXX 73220 ......... TC ...... A Mri uppr extremity w/o&w/dye ..................... 0.00 24.84 NA 0.84 25.68 NA XXX 73221 ......... ............ A Mri joint upr extrem w/o dye ........................ 1.35 11.63 NA 0.45 13.43 NA XXX 73221 ......... 26 ....... A Mri joint upr extrem w/o dye ........................ 1.35 0.44 0.44 0.06 1.85 1.85 XXX 73221 ......... TC ...... A Mri joint upr extrem w/o dye ........................ 0.00 11.19 NA 0.39 11.58 NA XXX 73222 ......... ............ A Mri joint upr extrem w/dye ........................... 1.62 13.95 NA 0.54 16.11 NA XXX 73222 ......... 26 ....... A Mri joint upr extrem w/dye ........................... 1.62 0.53 0.53 0.07 2.22 2.22 XXX 73222 ......... TC ...... A Mri joint upr extrem w/dye ........................... 0.00 13.42 NA 0.47 13.89 NA XXX 73223 ......... ............ A Mri joint upr extr w/o&w/dye ........................ 2.15 25.55 NA 0.94 28.64 NA XXX 73223 ......... 26 ....... A Mri joint upr extr w/o&w/dye ........................ 2.15 0.71 0.71 0.10 2.96 2.96 XXX 73223 ......... TC ...... A Mri joint upr extr w/o&w/dye ........................ 0.00 24.84 NA 0.84 25.68 NA XXX 73500 ......... ............ A X-ray exam of hip ........................................ 0.17 0.53 NA 0.03 0.73 NA XXX 73500 ......... 26 ....... A X-ray exam of hip ........................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX 73500 ......... TC ...... A X-ray exam of hip ........................................ 0.00 0.47 NA 0.02 0.49 NA XXX 73510 ......... ............ A X-ray exam of hip ........................................ 0.21 0.64 NA 0.05 0.90 NA XXX 73510 ......... 26 ....... A X-ray exam of hip ........................................ 0.21 0.07 0.07 0.01 0.29 0.29 XXX 73510 ......... TC ...... A X-ray exam of hip ........................................ 0.00 0.57 NA 0.04 0.61 NA XXX 73520 ......... ............ A X-ray exam of hips ...................................... 0.26 0.75 NA 0.05 1.06 NA XXX 73520 ......... 26 ....... A X-ray exam of hips ...................................... 0.26 0.09 0.09 0.01 0.36 0.36 XXX 73520 ......... TC ...... A X-ray exam of hips ...................................... 0.00 0.67 NA 0.04 0.71 NA XXX 73525 ......... ............ A Contrast x-ray of hip .................................... 0.54 2.27 NA 0.15 2.96 NA XXX 73525 ......... 26 ....... A Contrast x-ray of hip .................................... 0.54 0.18 0.18 0.03 0.75 0.75 XXX 73525 ......... TC ...... A Contrast x-ray of hip .................................... 0.00 2.09 NA 0.12 2.21 NA XXX 73530 ......... ............ A X-ray exam of hip ........................................ 0.29 0.62 NA 0.03 0.94 NA XXX 73530 ......... 26 ....... A X-ray exam of hip ........................................ 0.29 0.10 0.10 0.01 0.40 0.40 XXX 73530 ......... TC ...... A X-ray exam of hip ........................................ 0.00 0.52 NA 0.02 0.54 NA XXX 73540 ......... ............ A X-ray exam of pelvis & hips ........................ 0.20 0.64 NA 0.05 0.89 NA XXX 73540 ......... 26 ....... A X-ray exam of pelvis & hips ........................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 73540 ......... TC ...... A X-ray exam of pelvis & hips ........................ 0.00 0.57 NA 0.04 0.61 NA XXX 73542 ......... ............ A X-ray exam, sacroiliac joint ......................... 0.59 2.25 NA 0.15 2.99 NA XXX 73542 ......... 26 ....... A X-ray exam, sacroiliac joint ......................... 0.59 0.16 0.16 0.03 0.78 0.78 XXX 73542 ......... TC ...... A X-ray exam, sacroiliac joint ......................... 0.00 2.09 NA 0.12 2.21 NA XXX 73550 ......... ............ A X-ray exam of thigh ..................................... 0.17 0.63 NA 0.05 0.85 NA XXX 73550 ......... 26 ....... A X-ray exam of thigh ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 73550 ......... TC ...... A X-ray exam of thigh ..................................... 0.00 0.57 NA 0.04 0.61 NA XXX 73560 ......... ............ A X-ray exam of knee, 1 or 2 ......................... 0.17 0.58 NA 0.03 0.78 NA XXX 73560 ......... 26 ....... A X-ray exam of knee, 1 or 2 ......................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 73560 ......... TC ...... A X-ray exam of knee, 1 or 2 ......................... 0.00 0.52 NA 0.02 0.54 NA XXX 73562 ......... ............ A X-ray exam of knee, 3 ................................. 0.18 0.63 NA 0.05 0.86 NA XXX 73562 ......... 26 ....... A X-ray exam of knee, 3 ................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 73562 ......... TC ...... A X-ray exam of knee, 3 ................................. 0.00 0.57 NA 0.04 0.61 NA XXX 73564 ......... ............ A X-ray exam, knee, 4 or more ...................... 0.22 0.69 NA 0.05 0.96 NA XXX 73564 ......... 26 ....... A X-ray exam, knee, 4 or more ...................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 73564 ......... TC ...... A X-ray exam, knee, 4 or more ...................... 0.00 0.62 NA 0.04 0.66 NA XXX


## 47657

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

73565 ......... ............ A X-ray exam of knees ................................... 0.17 0.55 NA 0.03 0.75 NA XXX 73565 ......... 26 ....... A X-ray exam of knees ................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 73565 ......... TC ...... A X-ray exam of knees ................................... 0.00 0.49 NA 0.02 0.51 NA XXX 73580 ......... ............ A Contrast x-ray of knee joint ......................... 0.54 2.79 NA 0.17 3.50 NA XXX 73580 ......... 26 ....... A Contrast x-ray of knee joint ......................... 0.54 0.17 0.17 0.03 0.74 0.74 XXX 73580 ......... TC ...... A Contrast x-ray of knee joint ......................... 0.00 2.62 NA 0.14 2.76 NA XXX 73590 ......... ............ A X-ray exam of lower leg .............................. 0.17 0.58 NA 0.03 0.78 NA XXX 73590 ......... 26 ....... A X-ray exam of lower leg .............................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX 73590 ......... TC ...... A X-ray exam of lower leg .............................. 0.00 0.52 NA 0.02 0.54 NA XXX 73592 ......... ............ A X-ray exam of leg, infant ............................. 0.16 0.55 NA 0.03 0.74 NA XXX 73592 ......... 26 ....... A X-ray exam of leg, infant ............................. 0.16 0.05 0.05 0.01 0.22 0.22 XXX 73592 ......... TC ...... A X-ray exam of leg, infant ............................. 0.00 0.49 NA 0.02 0.51 NA XXX 73600 ......... ............ A X-ray exam of ankle .................................... 0.16 0.55 NA 0.03 0.74 NA XXX 73600 ......... 26 ....... A X-ray exam of ankle .................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 73600 ......... TC ...... A X-ray exam of ankle .................................... 0.00 0.49 NA 0.02 0.51 NA XXX 73610 ......... ............ A X-ray exam of ankle .................................... 0.17 0.59 NA 0.03 0.79 NA XXX 73610 ......... 26 ....... A X-ray exam of ankle .................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 73610 ......... TC ...... A X-ray exam of ankle .................................... 0.00 0.53 NA 0.02 0.55 NA XXX 73615 ......... ............ A Contrast x-ray of ankle ................................ 0.54 2.28 NA 0.15 2.97 NA XXX 73615 ......... 26 ....... A Contrast x-ray of ankle ................................ 0.54 0.18 0.18 0.03 0.75 0.75 XXX 73615 ......... TC ...... A Contrast x-ray of ankle ................................ 0.00 2.09 NA 0.12 2.21 NA XXX 73620 ......... ............ A X-ray exam of foot ....................................... 0.16 0.55 NA 0.03 0.74 NA XXX 73620 ......... 26 ....... A X-ray exam of foot ....................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 73620 ......... TC ...... A X-ray exam of foot ....................................... 0.00 0.49 NA 0.02 0.51 NA XXX 73630 ......... ............ A X-ray exam of foot ....................................... 0.17 0.59 NA 0.03 0.79 NA XXX 73630 ......... 26 ....... A X-ray exam of foot ....................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 73630 ......... TC ...... A X-ray exam of foot ....................................... 0.00 0.53 NA 0.02 0.55 NA XXX 73650 ......... ............ A X-ray exam of heel ...................................... 0.16 0.53 NA 0.03 0.72 NA XXX 73650 ......... 26 ....... A X-ray exam of heel ...................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 73650 ......... TC ...... A X-ray exam of heel ...................................... 0.00 0.47 NA 0.02 0.49 NA XXX 73660 ......... ............ A X-ray exam of toe(s) .................................... 0.13 0.46 NA 0.03 0.62 NA XXX 73660 ......... 26 ....... A X-ray exam of toe(s) .................................... 0.13 0.04 0.04 0.01 0.18 0.18 XXX 73660 ......... TC ...... A X-ray exam of toe(s) .................................... 0.00 0.42 NA 0.02 0.44 NA XXX 73700 ......... ............ A Ct lower extremity w/o dye .......................... 1.09 5.31 NA 0.30 6.70 NA XXX 73700 ......... 26 ....... A Ct lower extremity w/o dye .......................... 1.09 0.36 0.36 0.05 1.50 1.50 XXX 73700 ......... TC ...... A Ct lower extremity w/o dye .......................... 0.00 4.95 NA 0.25 5.20 NA XXX 73701 ......... ............ A Ct lower extremity w/dye ............................. 1.16 6.28 NA 0.36 7.80 NA XXX 73701 ......... 26 ....... A Ct lower extremity w/dye ............................. 1.16 0.38 0.38 0.05 1.59 1.59 XXX 73701 ......... TC ...... A Ct lower extremity w/dye ............................. 0.00 5.90 NA 0.31 6.21 NA XXX 73702 ......... ............ A Ct lwr extremity w/o&w/dye ......................... 1.22 7.81 NA 0.45 9.48 NA XXX 73702 ......... 26 ....... A Ct lwr extremity w/o&w/dye ......................... 1.22 0.40 0.40 0.06 1.68 1.68 XXX 73702 ......... TC ...... A Ct lwr extremity w/o&w/dye ......................... 0.00 7.41 NA 0.39 7.80 NA XXX 73706 ......... ............ A Ct angio lwr extr w/o&w/dye ........................ 1.90 11.57 NA 0.48 13.95 NA XXX 73706 ......... 26 ....... A Ct angio lwr extr w/o&w/dye ........................ 1.90 0.62 0.62 0.09 2.61 2.61 XXX 73706 ......... TC ...... A Ct angio lwr extr w/o&w/dye ........................ 0.00 10.94 NA 0.39 11.33 NA XXX 73718 ......... ............ A Mri lower extremity w/o dye ......................... 1.35 11.63 NA 0.45 13.43 NA XXX 73718 ......... 26 ....... A Mri lower extremity w/o dye ......................... 1.35 0.44 0.44 0.06 1.85 1.85 XXX 73718 ......... TC ...... A Mri lower extremity w/o dye ......................... 0.00 11.19 NA 0.39 11.58 NA XXX 73719 ......... ............ A Mri lower extremity w/dye ............................ 1.62 13.95 NA 0.54 16.11 NA XXX 73719 ......... 26 ....... A Mri lower extremity w/dye ............................ 1.62 0.53 0.53 0.07 2.22 2.22 XXX 73719 ......... TC ...... A Mri lower extremity w/dye ............................ 0.00 13.42 NA 0.47 13.89 NA XXX 73720 ......... ............ A Mri lwr extremity w/o&w/dye ........................ 2.15 25.55 NA 0.94 28.64 NA XXX 73720 ......... 26 ....... A Mri lwr extremity w/o&w/dye ........................ 2.15 0.70 0.70 0.10 2.95 2.95 XXX 73720 ......... TC ...... A Mri lwr extremity w/o&w/dye ........................ 0.00 24.84 NA 0.84 25.68 NA XXX 73721 ......... ............ A Mri jnt of lwr extre w/o dye .......................... 1.35 11.63 NA 0.45 13.43 NA XXX 73721 ......... 26 ....... A Mri jnt of lwr extre w/o dye .......................... 1.35 0.44 0.44 0.06 1.85 1.85 XXX 73721 ......... TC ...... A Mri jnt of lwr extre w/o dye .......................... 0.00 11.19 NA 0.39 11.58 NA XXX 73722 ......... ............ A Mri joint of lwr extr w/dye ............................ 1.62 13.95 NA 0.55 16.12 NA XXX 73722 ......... 26 ....... A Mri joint of lwr extr w/dye ............................ 1.62 0.53 0.53 0.08 2.23 2.23 XXX 73722 ......... TC ...... A Mri joint of lwr extr w/dye ............................ 0.00 13.42 NA 0.47 13.89 NA XXX 73723 ......... ............ A Mri joint lwr extr w/o&w/dye ......................... 2.15 25.55 NA 0.94 28.64 NA XXX 73723 ......... 26 ....... A Mri joint lwr extr w/o&w/dye ......................... 2.15 0.71 0.71 0.10 2.96 2.96 XXX 73723 ......... TC ...... A Mri joint lwr extr w/o&w/dye ......................... 0.00 24.84 NA 0.84 25.68 NA XXX 73725 ......... ............ R Mr ang lwr ext w or w/o dye ........................ 1.82 11.78 NA 0.67 14.27 NA XXX 73725 ......... 26 ....... R Mr ang lwr ext w or w/o dye ........................ 1.82 0.60 0.60 0.08 2.50 2.50 XXX 73725 ......... TC ...... R Mr ang lwr ext w or w/o dye ........................ 0.00 11.19 NA 0.59 11.78 NA XXX 74000 ......... ............ A X-ray exam of abdomen .............................. 0.18 0.58 NA 0.03 0.79 NA XXX 74000 ......... 26 ....... A X-ray exam of abdomen .............................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 74000 ......... TC ...... A X-ray exam of abdomen .............................. 0.00 0.52 NA 0.02 0.54 NA XXX 74010 ......... ............ A X-ray exam of abdomen .............................. 0.23 0.64 NA 0.05 0.92 NA XXX 74010 ......... 26 ....... A X-ray exam of abdomen .............................. 0.23 0.07 0.07 0.01 0.31 0.31 XXX 74010 ......... TC ...... A X-ray exam of abdomen .............................. 0.00 0.57 NA 0.04 0.61 NA XXX 74020 ......... ............ A X-ray exam of abdomen .............................. 0.27 0.71 NA 0.05 1.03 NA XXX 74020 ......... 26 ....... A X-ray exam of abdomen .............................. 0.27 0.09 0.09 0.01 0.37 0.37 XXX 74020 ......... TC ...... A X-ray exam of abdomen .............................. 0.00 0.62 NA 0.04 0.66 NA XXX


## 47658

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

74022 ......... ............ A X-ray exam series, abdomen ...................... 0.32 0.84 NA 0.06 1.22 NA XXX 74022 ......... 26 ....... A X-ray exam series, abdomen ...................... 0.32 0.10 0.10 0.01 0.43 0.43 XXX 74022 ......... TC ...... A X-ray exam series, abdomen ...................... 0.00 0.73 NA 0.05 0.78 NA XXX 74150 ......... ............ A Ct abdomen w/o dye ................................... 1.19 6.03 NA 0.35 7.57 NA XXX 74150 ......... 26 ....... A Ct abdomen w/o dye ................................... 1.19 0.39 0.39 0.05 1.63 1.63 XXX 74150 ......... TC ...... A Ct abdomen w/o dye ................................... 0.00 5.65 NA 0.30 5.95 NA XXX 74160 ......... ............ A Ct abdomen w/dye ....................................... 1.27 7.25 NA 0.42 8.94 NA XXX 74160 ......... 26 ....... A Ct abdomen w/dye ....................................... 1.27 0.41 0.41 0.06 1.74 1.74 XXX 74160 ......... TC ...... A Ct abdomen w/dye ....................................... 0.00 6.83 NA 0.36 7.19 NA XXX 74170 ......... ............ A Ct abdomen w/o &w /dye ............................ 1.40 8.93 NA 0.49 10.82 NA XXX 74170 ......... 26 ....... A Ct abdomen w/o &w /dye ............................ 1.40 0.46 0.46 0.06 1.92 1.92 XXX 74170 ......... TC ...... A Ct abdomen w/o &w /dye ............................ 0.00 8.47 NA 0.43 8.90 NA XXX 74175 ......... ............ A Ct angio abdom w/o & w/dye ...................... 1.90 12.63 NA 0.48 15.01 NA XXX 74175 ......... 26 ....... A Ct angio abdom w/o & w/dye ...................... 1.90 0.62 0.62 0.09 2.61 2.61 XXX 74175 ......... TC ...... A Ct angio abdom w/o & w/dye ...................... 0.00 12.01 NA 0.39 12.40 NA XXX 74181 ......... ............ A Mri abdomen w/o dye .................................. 1.46 11.66 NA 0.52 13.64 NA XXX 74181 ......... 26 ....... A Mri abdomen w/o dye .................................. 1.46 0.48 0.48 0.07 2.01 2.01 XXX 74181 ......... TC ...... A Mri abdomen w/o dye .................................. 0.00 11.19 NA 0.45 11.64 NA XXX 74182 ......... ............ A Mri abdomen w/dye ..................................... 1.73 13.98 NA 0.60 16.31 NA XXX 74182 ......... 26 ....... A Mri abdomen w/dye ..................................... 1.73 0.56 0.56 0.08 2.37 2.37 XXX 74182 ......... TC ...... A Mri abdomen w/dye ..................................... 0.00 13.42 NA 0.52 13.94 NA XXX 74183 ......... ............ A Mri abdomen w/o & w/dye ........................... 2.26 25.58 NA 1.02 28.86 NA XXX 74183 ......... 26 ....... A Mri abdomen w/o & w/dye ........................... 2.26 0.74 0.74 0.10 3.10 3.10 XXX 74183 ......... TC ...... A Mri abdomen w/o & w/dye ........................... 0.00 24.84 NA 0.92 25.76 NA XXX 74185 ......... ............ R Mri angio, abdom w orw/o dye .................... 1.80 11.78 NA 0.67 14.25 NA XXX 74185 ......... 26 ....... R Mri angio, abdom w orw/o dye .................... 1.80 0.59 0.59 0.08 2.47 2.47 XXX 74185 ......... TC ...... R Mri angio, abdom w orw/o dye .................... 0.00 11.19 NA 0.59 11.78 NA XXX 74190 ......... ............ A X-ray exam of peritoneum ........................... 0.48 1.46 NA 0.09 2.03 NA XXX 74190 ......... 26 ....... A X-ray exam of peritoneum ........................... 0.48 0.16 0.16 0.02 0.66 0.66 XXX 74190 ......... TC ...... A X-ray exam of peritoneum ........................... 0.00 1.30 NA 0.07 1.37 NA XXX 74210 ......... ............ A Contrst x-ray exam of throat ........................ 0.36 1.30 NA 0.08 1.74 NA XXX 74210 ......... 26 ....... A Contrst x-ray exam of throat ........................ 0.36 0.12 0.12 0.02 0.50 0.50 XXX 74210 ......... TC ...... A Contrst x-ray exam of throat ........................ 0.00 1.19 NA 0.06 1.25 NA XXX 74220 ......... ............ A Contrast x-ray, esophagus .......................... 0.46 1.34 NA 0.08 1.88 NA XXX 74220 ......... 26 ....... A Contrast x-ray, esophagus .......................... 0.46 0.15 0.15 0.02 0.63 0.63 XXX 74220 ......... TC ...... A Contrast x-ray, esophagus .......................... 0.00 1.19 NA 0.06 1.25 NA XXX 74230 ......... ............ A Cine/vid x-ray, throat/esoph ......................... 0.53 1.48 NA 0.09 2.10 NA XXX 74230 ......... 26 ....... A Cine/vid x-ray, throat/esoph ......................... 0.53 0.17 0.17 0.02 0.72 0.72 XXX 74230 ......... TC ...... A Cine/vid x-ray, throat/esoph ......................... 0.00 1.30 NA 0.07 1.37 NA XXX 74235 ......... ............ A Remove esophagus obstruction .................. 1.19 3.01 NA 0.19 4.39 NA XXX 74235 ......... 26 ....... A Remove esophagus obstruction .................. 1.19 0.39 0.39 0.05 1.63 1.63 XXX 74235 ......... TC ...... A Remove esophagus obstruction .................. 0.00 2.62 NA 0.14 2.76 NA XXX 74240 ......... ............ A X-ray exam, upper gi tract ........................... 0.69 1.68 NA 0.11 2.48 NA XXX 74240 ......... 26 ....... A X-ray exam, upper gi tract ........................... 0.69 0.22 0.22 0.03 0.94 0.94 XXX 74240 ......... TC ...... A X-ray exam, upper gi tract ........................... 0.00 1.46 NA 0.08 1.54 NA XXX 74241 ......... ............ A X-ray exam, upper gi tract ........................... 0.69 1.71 NA 0.11 2.51 NA XXX 74241 ......... 26 ....... A X-ray exam, upper gi tract ........................... 0.69 0.22 0.22 0.03 0.94 0.94 XXX 74241 ......... TC ...... A X-ray exam, upper gi tract ........................... 0.00 1.49 NA 0.08 1.57 NA XXX 74245 ......... ............ A X-ray exam, upper gi tract ........................... 0.91 2.67 NA 0.17 3.75 NA XXX 74245 ......... 26 ....... A X-ray exam, upper gi tract ........................... 0.91 0.30 0.30 0.04 1.25 1.25 XXX 74245 ......... TC ...... A X-ray exam, upper gi tract ........................... 0.00 2.37 NA 0.13 2.50 NA XXX 74246 ......... ............ A Contrst x-ray uppr gi tract ............................ 0.69 1.87 NA 0.13 2.69 NA XXX 74246 ......... 26 ....... A Contrst x-ray uppr gi tract ............................ 0.69 0.23 0.23 0.03 0.95 0.95 XXX 74246 ......... TC ...... A Contrst x-ray uppr gi tract ............................ 0.00 1.64 NA 0.10 1.74 NA XXX 74247 ......... ............ A Contrst x-ray uppr gi tract ............................ 0.69 1.90 NA 0.14 2.73 NA XXX 74247 ......... 26 ....... A Contrst x-ray uppr gi tract ............................ 0.69 0.23 0.23 0.03 0.95 0.95 XXX 74247 ......... TC ...... A Contrst x-ray uppr gi tract ............................ 0.00 1.68 NA 0.11 1.79 NA XXX 74249 ......... ............ A Contrst x-ray uppr gi tract ............................ 0.91 2.86 NA 0.18 3.95 NA XXX 74249 ......... 26 ....... A Contrst x-ray uppr gi tract ............................ 0.91 0.30 0.30 0.04 1.25 1.25 XXX 74249 ......... TC ...... A Contrst x-ray uppr gi tract ............................ 0.00 2.57 NA 0.14 2.71 NA XXX 74250 ......... ............ A X-ray exam of small bowel .......................... 0.47 1.46 NA 0.09 2.02 NA XXX 74250 ......... 26 ....... A X-ray exam of small bowel .......................... 0.47 0.15 0.15 0.02 0.64 0.64 XXX 74250 ......... TC ...... A X-ray exam of small bowel .......................... 0.00 1.30 NA 0.07 1.37 NA XXX 74251 ......... ............ A X-ray exam of small bowel .......................... 0.69 1.53 NA 0.10 2.32 NA XXX 74251 ......... 26 ....... A X-ray exam of small bowel .......................... 0.69 0.22 0.22 0.03 0.94 0.94 XXX 74251 ......... TC ...... A X-ray exam of small bowel .......................... 0.00 1.30 NA 0.07 1.37 NA XXX 74260 ......... ............ A X-ray exam of small bowel .......................... 0.50 1.65 NA 0.10 2.25 NA XXX 74260 ......... 26 ....... A X-ray exam of small bowel .......................... 0.50 0.16 0.16 0.02 0.68 0.68 XXX 74260 ......... TC ...... A X-ray exam of small bowel .......................... 0.00 1.49 NA 0.08 1.57 NA XXX 74270 ......... ............ A Contrast x-ray exam of colon ...................... 0.69 1.92 NA 0.14 2.75 NA XXX 74270 ......... 26 ....... A Contrast x-ray exam of colon ...................... 0.69 0.22 0.22 0.03 0.94 0.94 XXX 74270 ......... TC ...... A Contrast x-ray exam of colon ...................... 0.00 1.70 NA 0.11 1.81 NA XXX 74280 ......... ............ A Contrast x-ray exam of colon ...................... 0.99 2.55 NA 0.17 3.71 NA XXX 74280 ......... 26 ....... A Contrast x-ray exam of colon ...................... 0.99 0.32 0.32 0.04 1.35 1.35 XXX 74280 ......... TC ...... A Contrast x-ray exam of colon ...................... 0.00 2.23 NA 0.13 2.36 NA XXX


## 47659

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

74283 ......... ............ A Contrast x-ray exam of colon ...................... 2.02 3.22 NA 0.23 5.47 NA XXX 74283 ......... 26 ....... A Contrast x-ray exam of colon ...................... 2.02 0.66 0.66 0.09 2.77 2.77 XXX 74283 ......... TC ...... A Contrast x-ray exam of colon ...................... 0.00 2.56 NA 0.14 2.70 NA XXX 74290 ......... ............ A Contrast x-ray, gallbladder .......................... 0.32 0.84 NA 0.06 1.22 NA XXX 74290 ......... 26 ....... A Contrast x-ray, gallbladder .......................... 0.32 0.10 0.10 0.01 0.43 0.43 XXX 74290 ......... TC ...... A Contrast x-ray, gallbladder .......................... 0.00 0.73 NA 0.05 0.78 NA XXX 74291 ......... ............ A Contrast x-rays, gallbladder ......................... 0.20 0.48 NA 0.03 0.71 NA XXX 74291 ......... 26 ....... A Contrast x-rays, gallbladder ......................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX 74291 ......... TC ...... A Contrast x-rays, gallbladder ......................... 0.00 0.42 NA 0.02 0.44 NA XXX 74300 ......... 26 ....... A X-ray bile ducts/pancreas ............................ 0.36 0.12 0.12 0.02 0.50 0.50 XXX 74301 ......... 26 ....... A X-rays at surgery add-on ............................. 0.21 0.07 0.07 0.01 0.29 0.29 ZZZ 74305 ......... ............ A X-ray bile ducts/pancreas ............................ 0.42 0.92 NA 0.07 1.41 NA XXX 74305 ......... 26 ....... A X-ray bile ducts/pancreas ............................ 0.42 0.14 0.14 0.02 0.58 0.58 XXX 74305 ......... TC ...... A X-ray bile ducts/pancreas ............................ 0.00 0.78 NA 0.05 0.83 NA XXX 74320 ......... ............ A Contrast x-ray of bile ducts ......................... 0.54 3.32 NA 0.19 4.05 NA XXX 74320 ......... 26 ....... A Contrast x-ray of bile ducts ......................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 74320 ......... TC ...... A Contrast x-ray of bile ducts ......................... 0.00 3.15 NA 0.17 3.32 NA XXX 74327 ......... ............ A X-ray bile stone removal .............................. 0.70 1.98 NA 0.14 2.82 NA XXX 74327 ......... 26 ....... A X-ray bile stone removal .............................. 0.70 0.23 0.23 0.03 0.96 0.96 XXX 74327 ......... TC ...... A X-ray bile stone removal .............................. 0.00 1.76 NA 0.11 1.87 NA XXX 74328 ......... ............ A X-ray bile duct endoscopy ........................... 0.70 3.38 NA 0.20 4.28 NA XXX 74328 ......... 26 ....... A X-ray bile duct endoscopy ........................... 0.70 0.23 0.23 0.03 0.96 0.96 XXX 74328 ......... TC ...... A X-ray bile duct endoscopy ........................... 0.00 3.15 NA 0.17 3.32 NA XXX 74329 ......... ............ A X-ray for pancreas endoscopy .................... 0.70 3.38 NA 0.20 4.28 NA XXX 74329 ......... 26 ....... A X-ray for pancreas endoscopy .................... 0.70 0.23 0.23 0.03 0.96 0.96 XXX 74329 ......... TC ...... A X-ray for pancreas endoscopy .................... 0.00 3.15 NA 0.17 3.32 NA XXX 74330 ......... ............ A X-ray bile/panc endoscopy .......................... 0.90 3.44 NA 0.21 4.55 NA XXX 74330 ......... 26 ....... A X-ray bile/panc endoscopy .......................... 0.90 0.29 0.29 0.04 1.23 1.23 XXX 74330 ......... TC ...... A X-ray bile/panc endoscopy .......................... 0.00 3.15 NA 0.17 3.32 NA XXX 74340 ......... ............ A X-ray guide for GI tube ................................ 0.54 2.79 NA 0.16 3.49 NA XXX 74340 ......... 26 ....... A X-ray guide for GI tube ................................ 0.54 0.18 0.18 0.02 0.74 0.74 XXX 74340 ......... TC ...... A X-ray guide for GI tube ................................ 0.00 2.62 NA 0.14 2.76 NA XXX 74350 ......... ............ A X-ray guide, stomach tube .......................... 0.76 3.39 NA 0.20 4.35 NA XXX 74350 ......... 26 ....... A X-ray guide, stomach tube .......................... 0.76 0.25 0.25 0.03 1.04 1.04 XXX 74350 ......... TC ...... A X-ray guide, stomach tube .......................... 0.00 3.15 NA 0.17 3.32 NA XXX 74355 ......... ............ A X-ray guide, intestinal tube .......................... 0.76 2.86 NA 0.17 3.79 NA XXX 74355 ......... 26 ....... A X-ray guide, intestinal tube .......................... 0.76 0.25 0.25 0.03 1.04 1.04 XXX 74355 ......... TC ...... A X-ray guide, intestinal tube .......................... 0.00 2.62 NA 0.14 2.76 NA XXX 74360 ......... ............ A X-ray guide, GI dilation ................................ 0.54 3.33 NA 0.19 4.06 NA XXX 74360 ......... 26 ....... A X-ray guide, GI dilation ................................ 0.54 0.19 0.19 0.02 0.75 0.75 XXX 74360 ......... TC ...... A X-ray guide, GI dilation ................................ 0.00 3.15 NA 0.17 3.32 NA XXX 74363 ......... ............ A X-ray, bile duct dilation ................................ 0.88 6.38 NA 0.37 7.63 NA XXX 74363 ......... 26 ....... A X-ray, bile duct dilation ................................ 0.88 0.29 0.29 0.04 1.21 1.21 XXX 74363 ......... TC ...... A X-ray, bile duct dilation ................................ 0.00 6.09 NA 0.33 6.42 NA XXX 74400 ......... ............ A Contrst x-ray, urinary tract ........................... 0.49 1.84 NA 0.13 2.46 NA XXX 74400 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 74400 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 1.68 NA 0.11 1.79 NA XXX 74410 ......... ............ A Contrst x-ray, urinary tract ........................... 0.49 2.11 NA 0.13 2.73 NA XXX 74410 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 74410 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 1.95 NA 0.11 2.06 NA XXX 74415 ......... ............ A Contrst x-ray, urinary tract ........................... 0.49 2.27 NA 0.14 2.90 NA XXX 74415 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 74415 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 2.11 NA 0.12 2.23 NA XXX 74420 ......... ............ A Contrst x-ray, urinary tract ........................... 0.36 2.73 NA 0.16 3.25 NA XXX 74420 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX 74420 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 2.62 NA 0.14 2.76 NA XXX 74425 ......... ............ A Contrst x-ray, urinary tract ........................... 0.36 1.42 NA 0.09 1.87 NA XXX 74425 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX 74425 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 1.30 NA 0.07 1.37 NA XXX 74430 ......... ............ A Contrast x-ray, bladder ................................ 0.32 1.16 NA 0.08 1.56 NA XXX 74430 ......... 26 ....... A Contrast x-ray, bladder ................................ 0.32 0.10 0.10 0.02 0.44 0.44 XXX 74430 ......... TC ...... A Contrast x-ray, bladder ................................ 0.00 1.05 NA 0.06 1.11 NA XXX 74440 ......... ............ A X-ray, male genital tract .............................. 0.38 1.25 NA 0.08 1.71 NA XXX 74440 ......... 26 ....... A X-ray, male genital tract .............................. 0.38 0.12 0.12 0.02 0.52 0.52 XXX 74440 ......... TC ...... A X-ray, male genital tract .............................. 0.00 1.13 NA 0.06 1.19 NA XXX 74445 ......... ............ A X-ray exam of penis .................................... 1.14 1.50 NA 0.12 2.76 NA XXX 74445 ......... 26 ....... A X-ray exam of penis .................................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 74445 ......... TC ...... A X-ray exam of penis .................................... 0.00 1.13 NA 0.06 1.19 NA XXX 74450 ......... ............ A X-ray, urethra/bladder .................................. 0.33 1.56 NA 0.10 1.99 NA XXX 74450 ......... 26 ....... A X-ray, urethra/bladder .................................. 0.33 0.11 0.11 0.02 0.46 0.46 XXX 74450 ......... TC ...... A X-ray, urethra/bladder .................................. 0.00 1.46 NA 0.08 1.54 NA XXX 74455 ......... ............ A X-ray, urethra/bladder .................................. 0.33 1.68 NA 0.12 2.13 NA XXX 74455 ......... 26 ....... A X-ray, urethra/bladder .................................. 0.33 0.11 0.11 0.02 0.46 0.46 XXX 74455 ......... TC ...... A X-ray, urethra/bladder .................................. 0.00 1.57 NA 0.10 1.67 NA XXX 74470 ......... ............ A X-ray exam of kidney lesion ........................ 0.54 1.42 NA 0.10 2.06 NA XXX


## 47660

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

74470 ......... 26 ....... A X-ray exam of kidney lesion ........................ 0.54 0.18 0.18 0.03 0.75 0.75 XXX 74470 ......... TC ...... A X-ray exam of kidney lesion ........................ 0.00 1.25 NA 0.07 1.32 NA XXX 74475 ......... ............ A X-ray control, cath insert ............................. 0.54 4.24 NA 0.24 5.02 NA XXX 74475 ......... 26 ....... A X-ray control, cath insert ............................. 0.54 0.18 0.18 0.02 0.74 0.74 XXX 74475 ......... TC ...... A X-ray control, cath insert ............................. 0.00 4.06 NA 0.22 4.28 NA XXX 74480 ......... ............ A X-ray control, cath insert ............................. 0.54 4.24 NA 0.24 5.02 NA XXX 74480 ......... 26 ....... A X-ray control, cath insert ............................. 0.54 0.18 0.18 0.02 0.74 0.74 XXX 74480 ......... TC ...... A X-ray control, cath insert ............................. 0.00 4.06 NA 0.22 4.28 NA XXX 74485 ......... ............ A X-ray guide, GU dilation .............................. 0.54 3.32 NA 0.20 4.06 NA XXX 74485 ......... 26 ....... A X-ray guide, GU dilation .............................. 0.54 0.17 0.17 0.03 0.74 0.74 XXX 74485 ......... TC ...... A X-ray guide, GU dilation .............................. 0.00 3.15 NA 0.17 3.32 NA XXX 74710 ......... ............ A X-ray measurement of pelvis ....................... 0.34 1.16 NA 0.08 1.58 NA XXX 74710 ......... 26 ....... A X-ray measurement of pelvis ....................... 0.34 0.11 0.11 0.02 0.47 0.47 XXX 74710 ......... TC ...... A X-ray measurement of pelvis ....................... 0.00 1.05 NA 0.06 1.11 NA XXX 74740 ......... ............ A X-ray, female genital tract ........................... 0.38 1.43 NA 0.09 1.90 NA XXX 74740 ......... 26 ....... A X-ray, female genital tract ........................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 74740 ......... TC ...... A X-ray, female genital tract ........................... 0.00 1.30 NA 0.07 1.37 NA XXX 74742 ......... ............ A X-ray, fallopian tube ..................................... 0.61 3.35 NA 0.20 4.16 NA XXX 74742 ......... 26 ....... A X-ray, fallopian tube ..................................... 0.61 0.20 0.20 0.03 0.84 0.84 XXX 74742 ......... TC ...... A X-ray, fallopian tube ..................................... 0.00 3.15 NA 0.17 3.32 NA XXX 74775 ......... ............ A X-ray exam of perineum .............................. 0.62 1.66 NA 0.11 2.39 NA XXX 74775 ......... 26 ....... A X-ray exam of perineum .............................. 0.62 0.21 0.21 0.03 0.86 0.86 XXX 74775 ......... TC ...... A X-ray exam of perineum .............................. 0.00 1.46 NA 0.08 1.54 NA XXX 75552 ......... ............ A Heart mri for morph w/o dye ....................... 1.60 11.71 NA 0.66 13.97 NA XXX 75552 ......... 26 ....... A Heart mri for morph w/o dye ....................... 1.60 0.53 0.53 0.07 2.20 2.20 XXX 75552 ......... TC ...... A Heart mri for morph w/o dye ....................... 0.00 11.19 NA 0.59 11.78 NA XXX 75553 ......... ............ A Heart mri for morph w/dye ........................... 2.00 11.84 NA 0.68 14.52 NA XXX 75553 ......... 26 ....... A Heart mri for morph w/dye ........................... 2.00 0.65 0.65 0.09 2.74 2.74 XXX 75553 ......... TC ...... A Heart mri for morph w/dye ........................... 0.00 11.19 NA 0.59 11.78 NA XXX 75554 ......... ............ A Cardiac MRI/function ................................... 1.83 11.83 NA 0.66 14.32 NA XXX 75554 ......... 26 ....... A Cardiac MRI/function ................................... 1.83 0.64 0.64 0.07 2.54 2.54 XXX 75554 ......... TC ...... A Cardiac MRI/function ................................... 0.00 11.19 NA 0.59 11.78 NA XXX 75555 ......... ............ A Cardiac MRI/limited study ............................ 1.74 11.82 NA 0.66 14.22 NA XXX 75555 ......... 26 ....... A Cardiac MRI/limited study ............................ 1.74 0.64 0.64 0.07 2.45 2.45 XXX 75555 ......... TC ...... A Cardiac MRI/limited study ............................ 0.00 11.19 NA 0.59 11.78 NA XXX 75600 ......... ............ A Contrast x-ray exam of aorta ....................... 0.49 12.76 NA 0.67 13.92 NA XXX 75600 ......... 26 ....... A Contrast x-ray exam of aorta ....................... 0.49 0.19 0.19 0.02 0.70 0.70 XXX 75600 ......... TC ...... A Contrast x-ray exam of aorta ....................... 0.00 12.58 NA 0.65 13.23 NA XXX 75605 ......... ............ A Contrast x-ray exam of aorta ....................... 1.14 12.97 NA 0.70 14.81 NA XXX 75605 ......... 26 ....... A Contrast x-ray exam of aorta ....................... 1.14 0.40 0.40 0.05 1.59 1.59 XXX 75605 ......... TC ...... A Contrast x-ray exam of aorta ....................... 0.00 12.58 NA 0.65 13.23 NA XXX 75625 ......... ............ A Contrast x-ray exam of aorta ....................... 1.14 12.95 NA 0.71 14.80 NA XXX 75625 ......... 26 ....... A Contrast x-ray exam of aorta ....................... 1.14 0.38 0.38 0.06 1.58 1.58 XXX 75625 ......... TC ...... A Contrast x-ray exam of aorta ....................... 0.00 12.58 NA 0.65 13.23 NA XXX 75630 ......... ............ A X-ray aorta, leg arteries ............................... 1.79 13.72 NA 0.79 16.30 NA XXX 75630 ......... 26 ....... A X-ray aorta, leg arteries ............................... 1.79 0.61 0.61 0.10 2.50 2.50 XXX 75630 ......... TC ...... A X-ray aorta, leg arteries ............................... 0.00 13.11 NA 0.69 13.80 NA XXX 75635 ......... ............ A Ct angio abdominal arteries ........................ 2.40 16.68 NA 0.50 19.58 NA XXX 75635 ......... 26 ....... A Ct angio abdominal arteries ........................ 2.40 0.79 0.79 0.11 3.30 3.30 XXX 75635 ......... TC ...... A Ct angio abdominal arteries ........................ 0.00 15.89 NA 0.39 16.28 NA XXX 75650 ......... ............ A Artery x-rays, head & neck .......................... 1.49 13.07 NA 0.72 15.28 NA XXX 75650 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.49 0.49 0.49 0.07 2.05 2.05 XXX 75650 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.58 NA 0.65 13.23 NA XXX 75658 ......... ............ A Artery x-rays, arm ........................................ 1.31 13.05 NA 0.72 15.08 NA XXX 75658 ......... 26 ....... A Artery x-rays, arm ........................................ 1.31 0.47 0.47 0.07 1.85 1.85 XXX 75658 ......... TC ...... A Artery x-rays, arm ........................................ 0.00 12.58 NA 0.65 13.23 NA XXX 75660 ......... ............ A Artery x-rays, head & neck .......................... 1.31 13.02 NA 0.72 15.05 NA XXX 75660 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.31 0.44 0.44 0.07 1.82 1.82 XXX 75660 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.58 NA 0.65 13.23 NA XXX 75662 ......... ............ A Artery x-rays, head & neck .......................... 1.66 13.17 NA 0.73 15.56 NA XXX 75662 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.66 0.59 0.59 0.08 2.33 2.33 XXX 75662 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.58 NA 0.65 13.23 NA XXX 75665 ......... ............ A Artery x-rays, head & neck .......................... 1.31 13.01 NA 0.74 15.06 NA XXX 75665 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.31 0.44 0.44 0.09 1.84 1.84 XXX 75665 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.58 NA 0.65 13.23 NA XXX 75671 ......... ............ A Artery x-rays, head & neck .......................... 1.66 13.12 NA 0.73 15.51 NA XXX 75671 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.66 0.55 0.55 0.08 2.29 2.29 XXX 75671 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.58 NA 0.65 13.23 NA XXX 75676 ......... ............ A Artery x-rays, neck ....................................... 1.31 13.01 NA 0.73 15.05 NA XXX 75676 ......... 26 ....... A Artery x-rays, neck ....................................... 1.31 0.44 0.44 0.08 1.83 1.83 XXX 75676 ......... TC ...... A Artery x-rays, neck ....................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75680 ......... ............ A Artery x-rays, neck ....................................... 1.66 13.12 NA 0.73 15.51 NA XXX 75680 ......... 26 ....... A Artery x-rays, neck ....................................... 1.66 0.55 0.55 0.08 2.29 2.29 XXX 75680 ......... TC ...... A Artery x-rays, neck ....................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75685 ......... ............ A Artery x-rays, spine ...................................... 1.31 13.01 NA 0.72 15.04 NA XXX


## 47661

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

75685 ......... 26 ....... A Artery x-rays, spine ...................................... 1.31 0.43 0.43 0.07 1.81 1.81 XXX 75685 ......... TC ...... A Artery x-rays, spine ...................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75705 ......... ............ A Artery x-rays, spine ...................................... 2.18 13.31 NA 0.78 16.27 NA XXX 75705 ......... 26 ....... A Artery x-rays, spine ...................................... 2.18 0.73 0.73 0.13 3.04 3.04 XXX 75705 ......... TC ...... A Artery x-rays, spine ...................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75710 ......... ............ A Artery x-rays, arm/leg .................................. 1.14 12.96 NA 0.71 14.81 NA XXX 75710 ......... 26 ....... A Artery x-rays, arm/leg .................................. 1.14 0.39 0.39 0.06 1.59 1.59 XXX 75710 ......... TC ...... A Artery x-rays, arm/leg .................................. 0.00 12.58 NA 0.65 13.23 NA XXX 75716 ......... ............ A Artery x-rays, arms/legs ............................... 1.31 13.01 NA 0.72 15.04 NA XXX 75716 ......... 26 ....... A Artery x-rays, arms/legs ............................... 1.31 0.43 0.43 0.07 1.81 1.81 XXX 75716 ......... TC ...... A Artery x-rays, arms/legs ............................... 0.00 12.58 NA 0.65 13.23 NA XXX 75722 ......... ............ A Artery x-rays, kidney .................................... 1.14 12.97 NA 0.71 14.82 NA XXX 75722 ......... 26 ....... A Artery x-rays, kidney .................................... 1.14 0.40 0.40 0.06 1.60 1.60 XXX 75722 ......... TC ...... A Artery x-rays, kidney .................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75724 ......... ............ A Artery x-rays, kidneys .................................. 1.49 13.13 NA 0.71 15.33 NA XXX 75724 ......... 26 ....... A Artery x-rays, kidneys .................................. 1.49 0.56 0.56 0.06 2.11 2.11 XXX 75724 ......... TC ...... A Artery x-rays, kidneys .................................. 0.00 12.58 NA 0.65 13.23 NA XXX 75726 ......... ............ A Artery x-rays, abdomen ............................... 1.14 12.95 NA 0.70 14.79 NA XXX 75726 ......... 26 ....... A Artery x-rays, abdomen ............................... 1.14 0.37 0.37 0.05 1.56 1.56 XXX 75726 ......... TC ...... A Artery x-rays, abdomen ............................... 0.00 12.58 NA 0.65 13.23 NA XXX 75731 ......... ............ A Artery x-rays, adrenal gland ........................ 1.14 12.95 NA 0.70 14.79 NA XXX 75731 ......... 26 ....... A Artery x-rays, adrenal gland ........................ 1.14 0.37 0.37 0.05 1.56 1.56 XXX 75731 ......... TC ...... A Artery x-rays, adrenal gland ........................ 0.00 12.58 NA 0.65 13.23 NA XXX 75733 ......... ............ A Artery x-rays, adrenals ................................ 1.31 13.01 NA 0.70 15.02 NA XXX 75733 ......... 26 ....... A Artery x-rays, adrenals ................................ 1.31 0.43 0.43 0.05 1.79 1.79 XXX 75733 ......... TC ...... A Artery x-rays, adrenals ................................ 0.00 12.58 NA 0.65 13.23 NA XXX 75736 ......... ............ A Artery x-rays, pelvis ..................................... 1.14 12.95 NA 0.71 14.80 NA XXX 75736 ......... 26 ....... A Artery x-rays, pelvis ..................................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 75736 ......... TC ...... A Artery x-rays, pelvis ..................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75741 ......... ............ A Artery x-rays, lung ....................................... 1.31 13.01 NA 0.71 15.03 NA XXX 75741 ......... 26 ....... A Artery x-rays, lung ....................................... 1.31 0.43 0.43 0.06 1.80 1.80 XXX 75741 ......... TC ...... A Artery x-rays, lung ....................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75743 ......... ............ A Artery x-rays, lungs ...................................... 1.66 13.12 NA 0.73 15.51 NA XXX 75743 ......... 26 ....... A Artery x-rays, lungs ...................................... 1.66 0.54 0.54 0.08 2.28 2.28 XXX 75743 ......... TC ...... A Artery x-rays, lungs ...................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75746 ......... ............ A Artery x-rays, lung ....................................... 1.14 12.95 NA 0.70 14.79 NA XXX 75746 ......... 26 ....... A Artery x-rays, lung ....................................... 1.14 0.38 0.38 0.05 1.57 1.57 XXX 75746 ......... TC ...... A Artery x-rays, lung ....................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75756 ......... ............ A Artery x-rays, chest ...................................... 1.14 13.02 NA 0.69 14.85 NA XXX 75756 ......... 26 ....... A Artery x-rays, chest ...................................... 1.14 0.45 0.45 0.04 1.63 1.63 XXX 75756 ......... TC ...... A Artery x-rays, chest ...................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75774 ......... ............ A Artery x-ray, each vessel ............................. 0.36 12.70 NA 0.67 13.73 NA ZZZ 75774 ......... 26 ....... A Artery x-ray, each vessel ............................. 0.36 0.12 0.12 0.02 0.50 0.50 ZZZ 75774 ......... TC ...... A Artery x-ray, each vessel ............................. 0.00 12.58 NA 0.65 13.23 NA ZZZ
75790 ......... ............ A Visualize A-V shunt ..................................... 1.84 1.95 NA 0.18 3.97 NA XXX 75790 ......... 26 ....... A Visualize A-V shunt ..................................... 1.84 0.60 0.60 0.10 2.54 2.54 XXX 75790 ......... TC ...... A Visualize A-V shunt ..................................... 0.00 1.35 NA 0.08 1.43 NA XXX 75801 ......... ............ A Lymph vessel x-ray, arm/leg ....................... 0.81 5.67 NA 0.37 6.85 NA XXX 75801 ......... 26 ....... A Lymph vessel x-ray, arm/leg ....................... 0.81 0.27 0.27 0.08 1.16 1.16 XXX 75801 ......... TC ...... A Lymph vessel x-ray, arm/leg ....................... 0.00 5.40 NA 0.29 5.69 NA XXX 75803 ......... ............ A Lymph vessel x-ray,arms/legs ..................... 1.17 5.79 NA 0.34 7.30 NA XXX 75803 ......... 26 ....... A Lymph vessel x-ray,arms/legs ..................... 1.17 0.38 0.38 0.05 1.60 1.60 XXX 75803 ......... TC ...... A Lymph vessel x-ray,arms/legs ..................... 0.00 5.40 NA 0.29 5.69 NA XXX 75805 ......... ............ A Lymph vessel x-ray, trunk ........................... 0.81 6.36 NA 0.38 7.55 NA XXX 75805 ......... 26 ....... A Lymph vessel x-ray, trunk ........................... 0.81 0.27 0.27 0.05 1.13 1.13 XXX 75805 ......... TC ...... A Lymph vessel x-ray, trunk ........................... 0.00 6.09 NA 0.33 6.42 NA XXX 75807 ......... ............ A Lymph vessel x-ray, trunk ........................... 1.17 6.47 NA 0.39 8.03 NA XXX 75807 ......... 26 ....... A Lymph vessel x-ray, trunk ........................... 1.17 0.38 0.38 0.06 1.61 1.61 XXX 75807 ......... TC ...... A Lymph vessel x-ray, trunk ........................... 0.00 6.09 NA 0.33 6.42 NA XXX 75809 ......... ............ A Nonvascular shunt, x-ray ............................. 0.47 0.94 NA 0.07 1.48 NA XXX 75809 ......... 26 ....... A Nonvascular shunt, x-ray ............................. 0.47 0.15 0.15 0.02 0.64 0.64 XXX 75809 ......... TC ...... A Nonvascular shunt, x-ray ............................. 0.00 0.78 NA 0.05 0.83 NA XXX 75810 ......... ............ A Vein x-ray, spleen/liver ................................ 1.14 12.95 NA 0.70 14.79 NA XXX 75810 ......... 26 ....... A Vein x-ray, spleen/liver ................................ 1.14 0.37 0.37 0.05 1.56 1.56 XXX 75810 ......... TC ...... A Vein x-ray, spleen/liver ................................ 0.00 12.58 NA 0.65 13.23 NA XXX 75820 ......... ............ A Vein x-ray, arm/leg ...................................... 0.70 1.17 NA 0.10 1.97 NA XXX 75820 ......... 26 ....... A Vein x-ray, arm/leg ...................................... 0.70 0.23 0.23 0.04 0.97 0.97 XXX 75820 ......... TC ...... A Vein x-ray, arm/leg ...................................... 0.00 0.95 NA 0.06 1.01 NA XXX 75822 ......... ............ A Vein x-ray, arms/legs ................................... 1.06 1.82 NA 0.13 3.01 NA XXX 75822 ......... 26 ....... A Vein x-ray, arms/legs ................................... 1.06 0.35 0.35 0.05 1.46 1.46 XXX 75822 ......... TC ...... A Vein x-ray, arms/legs ................................... 0.00 1.48 NA 0.08 1.56 NA XXX 75825 ......... ............ A Vein x-ray, trunk .......................................... 1.14 12.95 NA 0.72 14.81 NA XXX 75825 ......... 26 ....... A Vein x-ray, trunk .......................................... 1.14 0.37 0.37 0.07 1.58 1.58 XXX 75825 ......... TC ...... A Vein x-ray, trunk .......................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75827 ......... ............ A Vein x-ray, chest .......................................... 1.14 12.95 NA 0.71 14.80 NA XXX


## 47662

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

75827 ......... 26 ....... A Vein x-ray, chest .......................................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 75827 ......... TC ...... A Vein x-ray, chest .......................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75831 ......... ............ A Vein x-ray, kidney ........................................ 1.14 12.94 NA 0.70 14.78 NA XXX 75831 ......... 26 ....... A Vein x-ray, kidney ........................................ 1.14 0.37 0.37 0.06 1.57 1.57 XXX 75831 ......... TC ...... A Vein x-ray, kidney ........................................ 0.00 12.58 NA 0.65 13.23 NA XXX 75833 ......... ............ A Vein x-ray, kidneys ...................................... 1.49 13.06 NA 0.73 15.28 NA XXX 75833 ......... 26 ....... A Vein x-ray, kidneys ...................................... 1.49 0.49 0.49 0.08 2.06 2.06 XXX 75833 ......... TC ...... A Vein x-ray, kidneys ...................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75840 ......... ............ A Vein x-ray, adrenal gland ............................ 1.14 12.95 NA 0.70 14.79 NA XXX 75840 ......... 26 ....... A Vein x-ray, adrenal gland ............................ 1.14 0.38 0.38 0.05 1.57 1.57 XXX 75840 ......... TC ...... A Vein x-ray, adrenal gland ............................ 0.00 12.58 NA 0.65 13.23 NA XXX 75842 ......... ............ A Vein x-ray, adrenal glands ........................... 1.49 13.06 NA 0.73 15.28 NA XXX 75842 ......... 26 ....... A Vein x-ray, adrenal glands ........................... 1.49 0.48 0.48 0.08 2.05 2.05 XXX 75842 ......... TC ...... A Vein x-ray, adrenal glands ........................... 0.00 12.58 NA 0.65 13.23 NA XXX 75860 ......... ............ A Vein x-ray, neck ........................................... 1.14 12.97 NA 0.70 14.81 NA XXX 75860 ......... 26 ....... A Vein x-ray, neck ........................................... 1.14 0.39 0.39 0.05 1.58 1.58 XXX 75860 ......... TC ...... A Vein x-ray, neck ........................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75870 ......... ............ A Vein x-ray, skull ........................................... 1.14 12.96 NA 0.71 14.81 NA XXX 75870 ......... 26 ....... A Vein x-ray, skull ........................................... 1.14 0.39 0.39 0.06 1.59 1.59 XXX 75870 ......... TC ...... A Vein x-ray, skull ........................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75872 ......... ............ A Vein x-ray, skull ........................................... 1.14 12.95 NA 0.76 14.85 NA XXX 75872 ......... 26 ....... A Vein x-ray, skull ........................................... 1.14 0.37 0.37 0.11 1.62 1.62 XXX 75872 ......... TC ...... A Vein x-ray, skull ........................................... 0.00 12.58 NA 0.65 13.23 NA XXX 75880 ......... ............ A Vein x-ray, eye socket ................................. 0.70 1.18 NA 0.10 1.98 NA XXX 75880 ......... 26 ....... A Vein x-ray, eye socket ................................. 0.70 0.23 0.23 0.04 0.97 0.97 XXX 75880 ......... TC ...... A Vein x-ray, eye socket ................................. 0.00 0.95 NA 0.06 1.01 NA XXX 75885 ......... ............ A Vein x-ray, liver ............................................ 1.44 13.04 NA 0.72 15.20 NA XXX 75885 ......... 26 ....... A Vein x-ray, liver ............................................ 1.44 0.47 0.47 0.07 1.98 1.98 XXX 75885 ......... TC ...... A Vein x-ray, liver ............................................ 0.00 12.58 NA 0.65 13.23 NA XXX 75887 ......... ............ A Vein x-ray, liver ............................................ 1.44 13.04 NA 0.72 15.20 NA XXX 75887 ......... 26 ....... A Vein x-ray, liver ............................................ 1.44 0.47 0.47 0.07 1.98 1.98 XXX 75887 ......... TC ...... A Vein x-ray, liver ............................................ 0.00 12.58 NA 0.65 13.23 NA XXX 75889 ......... ............ A Vein x-ray, liver ............................................ 1.14 12.95 NA 0.70 14.79 NA XXX 75889 ......... 26 ....... A Vein x-ray, liver ............................................ 1.14 0.37 0.37 0.05 1.56 1.56 XXX 75889 ......... TC ...... A Vein x-ray, liver ............................................ 0.00 12.58 NA 0.65 13.23 NA XXX 75891 ......... ............ A Vein x-ray, liver ............................................ 1.14 12.95 NA 0.70 14.79 NA XXX 75891 ......... 26 ....... A Vein x-ray, liver ............................................ 1.14 0.37 0.37 0.05 1.56 1.56 XXX 75891 ......... TC ...... A Vein x-ray, liver ............................................ 0.00 12.58 NA 0.65 13.23 NA XXX 75893 ......... ............ A Venous sampling by catheter ...................... 0.54 12.75 NA 0.68 13.97 NA XXX 75893 ......... 26 ....... A Venous sampling by catheter ...................... 0.54 0.18 0.18 0.03 0.75 0.75 XXX 75893 ......... TC ...... A Venous sampling by catheter ...................... 0.00 12.58 NA 0.65 13.23 NA XXX 75894 ......... ............ A X-rays, transcath therapy ............................ 1.31 24.52 NA 1.35 27.18 NA XXX 75894 ......... 26 ....... A X-rays, transcath therapy ............................ 1.31 0.43 0.43 0.08 1.82 1.82 XXX 75894 ......... TC ...... A X-rays, transcath therapy ............................ 0.00 24.09 NA 1.27 25.36 NA XXX 75896 ......... ............ A X-rays, transcath therapy ............................ 1.31 21.40 NA 1.16 23.87 NA XXX 75896 ......... 26 ....... A X-rays, transcath therapy ............................ 1.31 0.45 0.45 0.06 1.82 1.82 XXX 75896 ......... TC ...... A X-rays, transcath therapy ............................ 0.00 20.95 NA 1.10 22.05 NA XXX 75898 ......... ............ A Follow-up angiography ................................ 1.65 1.60 NA 0.14 3.39 NA XXX 75898 ......... 26 ....... A Follow-up angiography ................................ 1.65 0.55 0.55 0.08 2.28 2.28 XXX 75898 ......... TC ...... A Follow-up angiography ................................ 0.00 1.05 NA 0.06 1.11 NA XXX 75900 ......... ............ A Arterial catheter exchange ........................... 0.49 21.09 NA 1.14 22.72 NA XXX 75900 ......... 26 ....... A Arterial catheter exchange ........................... 0.49 0.16 0.16 0.03 0.68 0.68 XXX 75900 ......... TC ...... A Arterial catheter exchange ........................... 0.00 20.93 NA 1.11 22.04 NA XXX
75901 ......... ............ A Remove cva device obstruct ....................... 0.49 1.46 NA 1.04 2.99 NA XXX 75901 ......... 26 ....... A Remove cva device obstruct ....................... 0.49 0.16 0.16 0.21 0.86 0.86 XXX 75901 ......... TC ...... A Remove cva device obstruct ....................... 0.00 1.30 NA 0.83 2.13 NA XXX
75902 ......... ............ A Remove cva lumen obstruct ........................ 0.39 1.43 NA 0.86 2.68 NA XXX 75902 ......... 26 ....... A Remove cva lumen obstruct ........................ 0.39 0.13 0.13 0.03 0.55 0.55 XXX 75902 ......... TC ...... A Remove cva lumen obstruct ........................ 0.00 1.30 NA 0.83 2.13 NA XXX 75940 ......... ............ A X-ray placement, vein filter .......................... 0.54 12.75 NA 0.68 13.97 NA XXX 75940 ......... 26 ....... A X-ray placement, vein filter .......................... 0.54 0.18 0.18 0.03 0.75 0.75 XXX 75940 ......... TC ...... A X-ray placement, vein filter .......................... 0.00 12.58 NA 0.65 13.23 NA XXX
75945 ......... ............ A Intravascular us ........................................... 0.40 4.70 NA 0.27 5.37 NA XXX
75945 ......... 26 ....... A Intravascular us ........................................... 0.40 0.14 0.14 0.03 0.57 0.57 XXX 75945 ......... TC ...... A Intravascular us ........................................... 0.00 4.56 NA 0.24 4.80 NA XXX
75946 ......... ............ A Intravascular us add-on ............................... 0.40 2.42 NA 0.18 3.00 NA ZZZ
75946 ......... 26 ....... A Intravascular us add-on ............................... 0.40 0.14 0.14 0.05 0.59 0.59 ZZZ 75946 ......... TC ...... A Intravascular us add-on ............................... 0.00 2.29 NA 0.13 2.42 NA ZZZ 75952 ......... 26 ....... A Endovasc repair abdom aorta ..................... 4.49 1.49 1.49 0.43 6.41 6.41 XXX 75953 ......... 26 ....... A Abdom aneurysm endovas rpr .................... 1.36 0.45 0.45 0.13 1.94 1.94 XXX 75954 ......... 26 ....... A Iliac aneurysm endovas rpr ......................... 2.25 0.77 0.77 0.05 3.07 3.07 XXX 75960 ......... ............ A Transcatheter intro, stent ............................. 0.82 15.16 NA 0.82 16.80 NA XXX 75960 ......... 26 ....... A Transcatheter intro, stent ............................. 0.82 0.28 0.28 0.05 1.15 1.15 XXX 75960 ......... TC ...... A Transcatheter intro, stent ............................. 0.00 14.87 NA 0.77 15.64 NA XXX 75961 ......... ............ A Retrieval, broken catheter ........................... 4.24 11.87 NA 0.76 16.87 NA XXX


## 47663

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

75961 ......... 26 ....... A Retrieval, broken catheter ........................... 4.24 1.39 1.39 0.21 5.84 5.84 XXX 75961 ......... TC ...... A Retrieval, broken catheter ........................... 0.00 10.48 NA 0.55 11.03 NA XXX 75962 ......... ............ A Repair arterial blockage ............................... 0.54 15.90 NA 0.86 17.30 NA XXX 75962 ......... 26 ....... A Repair arterial blockage ............................... 0.54 0.18 0.18 0.03 0.75 0.75 XXX 75962 ......... TC ...... A Repair arterial blockage ............................... 0.00 15.71 NA 0.83 16.54 NA XXX 75964 ......... ............ A Repair artery blockage, each ...................... 0.36 8.50 NA 0.45 9.31 NA ZZZ 75964 ......... 26 ....... A Repair artery blockage, each ...................... 0.36 0.12 0.12 0.02 0.50 0.50 ZZZ 75964 ......... TC ...... A Repair artery blockage, each ...................... 0.00 8.38 NA 0.43 8.81 NA ZZZ 75966 ......... ............ A Repair arterial blockage ............................... 1.31 16.18 NA 0.89 18.38 NA XXX 75966 ......... 26 ....... A Repair arterial blockage ............................... 1.31 0.46 0.46 0.06 1.83 1.83 XXX 75966 ......... TC ...... A Repair arterial blockage ............................... 0.00 15.71 NA 0.83 16.54 NA XXX 75968 ......... ............ A Repair artery blockage, each ...................... 0.36 8.51 NA 0.45 9.32 NA ZZZ 75968 ......... 26 ....... A Repair artery blockage, each ...................... 0.36 0.13 0.13 0.02 0.51 0.51 ZZZ 75968 ......... TC ...... A Repair artery blockage, each ...................... 0.00 8.38 NA 0.43 8.81 NA ZZZ 75970 ......... ............ A Vascular biopsy ........................................... 0.83 11.80 NA 0.64 13.27 NA XXX 75970 ......... 26 ....... A Vascular biopsy ........................................... 0.83 0.28 0.28 0.04 1.15 1.15 XXX 75970 ......... TC ...... A Vascular biopsy ........................................... 0.00 11.52 NA 0.60 12.12 NA XXX 75978 ......... ............ A Repair venous blockage .............................. 0.54 15.89 NA 0.86 17.29 NA XXX 75978 ......... 26 ....... A Repair venous blockage .............................. 0.54 0.18 0.18 0.03 0.75 0.75 XXX 75978 ......... TC ...... A Repair venous blockage .............................. 0.00 15.71 NA 0.83 16.54 NA XXX 75980 ......... ............ A Contrast xray exam bile duct ....................... 1.44 5.87 NA 0.36 7.67 NA XXX 75980 ......... 26 ....... A Contrast xray exam bile duct ....................... 1.44 0.47 0.47 0.07 1.98 1.98 XXX 75980 ......... TC ...... A Contrast xray exam bile duct ....................... 0.00 5.40 NA 0.29 5.69 NA XXX 75982 ......... ............ A Contrast xray exam bile duct ....................... 1.44 6.56 NA 0.40 8.40 NA XXX 75982 ......... 26 ....... A Contrast xray exam bile duct ....................... 1.44 0.47 0.47 0.07 1.98 1.98 XXX 75982 ......... TC ...... A Contrast xray exam bile duct ....................... 0.00 6.09 NA 0.33 6.42 NA XXX 75984 ......... ............ A Xray control catheter change ...................... 0.72 2.18 NA 0.14 3.04 NA XXX 75984 ......... 26 ....... A Xray control catheter change ...................... 0.72 0.23 0.23 0.03 0.98 0.98 XXX 75984 ......... TC ...... A Xray control catheter change ...................... 0.00 1.95 NA 0.11 2.06 NA XXX 75989 ......... ............ A Abscess drainage under x-ray ..................... 1.19 3.53 NA 0.22 4.94 NA XXX 75989 ......... 26 ....... A Abscess drainage under x-ray ..................... 1.19 0.39 0.39 0.05 1.63 1.63 XXX 75989 ......... TC ...... A Abscess drainage under x-ray ..................... 0.00 3.15 NA 0.17 3.32 NA XXX 75992 ......... ............ A Atherectomy, x-ray exam ............................. 0.54 15.90 NA 0.86 17.30 NA XXX 75992 ......... 26 ....... A Atherectomy, x-ray exam ............................. 0.54 0.19 0.19 0.03 0.76 0.76 XXX 75992 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 15.71 NA 0.83 16.54 NA XXX 75993 ......... ............ A Atherectomy, x-ray exam ............................. 0.36 8.51 NA 0.45 9.32 NA ZZZ 75993 ......... 26 ....... A Atherectomy, x-ray exam ............................. 0.36 0.13 0.13 0.02 0.51 0.51 ZZZ 75993 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 8.38 NA 0.43 8.81 NA ZZZ 75994 ......... ............ A Atherectomy, x-ray exam ............................. 1.31 16.18 NA 0.87 18.36 NA XXX 75994 ......... 26 ....... A Atherectomy, x-ray exam ............................. 1.31 0.46 0.46 0.04 1.81 1.81 XXX 75994 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 15.71 NA 0.83 16.54 NA XXX 75995 ......... ............ A Atherectomy, x-ray exam ............................. 1.31 16.18 NA 0.91 18.40 NA XXX 75995 ......... 26 ....... A Atherectomy, x-ray exam ............................. 1.31 0.47 0.47 0.08 1.86 1.86 XXX 75995 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 15.71 NA 0.83 16.54 NA XXX 75996 ......... ............ A Atherectomy, x-ray exam ............................. 0.36 8.50 NA 0.44 9.30 NA ZZZ 75996 ......... 26 ....... A Atherectomy, x-ray exam ............................. 0.36 0.12 0.12 0.01 0.49 0.49 ZZZ 75996 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 8.38 NA 0.43 8.81 NA ZZZ 75998 ......... ............ A Fluoroguide for vein device ......................... 0.38 1.43 NA 0.11 1.92 NA ZZZ 75998 ......... 26 ....... A Fluoroguide for vein device ......................... 0.38 0.13 0.13 0.01 0.52 0.52 ZZZ 75998 ......... TC ...... A Fluoroguide for vein device ......................... 0.00 1.30 NA 0.10 1.40 NA ZZZ 76000 ......... ............ A Fluoroscope examination ............................. 0.17 1.36 NA 0.08 1.61 NA XXX 76000 ......... 26 ....... A Fluoroscope examination ............................. 0.17 0.05 0.05 0.01 0.23 0.23 XXX 76000 ......... TC ...... A Fluoroscope examination ............................. 0.00 1.30 NA 0.07 1.37 NA XXX 76001 ......... ............ A Fluoroscope exam, extensive ...................... 0.67 2.84 NA 0.18 3.69 NA XXX 76001 ......... 26 ....... A Fluoroscope exam, extensive ...................... 0.67 0.22 0.22 0.04 0.93 0.93 XXX 76001 ......... TC ...... A Fluoroscope exam, extensive ...................... 0.00 2.62 NA 0.14 2.76 NA XXX 76003 ......... ............ A Needle localization by x-ray ........................ 0.54 1.47 NA 0.10 2.11 NA XXX 76003 ......... 26 ....... A Needle localization by x-ray ........................ 0.54 0.17 0.17 0.03 0.74 0.74 XXX 76003 ......... TC ...... A Needle localization by x-ray ........................ 0.00 1.30 NA 0.07 1.37 NA XXX 76005 ......... ............ A Fluoroguide for spine inject ......................... 0.60 1.46 NA 0.11 2.17 NA XXX 76005 ......... 26 ....... A Fluoroguide for spine inject ......................... 0.60 0.15 0.15 0.04 0.79 0.79 XXX 76005 ......... TC ...... A Fluoroguide for spine inject ......................... 0.00 1.30 NA 0.07 1.37 NA XXX 76006 ......... ............ A X-ray stress view ......................................... 0.41 0.18 0.18 0.06 0.65 0.65 XXX 76010 ......... ............ A X-ray, nose to rectum .................................. 0.18 0.58 NA 0.03 0.79 NA XXX 76010 ......... 26 ....... A X-ray, nose to rectum .................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 76010 ......... TC ...... A X-ray, nose to rectum .................................. 0.00 0.52 NA 0.02 0.54 NA XXX 76012 ......... 26 ....... A Percut vertebroplasty fluor ........................... 1.31 0.47 0.47 0.09 1.87 1.87 XXX 76013 ......... 26 ....... A Percut vertebroplasty, ct .............................. 1.38 0.47 0.47 0.08 1.93 1.93 XXX 76020 ......... ............ A X-rays for bone age ..................................... 0.19 0.58 NA 0.03 0.80 NA XXX 76020 ......... 26 ....... A X-rays for bone age ..................................... 0.19 0.06 0.06 0.01 0.26 0.26 XXX 76020 ......... TC ...... A X-rays for bone age ..................................... 0.00 0.52 NA 0.02 0.54 NA XXX 76040 ......... ............ A X-rays, bone evaluation ............................... 0.27 0.87 NA 0.06 1.20 NA XXX 76040 ......... 26 ....... A X-rays, bone evaluation ............................... 0.27 0.09 0.09 0.01 0.37 0.37 XXX 76040 ......... TC ...... A X-rays, bone evaluation ............................... 0.00 0.78 NA 0.05 0.83 NA XXX 76061 ......... ............ A X-rays, bone survey ..................................... 0.45 1.14 NA 0.08 1.67 NA XXX


## 47664

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

76061 ......... 26 ....... A X-rays, bone survey ..................................... 0.45 0.15 0.15 0.02 0.62 0.62 XXX 76061 ......... TC ...... A X-rays, bone survey ..................................... 0.00 0.99 NA 0.06 1.05 NA XXX 76062 ......... ............ A X-rays, bone survey ..................................... 0.54 1.61 NA 0.10 2.25 NA XXX 76062 ......... 26 ....... A X-rays, bone survey ..................................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 76062 ......... TC ...... A X-rays, bone survey ..................................... 0.00 1.44 NA 0.08 1.52 NA XXX 76065 ......... ............ A X-rays, bone evaluation ............................... 0.70 0.97 NA 0.08 1.75 NA XXX 76065 ......... 26 ....... A X-rays, bone evaluation ............................... 0.70 0.23 0.23 0.03 0.96 0.96 XXX 76065 ......... TC ...... A X-rays, bone evaluation ............................... 0.00 0.73 NA 0.05 0.78 NA XXX 76066 ......... ............ A Joint survey, single view .............................. 0.31 1.21 NA 0.08 1.60 NA XXX 76066 ......... 26 ....... A Joint survey, single view .............................. 0.31 0.10 0.10 0.02 0.43 0.43 XXX 76066 ......... TC ...... A Joint survey, single view .............................. 0.00 1.11 NA 0.06 1.17 NA XXX 76070 ......... ............ A Ct bone density, axial .................................. 0.25 3.03 NA 0.17 3.45 NA XXX 76070 ......... 26 ....... A Ct bone density, axial .................................. 0.25 0.08 0.08 0.01 0.34 0.34 XXX 76070 ......... TC ...... A Ct bone density, axial .................................. 0.00 2.94 NA 0.16 3.10 NA XXX 76071 ......... ............ A Ct bone density, peripheral ......................... 0.22 3.02 NA 0.06 3.30 NA XXX 76071 ......... 26 ....... A Ct bone density, peripheral ......................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 76071 ......... TC ...... A Ct bone density, peripheral ......................... 0.00 2.94 NA 0.05 2.99 NA XXX 76075 ......... ............ A Dexa, axial skeleton study ........................... 0.30 3.19 NA 0.18 3.67 NA XXX 76075 ......... 26 ....... A Dexa, axial skeleton study ........................... 0.30 0.10 0.10 0.01 0.41 0.41 XXX 76075 ......... TC ...... A Dexa, axial skeleton study ........................... 0.00 3.09 NA 0.17 3.26 NA XXX 76076 ......... ............ A Dexa, peripheral study ................................. 0.22 0.83 NA 0.06 1.11 NA XXX 76076 ......... 26 ....... A Dexa, peripheral study ................................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX 76076 ......... TC ...... A Dexa, peripheral study ................................. 0.00 0.75 NA 0.05 0.80 NA XXX 76078 ......... ............ A Radiographic absorptiometry ....................... 0.20 0.82 NA 0.06 1.08 NA XXX 76078 ......... 26 ....... A Radiographic absorptiometry ....................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX 76078 ......... TC ...... A Radiographic absorptiometry ....................... 0.00 0.75 NA 0.05 0.80 NA XXX 76080 ......... ............ A X-ray exam of fistula .................................... 0.54 1.23 NA 0.08 1.85 NA XXX 76080 ......... 26 ....... A X-ray exam of fistula .................................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 76080 ......... TC ...... A X-ray exam of fistula .................................... 0.00 1.05 NA 0.06 1.11 NA XXX 76082 ......... ............ A Computer mammogram add-on .................. 0.06 0.43 NA 0.01 0.50 NA ZZZ 76082 ......... 26 ....... A Computer mammogram add-on .................. 0.06 0.02 0.02 0.00 0.08 0.08 ZZZ 76082 ......... TC ...... A Computer mammogram add-on .................. 0.00 0.42 NA 0.01 0.43 NA ZZZ 76083 ......... ............ A Computer mammogram add-on .................. 0.06 0.43 NA 0.01 0.50 NA ZZZ 76083 ......... 26 ....... A Computer mammogram add-on .................. 0.06 0.02 0.02 0.00 0.08 0.08 ZZZ 76083 ......... TC ...... A Computer mammogram add-on .................. 0.00 0.42 NA 0.01 0.43 NA ZZZ 76086 ......... ............ A X-ray of mammary duct ............................... 0.36 2.73 NA 0.16 3.25 NA XXX 76086 ......... 26 ....... A X-ray of mammary duct ............................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX 76086 ......... TC ...... A X-ray of mammary duct ............................... 0.00 2.62 NA 0.14 2.76 NA XXX 76088 ......... ............ A X-ray of mammary ducts ............................. 0.45 3.80 NA 0.21 4.46 NA XXX 76088 ......... 26 ....... A X-ray of mammary ducts ............................. 0.45 0.15 0.15 0.02 0.62 0.62 XXX 76088 ......... TC ...... A X-ray of mammary ducts ............................. 0.00 3.66 NA 0.19 3.85 NA XXX 76090 ......... ............ A Mammogram, one breast ............................ 0.70 1.28 NA 0.09 2.07 NA XXX 76090 ......... 26 ....... A Mammogram, one breast ............................ 0.70 0.23 0.23 0.03 0.96 0.96 XXX 76090 ......... TC ...... A Mammogram, one breast ............................ 0.00 1.05 NA 0.06 1.11 NA XXX 76091 ......... ............ A Mammogram, both breasts .......................... 0.87 1.59 NA 0.11 2.57 NA XXX 76091 ......... 26 ....... A Mammogram, both breasts .......................... 0.87 0.28 0.28 0.04 1.19 1.19 XXX 76091 ......... TC ...... A Mammogram, both breasts .......................... 0.00 1.30 NA 0.07 1.37 NA XXX 76092 ......... ............ A Mammogram, screening .............................. 0.70 1.45 NA 0.10 2.25 NA XXX 76092 ......... 26 ....... A Mammogram, screening .............................. 0.70 0.23 0.23 0.03 0.96 0.96 XXX 76092 ......... TC ...... A Mammogram, screening .............................. 0.00 1.23 NA 0.07 1.30 NA XXX 76093 ......... ............ A Magnetic image, breast ............................... 1.63 18.13 NA 0.99 20.75 NA XXX 76093 ......... 26 ....... A Magnetic image, breast ............................... 1.63 0.53 0.53 0.07 2.23 2.23 XXX 76093 ......... TC ...... A Magnetic image, breast ............................... 0.00 17.59 NA 0.92 18.51 NA XXX 76094 ......... ............ A Magnetic image, both breasts ..................... 1.63 24.40 NA 1.31 27.34 NA XXX 76094 ......... 26 ....... A Magnetic image, both breasts ..................... 1.63 0.53 0.53 0.07 2.23 2.23 XXX 76094 ......... TC ...... A Magnetic image, both breasts ..................... 0.00 23.87 NA 1.24 25.11 NA XXX 76095 ......... ............ A Stereotactic breast biopsy ........................... 1.59 7.67 NA 0.47 9.73 NA XXX 76095 ......... 26 ....... A Stereotactic breast biopsy ........................... 1.59 0.52 0.52 0.10 2.21 2.21 XXX 76095 ......... TC ...... A Stereotactic breast biopsy ........................... 0.00 7.15 NA 0.37 7.52 NA XXX 76096 ......... ............ A X-ray of needle wire, breast ........................ 0.56 1.49 NA 0.10 2.15 NA XXX 76096 ......... 26 ....... A X-ray of needle wire, breast ........................ 0.56 0.18 0.18 0.03 0.77 0.77 XXX 76096 ......... TC ...... A X-ray of needle wire, breast ........................ 0.00 1.30 NA 0.07 1.37 NA XXX 76098 ......... ............ A X-ray exam, breast specimen ...................... 0.16 0.47 NA 0.03 0.66 NA XXX 76098 ......... 26 ....... A X-ray exam, breast specimen ...................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 76098 ......... TC ...... A X-ray exam, breast specimen ...................... 0.00 0.42 NA 0.02 0.44 NA XXX 76100 ......... ............ A X-ray exam of body section ......................... 0.58 1.43 NA 0.10 2.11 NA XXX 76100 ......... 26 ....... A X-ray exam of body section ......................... 0.58 0.19 0.19 0.03 0.80 0.80 XXX 76100 ......... TC ...... A X-ray exam of body section ......................... 0.00 1.25 NA 0.07 1.32 NA XXX 76101 ......... ............ A Complex body section x-ray ........................ 0.58 1.61 NA 0.11 2.30 NA XXX 76101 ......... 26 ....... A Complex body section x-ray ........................ 0.58 0.19 0.19 0.03 0.80 0.80 XXX 76101 ......... TC ...... A Complex body section x-ray ........................ 0.00 1.42 NA 0.08 1.50 NA XXX 76102 ......... ............ A Complex body section x-rays ...................... 0.58 1.92 NA 0.14 2.64 NA XXX 76102 ......... 26 ....... A Complex body section x-rays ...................... 0.58 0.19 0.19 0.03 0.80 0.80 XXX 76102 ......... TC ...... A Complex body section x-rays ...................... 0.00 1.73 NA 0.11 1.84 NA XXX 76120 ......... ............ A Cine/video x-rays ......................................... 0.38 1.18 NA 0.08 1.64 NA XXX


## 47665

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

76120 ......... 26 ....... A Cine/video x-rays ......................................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 76120 ......... TC ...... A Cine/video x-rays ......................................... 0.00 1.05 NA 0.06 1.11 NA XXX 76125 ......... ............ A Cine/video x-rays add-on ............................. 0.27 0.87 NA 0.06 1.20 NA ZZZ 76125 ......... 26 ....... A Cine/video x-rays add-on ............................. 0.27 0.09 0.09 0.01 0.37 0.37 ZZZ 76125 ......... TC ...... A Cine/video x-rays add-on ............................. 0.00 0.78 NA 0.05 0.83 NA ZZZ 76150 ......... ............ A X-ray exam, dry process ............................. 0.00 0.42 NA 0.02 0.44 NA XXX 76355 ......... ............ A Ct scan for localization ................................ 1.21 8.64 NA 0.48 10.33 NA XXX 76355 ......... 26 ....... A Ct scan for localization ................................ 1.21 0.40 0.40 0.06 1.67 1.67 XXX 76355 ......... TC ...... A Ct scan for localization ................................ 0.00 8.24 NA 0.42 8.66 NA XXX 76360 ......... ............ A Ct scan for needle biopsy ............................ 1.16 8.62 NA 0.47 10.25 NA XXX 76360 ......... 26 ....... A Ct scan for needle biopsy ............................ 1.16 0.38 0.38 0.05 1.59 1.59 XXX 76360 ......... TC ...... A Ct scan for needle biopsy ............................ 0.00 8.24 NA 0.42 8.66 NA XXX 76362 ......... ............ A Ct guide for tissue ablation .......................... 3.99 9.54 NA 1.64 15.17 NA XXX 76362 ......... 26 ....... A Ct guide for tissue ablation .......................... 3.99 1.30 1.30 0.18 5.47 5.47 XXX 76362 ......... TC ...... A Ct guide for tissue ablation .......................... 0.00 8.24 NA 1.46 9.70 NA XXX 76370 ......... ............ A Ct scan for therapy guide ............................ 0.85 3.22 NA 0.20 4.27 NA XXX 76370 ......... 26 ....... A Ct scan for therapy guide ............................ 0.85 0.28 0.28 0.04 1.17 1.17 XXX 76370 ......... TC ...... A Ct scan for therapy guide ............................ 0.00 2.94 NA 0.16 3.10 NA XXX 76375 ......... ............ A 3d/holograph reconstr add-on ..................... 0.16 3.58 NA 0.19 3.93 NA XXX 76375 ......... 26 ....... A 3d/holograph reconstr add-on ..................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 76375 ......... TC ...... A 3d/holograph reconstr add-on ..................... 0.00 3.53 NA 0.18 3.71 NA XXX 76380 ......... ............ A CAT scan follow-up study ............................ 0.98 3.81 NA 0.22 5.01 NA XXX 76380 ......... 26 ....... A CAT scan follow-up study ............................ 0.98 0.32 0.32 0.04 1.34 1.34 XXX 76380 ......... TC ...... A CAT scan follow-up study ............................ 0.00 3.49 NA 0.18 3.67 NA XXX 76393 ......... ............ A Mr guidance for needle place ...................... 1.50 11.68 NA 0.65 13.83 NA XXX 76393 ......... 26 ....... A Mr guidance for needle place ...................... 1.50 0.50 0.50 0.10 2.10 2.10 XXX 76393 ......... TC ...... A Mr guidance for needle place ...................... 0.00 11.19 NA 0.55 11.74 NA XXX 76394 ......... ............ A Mri for tissue ablation .................................. 4.24 12.57 NA 1.80 18.61 NA XXX 76394 ......... 26 ....... A Mri for tissue ablation .................................. 4.24 1.38 1.38 0.24 5.86 5.86 XXX 76394 ......... TC ...... A Mri for tissue ablation .................................. 0.00 11.19 NA 1.56 12.75 NA XXX 76400 ......... ............ A Magnetic image, bone marrow .................... 1.60 11.71 NA 0.66 13.97 NA XXX 76400 ......... 26 ....... A Magnetic image, bone marrow .................... 1.60 0.52 0.52 0.07 2.19 2.19 XXX 76400 ......... TC ...... A Magnetic image, bone marrow .................... 0.00 11.19 NA 0.59 11.78 NA XXX 76506 ......... ............ A Echo exam of head ..................................... 0.63 1.66 NA 0.12 2.41 NA XXX 76506 ......... 26 ....... A Echo exam of head ..................................... 0.63 0.24 0.24 0.04 0.91 0.91 XXX 76506 ......... TC ...... A Echo exam of head ..................................... 0.00 1.42 NA 0.08 1.50 NA XXX 76511 ......... ............ A Echo exam of eye ........................................ 0.94 1.85 NA 0.10 2.89 NA XXX 76511 ......... 26 ....... A Echo exam of eye ........................................ 0.94 0.40 0.40 0.03 1.37 1.37 XXX 76511 ......... TC ...... A Echo exam of eye ........................................ 0.00 1.45 NA 0.07 1.52 NA XXX 76512 ......... ............ A Echo exam of eye ........................................ 0.66 1.73 NA 0.12 2.51 NA XXX 76512 ......... 26 ....... A Echo exam of eye ........................................ 0.66 0.29 0.29 0.02 0.97 0.97 XXX 76512 ......... TC ...... A Echo exam of eye ........................................ 0.00 1.44 NA 0.10 1.54 NA XXX 76513 ......... ............ A Echo exam of eye, water bath .................... 0.66 1.82 NA 0.12 2.60 NA XXX 76513 ......... 26 ....... A Echo exam of eye, water bath .................... 0.66 0.29 0.29 0.02 0.97 0.97 XXX 76513 ......... TC ...... A Echo exam of eye, water bath .................... 0.00 1.52 NA 0.10 1.62 NA XXX 76514 ......... ............ A Echo exam of eye, thickness ...................... 0.17 0.13 NA 0.02 0.32 NA XXX 76514 ......... 26 ....... A Echo exam of eye, thickness ...................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX 76514 ......... TC ...... A Echo exam of eye, thickness ...................... 0.00 0.05 NA 0.01 0.06 NA XXX 76516 ......... ............ A Echo exam of eye ........................................ 0.54 1.46 NA 0.08 2.08 NA XXX 76516 ......... 26 ....... A Echo exam of eye ........................................ 0.54 0.24 0.24 0.01 0.79 0.79 XXX 76516 ......... TC ...... A Echo exam of eye ........................................ 0.00 1.22 NA 0.07 1.29 NA XXX 76519 ......... ............ A Echo exam of eye ........................................ 0.54 1.56 NA 0.08 2.18 NA XXX 76519 ......... 26 ....... A Echo exam of eye ........................................ 0.54 0.24 0.24 0.01 0.79 0.79 XXX 76519 ......... TC ...... A Echo exam of eye ........................................ 0.00 1.32 NA 0.07 1.39 NA XXX 76529 ......... ............ A Echo exam of eye ........................................ 0.57 1.38 NA 0.10 2.05 NA XXX 76529 ......... 26 ....... A Echo exam of eye ........................................ 0.57 0.24 0.24 0.02 0.83 0.83 XXX 76529 ......... TC ...... A Echo exam of eye ........................................ 0.00 1.14 NA 0.08 1.22 NA XXX 76536 ......... ............ A Us exam of head and neck ......................... 0.56 1.60 NA 0.11 2.27 NA XXX 76536 ......... 26 ....... A Us exam of head and neck ......................... 0.56 0.18 0.18 0.03 0.77 0.77 XXX 76536 ......... TC ...... A Us exam of head and neck ......................... 0.00 1.42 NA 0.08 1.50 NA XXX 76604 ......... ............ A Us exam, chest, b-scan ............................... 0.55 1.48 NA 0.10 2.13 NA XXX 76604 ......... 26 ....... A Us exam, chest, b-scan ............................... 0.55 0.18 0.18 0.03 0.76 0.76 XXX 76604 ......... TC ...... A Us exam, chest, b-scan ............................... 0.00 1.30 NA 0.07 1.37 NA XXX 76645 ......... ............ A Us exam, breast(s) ...................................... 0.54 1.23 NA 0.08 1.85 NA XXX 76645 ......... 26 ....... A Us exam, breast(s) ...................................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 76645 ......... TC ...... A Us exam, breast(s) ...................................... 0.00 1.05 NA 0.06 1.11 NA XXX 76700 ......... ............ A Us exam, abdom, complete ......................... 0.81 2.23 NA 0.15 3.19 NA XXX 76700 ......... 26 ....... A Us exam, abdom, complete ......................... 0.81 0.26 0.26 0.04 1.11 1.11 XXX 76700 ......... TC ...... A Us exam, abdom, complete ......................... 0.00 1.97 NA 0.11 2.08 NA XXX 76705 ......... ............ A Echo exam of abdomen .............................. 0.59 1.61 NA 0.11 2.31 NA XXX 76705 ......... 26 ....... A Echo exam of abdomen .............................. 0.59 0.19 0.19 0.03 0.81 0.81 XXX 76705 ......... TC ...... A Echo exam of abdomen .............................. 0.00 1.42 NA 0.08 1.50 NA XXX 76770 ......... ............ A Us exam abdo back wall, comp .................. 0.74 2.21 NA 0.14 3.09 NA XXX 76770 ......... 26 ....... A Us exam abdo back wall, comp .................. 0.74 0.24 0.24 0.03 1.01 1.01 XXX 76770 ......... TC ...... A Us exam abdo back wall, comp .................. 0.00 1.97 NA 0.11 2.08 NA XXX


## 47666

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

76775 ......... ............ A Us exam abdo back wall, lim ...................... 0.58 1.61 NA 0.11 2.30 NA XXX 76775 ......... 26 ....... A Us exam abdo back wall, lim ...................... 0.58 0.19 0.19 0.03 0.80 0.80 XXX 76775 ......... TC ...... A Us exam abdo back wall, lim ...................... 0.00 1.42 NA 0.08 1.50 NA XXX 76778 ......... ............ A Us exam kidney transplant .......................... 0.74 2.21 NA 0.14 3.09 NA XXX 76778 ......... 26 ....... A Us exam kidney transplant .......................... 0.74 0.24 0.24 0.03 1.01 1.01 XXX 76778 ......... TC ...... A Us exam kidney transplant .......................... 0.00 1.97 NA 0.11 2.08 NA XXX 76800 ......... ............ A Us exam, spinal canal ................................. 1.13 1.76 NA 0.14 3.03 NA XXX 76800 ......... 26 ....... A Us exam, spinal canal ................................. 1.13 0.34 0.34 0.06 1.53 1.53 XXX 76800 ......... TC ...... A Us exam, spinal canal ................................. 0.00 1.42 NA 0.08 1.50 NA XXX 76801 ......... ............ A Ob us < 14 wks, single fetus ....................... 0.99 2.43 NA 0.17 3.59 NA XXX 76801 ......... 26 ....... A Ob us < 14 wks, single fetus ....................... 0.99 0.34 0.34 0.05 1.38 1.38 XXX 76801 ......... TC ...... A Ob us < 14 wks, single fetus ....................... 0.00 2.09 NA 0.12 2.21 NA XXX 76802 ......... ............ A Ob us < 14 wks, add-l fetus ........................ 0.83 1.34 NA 0.17 2.34 NA ZZZ 76802 ......... 26 ....... A Ob us < 14 wks, add-l fetus ........................ 0.83 0.29 0.29 0.05 1.17 1.17 ZZZ 76802 ......... TC ...... A Ob us < 14 wks, add-l fetus ........................ 0.00 1.05 NA 0.12 1.17 NA ZZZ 76805 ......... ............ A Ob us >/= 14 wks, sngl fetus ...................... 0.99 2.43 NA 0.17 3.59 NA XXX 76805 ......... 26 ....... A Ob us >/= 14 wks, sngl fetus ...................... 0.99 0.34 0.34 0.05 1.38 1.38 XXX 76805 ......... TC ...... A Ob us >/= 14 wks, sngl fetus ...................... 0.00 2.09 NA 0.12 2.21 NA XXX 76810 ......... ............ A Ob us >/= 14 wks, addl fetus ...................... 0.98 1.39 NA 0.31 2.68 NA ZZZ 76810 ......... 26 ....... A Ob us >/= 14 wks, addl fetus ...................... 0.98 0.34 0.34 0.09 1.41 1.41 ZZZ 76810 ......... TC ...... A Ob us >/= 14 wks, addl fetus ...................... 0.00 1.05 NA 0.22 1.27 NA ZZZ 76811 ......... ............ A Ob us, detailed, sngl fetus ........................... 1.90 4.23 NA 0.48 6.61 NA XXX 76811 ......... 26 ....... A Ob us, detailed, sngl fetus ........................... 1.90 0.71 0.71 0.05 2.66 2.66 XXX 76811 ......... TC ...... A Ob us, detailed, sngl fetus ........................... 0.00 3.52 NA 0.43 3.95 NA XXX 76812 ......... ............ A Ob us, detailed, addl fetus .......................... 1.78 1.71 NA 0.50 3.99 NA ZZZ 76812 ......... 26 ....... A Ob us, detailed, addl fetus .......................... 1.78 0.66 0.66 0.09 2.53 2.53 ZZZ 76812 ......... TC ...... A Ob us, detailed, addl fetus .......................... 0.00 1.05 NA 0.41 1.46 NA ZZZ 76815 ......... ............ A Ob us, limited, fetus(s) ................................ 0.65 1.65 NA 0.11 2.41 NA XXX 76815 ......... 26 ....... A Ob us, limited, fetus(s) ................................ 0.65 0.23 0.23 0.03 0.91 0.91 XXX 76815 ......... TC ...... A Ob us, limited, fetus(s) ................................ 0.00 1.42 NA 0.08 1.50 NA XXX 76816 ......... ............ A Ob us, follow-up, per fetus .......................... 0.85 1.42 NA 0.09 2.36 NA XXX 76816 ......... 26 ....... A Ob us, follow-up, per fetus .......................... 0.85 0.31 0.31 0.03 1.19 1.19 XXX 76816 ......... TC ...... A Ob us, follow-up, per fetus .......................... 0.00 1.11 NA 0.06 1.17 NA XXX 76817 ......... ............ A Transvaginal us, obstetric ............................ 0.75 1.78 NA 0.09 2.62 NA XXX 76817 ......... 26 ....... A Transvaginal us, obstetric ............................ 0.75 0.26 0.26 0.03 1.04 1.04 XXX 76817 ......... TC ...... A Transvaginal us, obstetric ............................ 0.00 1.52 NA 0.06 1.58 NA XXX 76818 ......... ............ A Fetal biophys profile w/nst ........................... 1.05 2.00 NA 0.15 3.20 NA XXX 76818 ......... 26 ....... A Fetal biophys profile w/nst ........................... 1.05 0.39 0.39 0.05 1.49 1.49 XXX 76818 ......... TC ...... A Fetal biophys profile w/nst ........................... 0.00 1.61 NA 0.10 1.71 NA XXX 76819 ......... ............ A Fetal biophys profil w/o nst .......................... 0.77 1.89 NA 0.14 2.80 NA XXX 76819 ......... 26 ....... A Fetal biophys profil w/o nst .......................... 0.77 0.28 0.28 0.04 1.09 1.09 XXX 76819 ......... TC ...... A Fetal biophys profil w/o nst .......................... 0.00 1.61 NA 0.10 1.71 NA XXX 76825 ......... ............ A Echo exam of fetal heart ............................. 1.67 2.57 NA 0.18 4.42 NA XXX 76825 ......... 26 ....... A Echo exam of fetal heart ............................. 1.67 0.60 0.60 0.07 2.34 2.34 XXX 76825 ......... TC ...... A Echo exam of fetal heart ............................. 0.00 1.97 NA 0.11 2.08 NA XXX 76826 ......... ............ A Echo exam of fetal heart ............................. 0.83 0.99 NA 0.09 1.91 NA XXX 76826 ......... 26 ....... A Echo exam of fetal heart ............................. 0.83 0.29 0.29 0.04 1.16 1.16 XXX 76826 ......... TC ...... A Echo exam of fetal heart ............................. 0.00 0.70 NA 0.05 0.75 NA XXX 76827 ......... ............ A Echo exam of fetal heart ............................. 0.58 1.93 NA 0.15 2.66 NA XXX 76827 ......... 26 ....... A Echo exam of fetal heart ............................. 0.58 0.21 0.21 0.03 0.82 0.82 XXX 76827 ......... TC ...... A Echo exam of fetal heart ............................. 0.00 1.72 NA 0.12 1.84 NA XXX 76828 ......... ............ A Echo exam of fetal heart ............................. 0.56 1.32 NA 0.11 1.99 NA XXX 76828 ......... 26 ....... A Echo exam of fetal heart ............................. 0.56 0.21 0.21 0.03 0.80 0.80 XXX 76828 ......... TC ...... A Echo exam of fetal heart ............................. 0.00 1.11 NA 0.08 1.19 NA XXX 76830 ......... ............ A Transvaginal us, non-ob .............................. 0.69 1.74 NA 0.13 2.56 NA XXX 76830 ......... 26 ....... A Transvaginal us, non-ob .............................. 0.69 0.23 0.23 0.03 0.95 0.95 XXX 76830 ......... TC ...... A Transvaginal us, non-ob .............................. 0.00 1.52 NA 0.10 1.62 NA XXX 76831 ......... ............ A Echo exam, uterus ....................................... 0.72 1.77 NA 0.13 2.62 NA XXX 76831 ......... 26 ....... A Echo exam, uterus ....................................... 0.72 0.25 0.25 0.03 1.00 1.00 XXX 76831 ......... TC ...... A Echo exam, uterus ....................................... 0.00 1.52 NA 0.10 1.62 NA XXX 76856 ......... ............ A Us exam, pelvic, complete .......................... 0.69 1.74 NA 0.13 2.56 NA XXX 76856 ......... 26 ....... A Us exam, pelvic, complete .......................... 0.69 0.23 0.23 0.03 0.95 0.95 XXX 76856 ......... TC ...... A Us exam, pelvic, complete .......................... 0.00 1.52 NA 0.10 1.62 NA XXX 76857 ......... ............ A Us exam, pelvic, limited ............................... 0.38 1.83 NA 0.08 2.29 NA XXX 76857 ......... 26 ....... A Us exam, pelvic, limited ............................... 0.38 0.12 0.12 0.02 0.52 0.52 XXX 76857 ......... TC ...... A Us exam, pelvic, limited ............................... 0.00 1.70 NA 0.06 1.76 NA XXX 76870 ......... ............ A Us exam, scrotum ........................................ 0.64 1.72 NA 0.13 2.49 NA XXX 76870 ......... 26 ....... A Us exam, scrotum ........................................ 0.64 0.21 0.21 0.03 0.88 0.88 XXX 76870 ......... TC ...... A Us exam, scrotum ........................................ 0.00 1.52 NA 0.10 1.62 NA XXX 76872 ......... ............ A Us, transrectal .............................................. 0.69 2.25 NA 0.14 3.08 NA XXX 76872 ......... 26 ....... A Us, transrectal .............................................. 0.69 0.22 0.22 0.04 0.95 0.95 XXX 76872 ......... TC ...... A Us, transrectal .............................................. 0.00 2.02 NA 0.10 2.12 NA XXX 76873 ......... ............ A Echograp trans r, pros study ....................... 1.55 2.59 NA 0.25 4.39 NA XXX 76873 ......... 26 ....... A Echograp trans r, pros study ....................... 1.55 0.50 0.50 0.09 2.14 2.14 XXX 76873 ......... TC ...... A Echograp trans r, pros study ....................... 0.00 2.09 NA 0.16 2.25 NA XXX


## 47667

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

76880 ......... ............ A Us exam, extremity ...................................... 0.59 1.61 NA 0.11 2.31 NA XXX 76880 ......... 26 ....... A Us exam, extremity ...................................... 0.59 0.19 0.19 0.03 0.81 0.81 XXX 76880 ......... TC ...... A Us exam, extremity ...................................... 0.00 1.42 NA 0.08 1.50 NA XXX 76885 ......... ............ A Us exam infant hips, dynamic ..................... 0.74 1.76 NA 0.13 2.63 NA XXX 76885 ......... 26 ....... A Us exam infant hips, dynamic ..................... 0.74 0.24 0.24 0.03 1.01 1.01 XXX 76885 ......... TC ...... A Us exam infant hips, dynamic ..................... 0.00 1.52 NA 0.10 1.62 NA XXX 76886 ......... ............ A Us exam infant hips, static .......................... 0.62 1.62 NA 0.11 2.35 NA XXX 76886 ......... 26 ....... A Us exam infant hips, static .......................... 0.62 0.20 0.20 0.03 0.85 0.85 XXX 76886 ......... TC ...... A Us exam infant hips, static .......................... 0.00 1.42 NA 0.08 1.50 NA XXX 76930 ......... ............ A Echo guide, cardiocentesis .......................... 0.67 1.77 NA 0.12 2.56 NA XXX 76930 ......... 26 ....... A Echo guide, cardiocentesis .......................... 0.67 0.25 0.25 0.02 0.94 0.94 XXX 76930 ......... TC ...... A Echo guide, cardiocentesis .......................... 0.00 1.52 NA 0.10 1.62 NA XXX 76932 ......... ............ A Echo guide for heart biopsy ........................ 0.67 1.77 NA 0.12 2.56 NA XXX 76932 ......... 26 ....... A Echo guide for heart biopsy ........................ 0.67 0.25 0.25 0.02 0.94 0.94 XXX 76932 ......... TC ...... A Echo guide for heart biopsy ........................ 0.00 1.52 NA 0.10 1.62 NA XXX 76936 ......... ............ A Echo guide for artery repair ......................... 1.99 6.94 NA 0.47 9.40 NA XXX 76936 ......... 26 ....... A Echo guide for artery repair ......................... 1.99 0.66 0.66 0.13 2.78 2.78 XXX 76936 ......... TC ...... A Echo guide for artery repair ......................... 0.00 6.28 NA 0.34 6.62 NA XXX 76937 ......... ............ A Us guide, vascular access ........................... 0.30 0.47 NA 0.13 0.90 NA ZZZ 76937 ......... 26 ....... A Us guide, vascular access ........................... 0.30 0.10 0.10 0.03 0.43 0.43 ZZZ 76937 ......... TC ...... A Us guide, vascular access ........................... 0.00 0.38 NA 0.10 0.48 NA ZZZ 76940 ......... ............ A Us guide, tissue ablation ............................. 2.00 2.17 NA 0.48 4.65 NA XXX 76940 ......... 26 ....... A Us guide, tissue ablation ............................. 2.00 0.65 0.65 0.19 2.84 2.84 XXX 76940 ......... TC ...... A Us guide, tissue ablation ............................. 0.00 1.52 NA 0.29 1.81 NA XXX 76941 ......... ............ A Echo guide for transfusion ........................... 1.34 2.00 NA 0.14 3.48 NA XXX 76941 ......... 26 ....... A Echo guide for transfusion ........................... 1.34 0.47 0.47 0.06 1.87 1.87 XXX 76941 ......... TC ...... A Echo guide for transfusion ........................... 0.00 1.52 NA 0.08 1.60 NA XXX 76942 ......... ............ A Echo guide for biopsy .................................. 0.67 3.03 NA 0.13 3.83 NA XXX 76942 ......... 26 ....... A Echo guide for biopsy .................................. 0.67 0.22 0.22 0.03 0.92 0.92 XXX 76942 ......... TC ...... A Echo guide for biopsy .................................. 0.00 2.81 NA 0.10 2.91 NA XXX 76945 ......... ............ A Echo guide, villus sampling ......................... 0.67 1.75 NA 0.11 2.53 NA XXX 76945 ......... 26 ....... A Echo guide, villus sampling ......................... 0.67 0.22 0.22 0.03 0.92 0.92 XXX 76945 ......... TC ...... A Echo guide, villus sampling ......................... 0.00 1.52 NA 0.08 1.60 NA XXX 76946 ......... ............ A Echo guide for amniocentesis ..................... 0.38 1.66 NA 0.12 2.16 NA XXX 76946 ......... 26 ....... A Echo guide for amniocentesis ..................... 0.38 0.14 0.14 0.02 0.54 0.54 XXX 76946 ......... TC ...... A Echo guide for amniocentesis ..................... 0.00 1.52 NA 0.10 1.62 NA XXX 76948 ......... ............ A Echo guide, ova aspiration .......................... 0.38 1.64 NA 0.12 2.14 NA XXX 76948 ......... 26 ....... A Echo guide, ova aspiration .......................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 76948 ......... TC ...... A Echo guide, ova aspiration .......................... 0.00 1.52 NA 0.10 1.62 NA XXX 76950 ......... ............ A Echo guidance radiotherapy ........................ 0.58 1.49 NA 0.10 2.17 NA XXX 76950 ......... 26 ....... A Echo guidance radiotherapy ........................ 0.58 0.19 0.19 0.03 0.80 0.80 XXX 76950 ......... TC ...... A Echo guidance radiotherapy ........................ 0.00 1.30 NA 0.07 1.37 NA XXX 76965 ......... ............ A Echo guidance radiotherapy ........................ 1.34 5.99 NA 0.38 7.71 NA XXX 76965 ......... 26 ....... A Echo guidance radiotherapy ........................ 1.34 0.43 0.43 0.09 1.86 1.86 XXX 76965 ......... TC ...... A Echo guidance radiotherapy ........................ 0.00 5.56 NA 0.29 5.85 NA XXX 76970 ......... ............ A Ultrasound exam follow-up .......................... 0.40 1.18 NA 0.08 1.66 NA XXX 76970 ......... 26 ....... A Ultrasound exam follow-up .......................... 0.40 0.13 0.13 0.02 0.55 0.55 XXX 76970 ......... TC ...... A Ultrasound exam follow-up .......................... 0.00 1.05 NA 0.06 1.11 NA XXX 76975 ......... ............ A GI endoscopic ultrasound ............................ 0.81 1.79 NA 0.14 2.74 NA XXX 76975 ......... 26 ....... A GI endoscopic ultrasound ............................ 0.81 0.28 0.28 0.04 1.13 1.13 XXX 76975 ......... TC ...... A GI endoscopic ultrasound ............................ 0.00 1.52 NA 0.10 1.62 NA XXX 76977 ......... ............ A Us bone density measure ............................ 0.05 0.84 NA 0.05 0.94 NA XXX 76977 ......... 26 ....... A Us bone density measure ............................ 0.05 0.02 0.02 0.00 0.07 0.07 XXX 76977 ......... TC ...... A Us bone density measure ............................ 0.00 0.82 NA 0.05 0.87 NA XXX 76986 ......... ............ A Ultrasound guide intraoper .......................... 1.20 3.01 NA 0.24 4.45 NA XXX 76986 ......... 26 ....... A Ultrasound guide intraoper .......................... 1.20 0.40 0.40 0.10 1.70 1.70 XXX 76986 ......... TC ...... A Ultrasound guide intraoper .......................... 0.00 2.62 NA 0.14 2.76 NA XXX 77261 ......... ............ A Radiation therapy planning .......................... 1.39 0.51 0.51 0.07 1.97 1.97 XXX 77262 ......... ............ A Radiation therapy planning .......................... 2.11 0.76 0.76 0.11 2.98 2.98 XXX 77263 ......... ............ A Radiation therapy planning .......................... 3.14 1.11 1.11 0.16 4.41 4.41 XXX 77280 ......... ............ A Set radiation therapy field ............................ 0.70 3.69 NA 0.22 4.61 NA XXX 77280 ......... 26 ....... A Set radiation therapy field ............................ 0.70 0.22 0.22 0.04 0.96 0.96 XXX 77280 ......... TC ...... A Set radiation therapy field ............................ 0.00 3.46 NA 0.18 3.64 NA XXX 77285 ......... ............ A Set radiation therapy field ............................ 1.05 5.89 NA 0.35 7.29 NA XXX 77285 ......... 26 ....... A Set radiation therapy field ............................ 1.05 0.34 0.34 0.05 1.44 1.44 XXX 77285 ......... TC ...... A Set radiation therapy field ............................ 0.00 5.56 NA 0.30 5.86 NA XXX 77290 ......... ............ A Set radiation therapy field ............................ 1.56 6.99 NA 0.43 8.98 NA XXX 77290 ......... 26 ....... A Set radiation therapy field ............................ 1.56 0.50 0.50 0.08 2.14 2.14 XXX 77290 ......... TC ...... A Set radiation therapy field ............................ 0.00 6.50 NA 0.35 6.85 NA XXX 77295 ......... ............ A Set radiation therapy field ............................ 4.56 29.34 NA 1.72 35.62 NA XXX 77295 ......... 26 ....... A Set radiation therapy field ............................ 4.56 1.46 1.46 0.24 6.26 6.26 XXX 77295 ......... TC ...... A Set radiation therapy field ............................ 0.00 27.88 NA 1.48 29.36 NA XXX 77300 ......... ............ A Radiation therapy dose plan ........................ 0.62 1.54 NA 0.10 2.26 NA XXX 77300 ......... 26 ....... A Radiation therapy dose plan ........................ 0.62 0.20 0.20 0.03 0.85 0.85 XXX 77300 ......... TC ...... A Radiation therapy dose plan ........................ 0.00 1.34 NA 0.07 1.41 NA XXX


## 47668

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

77301 ......... ............ A Radiotherapy dose plan, imrt ...................... 7.99 30.44 NA 1.88 40.31 NA XXX 77301 ......... 26 ....... A Radiotherapy dose plan, imrt ...................... 7.99 2.55 2.55 0.40 10.94 10.94 XXX 77301 ......... TC ...... A Radiotherapy dose plan, imrt ...................... 0.00 27.88 NA 1.48 29.36 NA XXX 77305 ......... ............ A Teletx isodose plan simple .......................... 0.70 2.08 NA 0.15 2.93 NA XXX 77305 ......... 26 ....... A Teletx isodose plan simple .......................... 0.70 0.23 0.23 0.04 0.97 0.97 XXX 77305 ......... TC ...... A Teletx isodose plan simple .......................... 0.00 1.85 NA 0.11 1.96 NA XXX 77310 ......... ............ A Teletx isodose plan intermed ...................... 1.05 2.66 NA 0.18 3.89 NA XXX 77310 ......... 26 ....... A Teletx isodose plan intermed ...................... 1.05 0.34 0.34 0.05 1.44 1.44 XXX 77310 ......... TC ...... A Teletx isodose plan intermed ...................... 0.00 2.33 NA 0.13 2.46 NA XXX 77315 ......... ............ A Teletx isodose plan complex ....................... 1.56 3.15 NA 0.22 4.93 NA XXX 77315 ......... 26 ....... A Teletx isodose plan complex ....................... 1.56 0.50 0.50 0.08 2.14 2.14 XXX 77315 ......... TC ...... A Teletx isodose plan complex ....................... 0.00 2.65 NA 0.14 2.79 NA XXX 77321 ......... ............ A Special teletx port plan ................................ 0.95 4.34 NA 0.26 5.55 NA XXX 77321 ......... 26 ....... A Special teletx port plan ................................ 0.95 0.30 0.30 0.05 1.30 1.30 XXX 77321 ......... TC ...... A Special teletx port plan ................................ 0.00 4.03 NA 0.21 4.24 NA XXX 77326 ......... ............ A Brachytx isodose calc simp ......................... 0.93 2.65 NA 0.18 3.76 NA XXX 77326 ......... 26 ....... A Brachytx isodose calc simp ......................... 0.93 0.30 0.30 0.05 1.28 1.28 XXX 77326 ......... TC ...... A Brachytx isodose calc simp ......................... 0.00 2.35 NA 0.13 2.48 NA XXX 77327 ......... ............ A Brachytx isodose calc interm ....................... 1.39 3.91 NA 0.25 5.55 NA XXX 77327 ......... 26 ....... A Brachytx isodose calc interm ....................... 1.39 0.44 0.44 0.07 1.90 1.90 XXX 77327 ......... TC ...... A Brachytx isodose calc interm ....................... 0.00 3.46 NA 0.18 3.64 NA XXX 77328 ......... ............ A Brachytx isodose plan compl ....................... 2.09 5.62 NA 0.36 8.07 NA XXX 77328 ......... 26 ....... A Brachytx isodose plan compl ....................... 2.09 0.67 0.67 0.11 2.87 2.87 XXX 77328 ......... TC ...... A Brachytx isodose plan compl ....................... 0.00 4.95 NA 0.25 5.20 NA XXX 77331 ......... ............ A Special radiation dosimetry ......................... 0.87 0.78 NA 0.06 1.71 NA XXX 77331 ......... 26 ....... A Special radiation dosimetry ......................... 0.87 0.28 0.28 0.04 1.19 1.19 XXX 77331 ......... TC ...... A Special radiation dosimetry ......................... 0.00 0.50 NA 0.02 0.52 NA XXX 77332 ......... ............ A Radiation treatment aid(s) ........................... 0.54 1.51 NA 0.10 2.15 NA XXX 77332 ......... 26 ....... A Radiation treatment aid(s) ........................... 0.54 0.17 0.17 0.03 0.74 0.74 XXX 77332 ......... TC ...... A Radiation treatment aid(s) ........................... 0.00 1.34 NA 0.07 1.41 NA XXX 77333 ......... ............ A Radiation treatment aid(s) ........................... 0.84 2.16 NA 0.15 3.15 NA XXX 77333 ......... 26 ....... A Radiation treatment aid(s) ........................... 0.84 0.27 0.27 0.04 1.15 1.15 XXX 77333 ......... TC ...... A Radiation treatment aid(s) ........................... 0.00 1.89 NA 0.11 2.00 NA XXX 77334 ......... ............ A Radiation treatment aid(s) ........................... 1.24 3.64 NA 0.23 5.11 NA XXX 77334 ......... 26 ....... A Radiation treatment aid(s) ........................... 1.24 0.40 0.40 0.06 1.70 1.70 XXX 77334 ......... TC ...... A Radiation treatment aid(s) ........................... 0.00 3.24 NA 0.17 3.41 NA XXX 77336 ......... ............ A Radiation physics consult ............................ 0.00 2.97 NA 0.16 3.13 NA XXX 77370 ......... ............ A Radiation physics consult ............................ 0.00 3.48 NA 0.18 3.66 NA XXX 77401 ......... ............ A Radiation treatment delivery ........................ 0.00 1.77 NA 0.11 1.88 NA XXX 77402 ......... ............ A Radiation treatment delivery ........................ 0.00 1.77 NA 0.11 1.88 NA XXX 77403 ......... ............ A Radiation treatment delivery ........................ 0.00 1.77 NA 0.11 1.88 NA XXX 77404 ......... ............ A Radiation treatment delivery ........................ 0.00 1.77 NA 0.11 1.88 NA XXX 77406 ......... ............ A Radiation treatment delivery ........................ 0.00 1.77 NA 0.11 1.88 NA XXX 77407 ......... ............ A Radiation treatment delivery ........................ 0.00 2.08 NA 0.12 2.20 NA XXX 77408 ......... ............ A Radiation treatment delivery ........................ 0.00 2.08 NA 0.12 2.20 NA XXX 77409 ......... ............ A Radiation treatment delivery ........................ 0.00 2.08 NA 0.12 2.20 NA XXX 77411 ......... ............ A Radiation treatment delivery ........................ 0.00 2.08 NA 0.12 2.20 NA XXX 77412 ......... ............ A Radiation treatment delivery ........................ 0.00 2.33 NA 0.13 2.46 NA XXX 77413 ......... ............ A Radiation treatment delivery ........................ 0.00 2.33 NA 0.13 2.46 NA XXX 77414 ......... ............ A Radiation treatment delivery ........................ 0.00 2.33 NA 0.13 2.46 NA XXX 77416 ......... ............ A Radiation treatment delivery ........................ 0.00 2.33 NA 0.13 2.46 NA XXX 77417 ......... ............ A Radiology port film(s) ................................... 0.00 0.59 NA 0.04 0.63 NA XXX 77418 ......... ............ A Radiation tx delivery, imrt ............................ 0.00 17.95 NA 0.13 18.08 NA XXX 77427 ......... ............ A Radiation tx management, x5 ...................... 3.31 1.06 1.06 0.17 4.54 4.54 090 77431 ......... ............ A Radiation therapy management .................. 1.81 0.68 0.68 0.09 2.58 2.58 XXX 77432 ......... ............ A Stereotactic radiation trmt ............................ 7.92 2.91 2.91 0.42 11.25 11.25 XXX 77470 ......... ............ A Special radiation treatment .......................... 2.09 11.79 NA 0.70 14.58 NA XXX 77470 ......... 26 ....... A Special radiation treatment .......................... 2.09 0.67 0.67 0.11 2.87 2.87 XXX 77470 ......... TC ...... A Special radiation treatment .......................... 0.00 11.13 NA 0.59 11.72 NA XXX 77600 ......... ............ R Hyperthermia treatment ............................... 1.56 3.54 NA 0.24 5.34 NA XXX 77600 ......... 26 ....... R Hyperthermia treatment ............................... 1.56 0.50 0.50 0.08 2.14 2.14 XXX 77600 ......... TC ...... R Hyperthermia treatment ............................... 0.00 3.04 NA 0.16 3.20 NA XXX 77605 ......... ............ R Hyperthermia treatment ............................... 2.09 4.72 NA 0.33 7.14 NA XXX 77605 ......... 26 ....... R Hyperthermia treatment ............................... 2.09 0.66 0.66 0.11 2.86 2.86 XXX 77605 ......... TC ...... R Hyperthermia treatment ............................... 0.00 4.05 NA 0.22 4.27 NA XXX 77610 ......... ............ R Hyperthermia treatment ............................... 1.56 3.55 NA 0.24 5.35 NA XXX 77610 ......... 26 ....... R Hyperthermia treatment ............................... 1.56 0.51 0.51 0.07 2.14 2.14 XXX 77610 ......... TC ...... R Hyperthermia treatment ............................... 0.00 3.04 NA 0.16 3.20 NA XXX 77615 ......... ............ R Hyperthermia treatment ............................... 2.09 4.72 NA 0.33 7.14 NA XXX 77615 ......... 26 ....... R Hyperthermia treatment ............................... 2.09 0.66 0.66 0.11 2.86 2.86 XXX 77615 ......... TC ...... R Hyperthermia treatment ............................... 0.00 4.05 NA 0.22 4.27 NA XXX 77620 ......... ............ R Hyperthermia treatment ............................... 1.56 3.56 NA 0.23 5.35 NA XXX 77620 ......... 26 ....... R Hyperthermia treatment ............................... 1.56 0.52 0.52 0.19 2.27 2.27 XXX 77620 ......... TC ...... R Hyperthermia treatment ............................... 0.00 3.04 NA 0.16 3.20 NA XXX 77750 ......... ............ A Infuse radioactive materials ......................... 4.90 2.91 NA 0.32 8.13 NA 090


## 47669

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

77750 ......... 26 ....... A Infuse radioactive materials ......................... 4.90 1.58 1.58 0.25 6.73 6.73 090 77750 ......... TC ...... A Infuse radioactive materials ......................... 0.00 1.33 NA 0.07 1.40 NA 090 77761 ......... ............ A Apply intrcav radiat simple .......................... 3.80 3.59 NA 0.33 7.72 NA 090 77761 ......... 26 ....... A Apply intrcav radiat simple .......................... 3.80 1.09 1.09 0.19 5.08 5.08 090 77761 ......... TC ...... A Apply intrcav radiat simple .......................... 0.00 2.50 NA 0.14 2.64 NA 090 77762 ......... ............ A Apply intrcav radiat interm ........................... 5.71 5.43 NA 0.48 11.62 NA 090 77762 ......... 26 ....... A Apply intrcav radiat interm ........................... 5.71 1.83 1.83 0.29 7.83 7.83 090 77762 ......... TC ...... A Apply intrcav radiat interm ........................... 0.00 3.60 NA 0.19 3.79 NA 090 77763 ......... ............ A Apply intrcav radiat compl ........................... 8.56 7.21 NA 0.67 16.44 NA 090 77763 ......... 26 ....... A Apply intrcav radiat compl ........................... 8.56 2.73 2.73 0.44 11.73 11.73 090 77763 ......... TC ...... A Apply intrcav radiat compl ........................... 0.00 4.48 NA 0.23 4.71 NA 090 77776 ......... ............ A Apply interstit radiat simpl ........................... 4.65 3.12 NA 0.48 8.25 NA 090 77776 ......... 26 ....... A Apply interstit radiat simpl ........................... 4.65 0.95 0.95 0.35 5.95 5.95 090 77776 ......... TC ...... A Apply interstit radiat simpl ........................... 0.00 2.17 NA 0.13 2.30 NA 090 77777 ......... ............ A Apply interstit radiat inter ............................. 7.47 6.59 NA 0.62 14.68 NA 090 77777 ......... 26 ....... A Apply interstit radiat inter ............................. 7.47 2.37 2.37 0.40 10.24 10.24 090 77777 ......... TC ...... A Apply interstit radiat inter ............................. 0.00 4.23 NA 0.22 4.45 NA 090 77778 ......... ............ A Apply interstit radiat compl .......................... 11.17 8.69 NA 0.85 20.71 NA 090 77778 ......... 26 ....... A Apply interstit radiat compl .......................... 11.17 3.56 3.56 0.58 15.31 15.31 090 77778 ......... TC ...... A Apply interstit radiat compl .......................... 0.00 5.12 NA 0.27 5.39 NA 090 77781 ......... ............ A High intensity brachytherapy ....................... 1.66 20.80 NA 1.14 23.60 NA 090 77781 ......... 26 ....... A High intensity brachytherapy ....................... 1.66 0.53 0.53 0.08 2.27 2.27 090 77781 ......... TC ...... A High intensity brachytherapy ....................... 0.00 20.27 NA 1.06 21.33 NA 090 77782 ......... ............ A High intensity brachytherapy ....................... 2.49 21.07 NA 1.19 24.75 NA 090 77782 ......... 26 ....... A High intensity brachytherapy ....................... 2.49 0.80 0.80 0.13 3.42 3.42 090 77782 ......... TC ...... A High intensity brachytherapy ....................... 0.00 20.27 NA 1.06 21.33 NA 090 77783 ......... ............ A High intensity brachytherapy ....................... 3.72 21.46 NA 1.25 26.43 NA 090 77783 ......... 26 ....... A High intensity brachytherapy ....................... 3.72 1.19 1.19 0.19 5.10 5.10 090 77783 ......... TC ...... A High intensity brachytherapy ....................... 0.00 20.27 NA 1.06 21.33 NA 090 77784 ......... ............ A High intensity brachytherapy ....................... 5.60 22.06 NA 1.35 29.01 NA 090 77784 ......... 26 ....... A High intensity brachytherapy ....................... 5.60 1.79 1.79 0.29 7.68 7.68 090 77784 ......... TC ...... A High intensity brachytherapy ....................... 0.00 20.27 NA 1.06 21.33 NA 090 77789 ......... ............ A Apply surface radiation ................................ 1.12 0.82 NA 0.08 2.02 NA 000 77789 ......... 26 ....... A Apply surface radiation ................................ 1.12 0.37 0.37 0.06 1.55 1.55 000 77789 ......... TC ...... A Apply surface radiation ................................ 0.00 0.45 NA 0.02 0.47 NA 000 77790 ......... ............ A Radiation handling ....................................... 1.05 0.84 NA 0.07 1.96 NA XXX 77790 ......... 26 ....... A Radiation handling ....................................... 1.05 0.34 0.34 0.05 1.44 1.44 XXX 77790 ......... TC ...... A Radiation handling ....................................... 0.00 0.50 NA 0.02 0.52 NA XXX 78000 ......... ............ A Thyroid, single uptake ................................. 0.19 1.03 NA 0.07 1.29 NA XXX 78000 ......... 26 ....... A Thyroid, single uptake ................................. 0.19 0.06 0.06 0.01 0.26 0.26 XXX 78000 ......... TC ...... A Thyroid, single uptake ................................. 0.00 0.97 NA 0.06 1.03 NA XXX 78001 ......... ............ A Thyroid, multiple uptakes ............................. 0.26 1.39 NA 0.08 1.73 NA XXX 78001 ......... 26 ....... A Thyroid, multiple uptakes ............................. 0.26 0.09 0.09 0.01 0.36 0.36 XXX 78001 ......... TC ...... A Thyroid, multiple uptakes ............................. 0.00 1.30 NA 0.07 1.37 NA XXX 78003 ......... ............ A Thyroid suppress/stimul ............................... 0.33 1.07 NA 0.07 1.47 NA XXX 78003 ......... 26 ....... A Thyroid suppress/stimul ............................... 0.33 0.11 0.11 0.01 0.45 0.45 XXX 78003 ......... TC ...... A Thyroid suppress/stimul ............................... 0.00 0.97 NA 0.06 1.03 NA XXX 78006 ......... ............ A Thyroid imaging with uptake ........................ 0.49 2.54 NA 0.15 3.18 NA XXX 78006 ......... 26 ....... A Thyroid imaging with uptake ........................ 0.49 0.16 0.16 0.02 0.67 0.67 XXX 78006 ......... TC ...... A Thyroid imaging with uptake ........................ 0.00 2.37 NA 0.13 2.50 NA XXX 78007 ......... ............ A Thyroid image, mult uptakes ....................... 0.50 2.73 NA 0.16 3.39 NA XXX 78007 ......... 26 ....... A Thyroid image, mult uptakes ....................... 0.50 0.17 0.17 0.02 0.69 0.69 XXX 78007 ......... TC ...... A Thyroid image, mult uptakes ....................... 0.00 2.57 NA 0.14 2.71 NA XXX 78010 ......... ............ A Thyroid imaging ........................................... 0.39 1.94 NA 0.13 2.46 NA XXX 78010 ......... 26 ....... A Thyroid imaging ........................................... 0.39 0.13 0.13 0.02 0.54 0.54 XXX 78010 ......... TC ...... A Thyroid imaging ........................................... 0.00 1.81 NA 0.11 1.92 NA XXX 78011 ......... ............ A Thyroid imaging with flow ............................ 0.45 2.55 NA 0.15 3.15 NA XXX 78011 ......... 26 ....... A Thyroid imaging with flow ............................ 0.45 0.15 0.15 0.02 0.62 0.62 XXX 78011 ......... TC ...... A Thyroid imaging with flow ............................ 0.00 2.40 NA 0.13 2.53 NA XXX 78015 ......... ............ A Thyroid met imaging .................................... 0.67 2.79 NA 0.17 3.63 NA XXX 78015 ......... 26 ....... A Thyroid met imaging .................................... 0.67 0.23 0.23 0.03 0.93 0.93 XXX 78015 ......... TC ...... A Thyroid met imaging .................................... 0.00 2.57 NA 0.14 2.71 NA XXX 78016 ......... ............ A Thyroid met imaging/studies ........................ 0.82 3.76 NA 0.21 4.79 NA XXX 78016 ......... 26 ....... A Thyroid met imaging/studies ........................ 0.82 0.28 0.28 0.03 1.13 1.13 XXX 78016 ......... TC ...... A Thyroid met imaging/studies ........................ 0.00 3.47 NA 0.18 3.65 NA XXX 78018 ......... ............ A Thyroid met imaging, body .......................... 0.86 5.71 NA 0.33 6.90 NA XXX 78018 ......... 26 ....... A Thyroid met imaging, body .......................... 0.86 0.29 0.29 0.04 1.19 1.19 XXX 78018 ......... TC ...... A Thyroid met imaging, body .......................... 0.00 5.41 NA 0.29 5.70 NA XXX 78020 ......... ............ A Thyroid met uptake ...................................... 0.60 1.51 NA 0.17 2.28 NA ZZZ 78020 ......... 26 ....... A Thyroid met uptake ...................................... 0.60 0.21 0.21 0.03 0.84 0.84 ZZZ 78020 ......... TC ...... A Thyroid met uptake ...................................... 0.00 1.30 NA 0.14 1.44 NA ZZZ 78070 ......... ............ A Parathyroid nuclear imaging ........................ 0.82 4.54 NA 0.15 5.51 NA XXX 78070 ......... 26 ....... A Parathyroid nuclear imaging ........................ 0.82 0.28 0.28 0.04 1.14 1.14 XXX 78070 ......... TC ...... A Parathyroid nuclear imaging ........................ 0.00 4.27 NA 0.11 4.38 NA XXX 78075 ......... ............ A Adrenal nuclear imaging .............................. 0.74 5.68 NA 0.32 6.74 NA XXX


## 47670

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

78075 ......... 26 ....... A Adrenal nuclear imaging .............................. 0.74 0.26 0.26 0.03 1.03 1.03 XXX 78075 ......... TC ...... A Adrenal nuclear imaging .............................. 0.00 5.41 NA 0.29 5.70 NA XXX 78102 ......... ............ A Bone marrow imaging, ltd ............................ 0.55 2.23 NA 0.14 2.92 NA XXX 78102 ......... 26 ....... A Bone marrow imaging, ltd ............................ 0.55 0.19 0.19 0.02 0.76 0.76 XXX 78102 ......... TC ...... A Bone marrow imaging, ltd ............................ 0.00 2.04 NA 0.12 2.16 NA XXX 78103 ......... ............ A Bone marrow imaging, mult ......................... 0.75 3.42 NA 0.20 4.37 NA XXX 78103 ......... 26 ....... A Bone marrow imaging, mult ......................... 0.75 0.26 0.26 0.03 1.04 1.04 XXX 78103 ......... TC ...... A Bone marrow imaging, mult ......................... 0.00 3.17 NA 0.17 3.34 NA XXX 78104 ......... ............ A Bone marrow imaging, body ........................ 0.80 4.33 NA 0.26 5.39 NA XXX 78104 ......... 26 ....... A Bone marrow imaging, body ........................ 0.80 0.27 0.27 0.04 1.11 1.11 XXX 78104 ......... TC ...... A Bone marrow imaging, body ........................ 0.00 4.06 NA 0.22 4.28 NA XXX 78110 ......... ............ A Plasma volume, single ................................. 0.19 1.02 NA 0.07 1.28 NA XXX 78110 ......... 26 ....... A Plasma volume, single ................................. 0.19 0.07 0.07 0.01 0.27 0.27 XXX 78110 ......... TC ...... A Plasma volume, single ................................. 0.00 0.95 NA 0.06 1.01 NA XXX 78111 ......... ............ A Plasma volume, multiple .............................. 0.22 2.65 NA 0.15 3.02 NA XXX 78111 ......... 26 ....... A Plasma volume, multiple .............................. 0.22 0.08 0.08 0.01 0.31 0.31 XXX 78111 ......... TC ...... A Plasma volume, multiple .............................. 0.00 2.57 NA 0.14 2.71 NA XXX 78120 ......... ............ A Red cell mass, single .................................. 0.23 1.81 NA 0.12 2.16 NA XXX 78120 ......... 26 ....... A Red cell mass, single .................................. 0.23 0.08 0.08 0.01 0.32 0.32 XXX 78120 ......... TC ...... A Red cell mass, single .................................. 0.00 1.73 NA 0.11 1.84 NA XXX 78121 ......... ............ A Red cell mass, multiple ............................... 0.32 3.02 NA 0.15 3.49 NA XXX 78121 ......... 26 ....... A Red cell mass, multiple ............................... 0.32 0.11 0.11 0.01 0.44 0.44 XXX 78121 ......... TC ...... A Red cell mass, multiple ............................... 0.00 2.91 NA 0.14 3.05 NA XXX
78122 ......... ............ A Blood volume ............................................... 0.45 4.75 NA 0.26 5.46 NA XXX 78122 ......... 26 ....... A Blood volume ............................................... 0.45 0.16 0.16 0.02 0.63 0.63 XXX 78122 ......... TC ...... A Blood volume ............................................... 0.00 4.59 NA 0.24 4.83 NA XXX 78130 ......... ............ A Red cell survival study ................................. 0.61 3.06 NA 0.17 3.84 NA XXX 78130 ......... 26 ....... A Red cell survival study ................................. 0.61 0.21 0.21 0.03 0.85 0.85 XXX 78130 ......... TC ...... A Red cell survival study ................................. 0.00 2.85 NA 0.14 2.99 NA XXX
78135 ......... ............ A Red cell survival kinetics ............................. 0.64 5.08 NA 0.28 6.00 NA XXX 78135 ......... 26 ....... A Red cell survival kinetics ............................. 0.64 0.22 0.22 0.03 0.89 0.89 XXX 78135 ......... TC ...... A Red cell survival kinetics ............................. 0.00 4.86 NA 0.25 5.11 NA XXX 78140 ......... ............ A Red cell sequestration ................................. 0.61 4.13 NA 0.24 4.98 NA XXX 78140 ......... 26 ....... A Red cell sequestration ................................. 0.61 0.20 0.20 0.03 0.84 0.84 XXX 78140 ......... TC ...... A Red cell sequestration ................................. 0.00 3.93 NA 0.21 4.14 NA XXX
78160 ......... ............ A Plasma iron turnover ................................... 0.33 3.78 NA 0.20 4.31 NA XXX 78160 ......... 26 ....... A Plasma iron turnover ................................... 0.33 0.12 0.12 0.01 0.46 0.46 XXX 78160 ......... TC ...... A Plasma iron turnover ................................... 0.00 3.66 NA 0.19 3.85 NA XXX 78162 ......... ............ A Radioiron absorption exam .......................... 0.45 3.38 NA 0.18 4.01 NA XXX 78162 ......... 26 ....... A Radioiron absorption exam .......................... 0.45 0.19 0.19 0.01 0.65 0.65 XXX 78162 ......... TC ...... A Radioiron absorption exam .......................... 0.00 3.19 NA 0.17 3.36 NA XXX
78170 ......... ............ A Red cell iron utilization ................................ 0.41 5.44 NA 0.30 6.15 NA XXX 78170 ......... 26 ....... A Red cell iron utilization ................................ 0.41 0.14 0.14 0.02 0.57 0.57 XXX 78170 ......... TC ...... A Red cell iron utilization ................................ 0.00 5.30 NA 0.28 5.58 NA XXX 78172 ......... 26 ....... A Total body iron estimation ........................... 0.53 0.17 0.17 0.02 0.72 0.72 XXX 78185 ......... ............ A Spleen imaging ............................................ 0.40 2.49 NA 0.15 3.04 NA XXX 78185 ......... 26 ....... A Spleen imaging ............................................ 0.40 0.14 0.14 0.02 0.56 0.56 XXX 78185 ......... TC ...... A Spleen imaging ............................................ 0.00 2.35 NA 0.13 2.48 NA XXX 78190 ......... ............ A Platelet survival, kinetics ............................. 1.09 6.10 NA 0.34 7.53 NA XXX 78190 ......... 26 ....... A Platelet survival, kinetics ............................. 1.09 0.39 0.39 0.04 1.52 1.52 XXX 78190 ......... TC ...... A Platelet survival, kinetics ............................. 0.00 5.70 NA 0.30 6.00 NA XXX
78191 ......... ............ A Platelet survival ............................................ 0.61 7.53 NA 0.40 8.54 NA XXX 78191 ......... 26 ....... A Platelet survival ............................................ 0.61 0.20 0.20 0.03 0.84 0.84 XXX 78191 ......... TC ...... A Platelet survival ............................................ 0.00 7.33 NA 0.37 7.70 NA XXX 78195 ......... ............ A Lymph system imaging ................................ 1.20 4.47 NA 0.28 5.95 NA XXX 78195 ......... 26 ....... A Lymph system imaging ................................ 1.20 0.41 0.41 0.06 1.67 1.67 XXX 78195 ......... TC ...... A Lymph system imaging ................................ 0.00 4.06 NA 0.22 4.28 NA XXX 78201 ......... ............ A Liver imaging ............................................... 0.44 2.50 NA 0.15 3.09 NA XXX 78201 ......... 26 ....... A Liver imaging ............................................... 0.44 0.15 0.15 0.02 0.61 0.61 XXX 78201 ......... TC ...... A Liver imaging ............................................... 0.00 2.35 NA 0.13 2.48 NA XXX 78202 ......... ............ A Liver imaging with flow ................................ 0.51 3.05 NA 0.16 3.72 NA XXX 78202 ......... 26 ....... A Liver imaging with flow ................................ 0.51 0.17 0.17 0.02 0.70 0.70 XXX 78202 ......... TC ...... A Liver imaging with flow ................................ 0.00 2.88 NA 0.14 3.02 NA XXX 78205 ......... ............ A Liver imaging (3D) ....................................... 0.71 6.14 NA 0.34 7.19 NA XXX 78205 ......... 26 ....... A Liver imaging (3D) ....................................... 0.71 0.24 0.24 0.03 0.98 0.98 XXX 78205 ......... TC ...... A Liver imaging (3D) ....................................... 0.00 5.90 NA 0.31 6.21 NA XXX 78206 ......... ............ A Liver image (3d) with flow ........................... 0.96 6.23 NA 0.15 7.34 NA XXX 78206 ......... 26 ....... A Liver image (3d) with flow ........................... 0.96 0.33 0.33 0.04 1.33 1.33 XXX 78206 ......... TC ...... A Liver image (3d) with flow ........................... 0.00 5.90 NA 0.11 6.01 NA XXX 78215 ......... ............ A Liver and spleen imaging ............................ 0.49 3.10 NA 0.16 3.75 NA XXX 78215 ......... 26 ....... A Liver and spleen imaging ............................ 0.49 0.16 0.16 0.02 0.67 0.67 XXX 78215 ......... TC ...... A Liver and spleen imaging ............................ 0.00 2.93 NA 0.14 3.07 NA XXX 78216 ......... ............ A Liver & spleen image/flow ........................... 0.57 3.67 NA 0.20 4.44 NA XXX 78216 ......... 26 ....... A Liver & spleen image/flow ........................... 0.57 0.19 0.19 0.02 0.78 0.78 XXX 78216 ......... TC ...... A Liver & spleen image/flow ........................... 0.00 3.47 NA 0.18 3.65 NA XXX


## 47671

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

78220 ......... ............ A Liver function study ...................................... 0.49 3.88 NA 0.21 4.58 NA XXX 78220 ......... 26 ....... A Liver function study ...................................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 78220 ......... TC ...... A Liver function study ...................................... 0.00 3.72 NA 0.19 3.91 NA XXX 78223 ......... ............ A Hepatobiliary imaging .................................. 0.84 3.94 NA 0.23 5.01 NA XXX 78223 ......... 26 ....... A Hepatobiliary imaging .................................. 0.84 0.28 0.28 0.04 1.16 1.16 XXX 78223 ......... TC ...... A Hepatobiliary imaging .................................. 0.00 3.66 NA 0.19 3.85 NA XXX 78230 ......... ............ A Salivary gland imaging ................................ 0.45 2.32 NA 0.15 2.92 NA XXX 78230 ......... 26 ....... A Salivary gland imaging ................................ 0.45 0.15 0.15 0.02 0.62 0.62 XXX 78230 ......... TC ...... A Salivary gland imaging ................................ 0.00 2.17 NA 0.13 2.30 NA XXX 78231 ......... ............ A Serial salivary imaging ................................. 0.52 3.35 NA 0.19 4.06 NA XXX 78231 ......... 26 ....... A Serial salivary imaging ................................. 0.52 0.18 0.18 0.02 0.72 0.72 XXX 78231 ......... TC ...... A Serial salivary imaging ................................. 0.00 3.17 NA 0.17 3.34 NA XXX 78232 ......... ............ A Salivary gland function exam ...................... 0.47 3.70 NA 0.20 4.37 NA XXX 78232 ......... 26 ....... A Salivary gland function exam ...................... 0.47 0.16 0.16 0.02 0.65 0.65 XXX 78232 ......... TC ...... A Salivary gland function exam ...................... 0.00 3.53 NA 0.18 3.71 NA XXX 78258 ......... ............ A Esophageal motility study ............................ 0.74 3.12 NA 0.17 4.03 NA XXX 78258 ......... 26 ....... A Esophageal motility study ............................ 0.74 0.25 0.25 0.03 1.02 1.02 XXX 78258 ......... TC ...... A Esophageal motility study ............................ 0.00 2.88 NA 0.14 3.02 NA XXX 78261 ......... ............ A Gastric mucosa imaging .............................. 0.69 4.33 NA 0.25 5.27 NA XXX 78261 ......... 26 ....... A Gastric mucosa imaging .............................. 0.69 0.24 0.24 0.03 0.96 0.96 XXX 78261 ......... TC ...... A Gastric mucosa imaging .............................. 0.00 4.09 NA 0.22 4.31 NA XXX 78262 ......... ............ A Gastroesophageal reflux exam .................... 0.68 4.48 NA 0.25 5.41 NA XXX 78262 ......... 26 ....... A Gastroesophageal reflux exam .................... 0.68 0.23 0.23 0.03 0.94 0.94 XXX 78262 ......... TC ...... A Gastroesophageal reflux exam .................... 0.00 4.25 NA 0.22 4.47 NA XXX 78264 ......... ............ A Gastric emptying study ................................ 0.78 4.38 NA 0.25 5.41 NA XXX 78264 ......... 26 ....... A Gastric emptying study ................................ 0.78 0.26 0.26 0.03 1.07 1.07 XXX 78264 ......... TC ...... A Gastric emptying study ................................ 0.00 4.12 NA 0.22 4.34 NA XXX 78270 ......... ............ A Vit B-12 absorption exam ............................ 0.20 1.61 NA 0.11 1.92 NA XXX 78270 ......... 26 ....... A Vit B-12 absorption exam ............................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 78270 ......... TC ...... A Vit B-12 absorption exam ............................ 0.00 1.54 NA 0.10 1.64 NA XXX 78271 ......... ............ A Vit b-12 absrp exam, int fac ........................ 0.20 1.71 NA 0.11 2.02 NA XXX 78271 ......... 26 ....... A Vit b-12 absrp exam, int fac ........................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 78271 ......... TC ...... A Vit b-12 absrp exam, int fac ........................ 0.00 1.64 NA 0.10 1.74 NA XXX 78272 ......... ............ A Vit B-12 absorp, combined .......................... 0.27 2.41 NA 0.14 2.82 NA XXX 78272 ......... 26 ....... A Vit B-12 absorp, combined .......................... 0.27 0.09 0.09 0.01 0.37 0.37 XXX 78272 ......... TC ...... A Vit B-12 absorp, combined .......................... 0.00 2.32 NA 0.13 2.45 NA XXX 78278 ......... ............ A Acute GI blood loss imaging ....................... 0.99 5.19 NA 0.29 6.47 NA XXX 78278 ......... 26 ....... A Acute GI blood loss imaging ....................... 0.99 0.33 0.33 0.04 1.36 1.36 XXX 78278 ......... TC ...... A Acute GI blood loss imaging ....................... 0.00 4.86 NA 0.25 5.11 NA XXX 78282 ......... 26 ....... A GI protein loss exam ................................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX
78290 ......... ............ A Meckel-s divert exam ................................... 0.68 3.27 NA 0.19 4.14 NA XXX 78290 ......... 26 ....... A Meckel-s divert exam ................................... 0.68 0.23 0.23 0.03 0.94 0.94 XXX 78290 ......... TC ...... A Meckel-s divert exam ................................... 0.00 3.04 NA 0.16 3.20 NA XXX 78291 ......... ............ A Leveen/shunt patency exam ........................ 0.88 3.36 NA 0.20 4.44 NA XXX 78291 ......... 26 ....... A Leveen/shunt patency exam ........................ 0.88 0.30 0.30 0.04 1.22 1.22 XXX 78291 ......... TC ...... A Leveen/shunt patency exam ........................ 0.00 3.06 NA 0.16 3.22 NA XXX 78300 ......... ............ A Bone imaging, limited area .......................... 0.62 2.69 NA 0.17 3.48 NA XXX 78300 ......... 26 ....... A Bone imaging, limited area .......................... 0.62 0.21 0.21 0.03 0.86 0.86 XXX 78300 ......... TC ...... A Bone imaging, limited area .......................... 0.00 2.48 NA 0.14 2.62 NA XXX 78305 ......... ............ A Bone imaging, multiple areas ...................... 0.83 3.93 NA 0.23 4.99 NA XXX 78305 ......... 26 ....... A Bone imaging, multiple areas ...................... 0.83 0.28 0.28 0.04 1.15 1.15 XXX 78305 ......... TC ...... A Bone imaging, multiple areas ...................... 0.00 3.66 NA 0.19 3.85 NA XXX 78306 ......... ............ A Bone imaging, whole body .......................... 0.86 4.55 NA 0.26 5.67 NA XXX 78306 ......... 26 ....... A Bone imaging, whole body .......................... 0.86 0.29 0.29 0.04 1.19 1.19 XXX 78306 ......... TC ...... A Bone imaging, whole body .......................... 0.00 4.27 NA 0.22 4.49 NA XXX 78315 ......... ............ A Bone imaging, 3 phase ................................ 1.02 5.11 NA 0.29 6.42 NA XXX 78315 ......... 26 ....... A Bone imaging, 3 phase ................................ 1.02 0.34 0.34 0.04 1.40 1.40 XXX 78315 ......... TC ...... A Bone imaging, 3 phase ................................ 0.00 4.77 NA 0.25 5.02 NA XXX 78320 ......... ............ A Bone imaging (3D) ....................................... 1.04 6.26 NA 0.36 7.66 NA XXX 78320 ......... 26 ....... A Bone imaging (3D) ....................................... 1.04 0.36 0.36 0.05 1.45 1.45 XXX 78320 ......... TC ...... A Bone imaging (3D) ....................................... 0.00 5.90 NA 0.31 6.21 NA XXX 78350 ......... ............ A Bone mineral, single photon ........................ 0.22 0.83 NA 0.06 1.11 NA XXX 78350 ......... 26 ....... A Bone mineral, single photon ........................ 0.22 0.07 0.07 0.01 0.30 0.30 XXX 78350 ......... TC ...... A Bone mineral, single photon ........................ 0.00 0.75 NA 0.05 0.80 NA XXX 78414 ......... 26 ....... A Non-imaging heart function ......................... 0.45 0.16 0.16 0.02 0.63 0.63 XXX 78428 ......... ............ A Cardiac shunt imaging ................................. 0.78 2.54 NA 0.16 3.48 NA XXX 78428 ......... 26 ....... A Cardiac shunt imaging ................................. 0.78 0.29 0.29 0.03 1.10 1.10 XXX 78428 ......... TC ...... A Cardiac shunt imaging ................................. 0.00 2.25 NA 0.13 2.38 NA XXX 78445 ......... ............ A Vascular flow imaging .................................. 0.49 2.02 NA 0.13 2.64 NA XXX 78445 ......... 26 ....... A Vascular flow imaging .................................. 0.49 0.17 0.17 0.02 0.68 0.68 XXX 78445 ......... TC ...... A Vascular flow imaging .................................. 0.00 1.85 NA 0.11 1.96 NA XXX 78455 ......... ............ A Venous thrombosis study ............................ 0.73 4.22 NA 0.24 5.19 NA XXX 78455 ......... 26 ....... A Venous thrombosis study ............................ 0.73 0.25 0.25 0.03 1.01 1.01 XXX 78455 ......... TC ...... A Venous thrombosis study ............................ 0.00 3.98 NA 0.21 4.19 NA XXX 78456 ......... ............ A Acute venous thrombus image .................... 1.00 4.32 NA 0.33 5.65 NA XXX


## 47672

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

78456 ......... 26 ....... A Acute venous thrombus image .................... 1.00 0.34 0.34 0.04 1.38 1.38 XXX 78456 ......... TC ...... A Acute venous thrombus image .................... 0.00 3.98 NA 0.29 4.27 NA XXX 78457 ......... ............ A Venous thrombosis imaging ........................ 0.77 2.91 NA 0.18 3.86 NA XXX 78457 ......... 26 ....... A Venous thrombosis imaging ........................ 0.77 0.26 0.26 0.04 1.07 1.07 XXX 78457 ......... TC ...... A Venous thrombosis imaging ........................ 0.00 2.65 NA 0.14 2.79 NA XXX 78458 ......... ............ A Ven thrombosis images, bilat ...................... 0.90 4.34 NA 0.25 5.49 NA XXX 78458 ......... 26 ....... A Ven thrombosis images, bilat ...................... 0.90 0.32 0.32 0.04 1.26 1.26 XXX 78458 ......... TC ...... A Ven thrombosis images, bilat ...................... 0.00 4.02 NA 0.21 4.23 NA XXX 78459 ......... 26 ....... R Heart muscle imaging (PET) ....................... 1.50 0.57 0.57 0.06 2.13 2.13 XXX 78460 ......... ............ A Heart muscle blood, single .......................... 0.86 2.65 NA 0.17 3.68 NA XXX 78460 ......... 26 ....... A Heart muscle blood, single .......................... 0.86 0.29 0.29 0.04 1.19 1.19 XXX 78460 ......... TC ...... A Heart muscle blood, single .......................... 0.00 2.35 NA 0.13 2.48 NA XXX 78461 ......... ............ A Heart muscle blood, multiple ....................... 1.23 5.14 NA 0.30 6.67 NA XXX 78461 ......... 26 ....... A Heart muscle blood, multiple ....................... 1.23 0.43 0.43 0.05 1.71 1.71 XXX 78461 ......... TC ...... A Heart muscle blood, multiple ....................... 0.00 4.71 NA 0.25 4.96 NA XXX 78464 ......... ............ A Heart image (3d), single .............................. 1.09 7.44 NA 0.41 8.94 NA XXX 78464 ......... 26 ....... A Heart image (3d), single .............................. 1.09 0.38 0.38 0.04 1.51 1.51 XXX 78464 ......... TC ...... A Heart image (3d), single .............................. 0.00 7.06 NA 0.37 7.43 NA XXX 78465 ......... ............ A Heart image (3d), multiple ........................... 1.46 12.30 NA 0.68 14.44 NA XXX 78465 ......... 26 ....... A Heart image (3d), multiple ........................... 1.46 0.52 0.52 0.06 2.04 2.04 XXX 78465 ......... TC ...... A Heart image (3d), multiple ........................... 0.00 11.77 NA 0.62 12.39 NA XXX 78466 ......... ............ A Heart infarct image ...................................... 0.69 2.86 NA 0.17 3.72 NA XXX 78466 ......... 26 ....... A Heart infarct image ...................................... 0.69 0.24 0.24 0.03 0.96 0.96 XXX 78466 ......... TC ...... A Heart infarct image ...................................... 0.00 2.62 NA 0.14 2.76 NA XXX 78468 ......... ............ A Heart infarct image (ef) ................................ 0.80 3.93 NA 0.22 4.95 NA XXX 78468 ......... 26 ....... A Heart infarct image (ef) ................................ 0.80 0.27 0.27 0.03 1.10 1.10 XXX 78468 ......... TC ...... A Heart infarct image (ef) ................................ 0.00 3.66 NA 0.19 3.85 NA XXX 78469 ......... ............ A Heart infarct image (3D) .............................. 0.92 5.53 NA 0.31 6.76 NA XXX 78469 ......... 26 ....... A Heart infarct image (3D) .............................. 0.92 0.31 0.31 0.03 1.26 1.26 XXX 78469 ......... TC ...... A Heart infarct image (3D) .............................. 0.00 5.21 NA 0.28 5.49 NA XXX 78472 ......... ............ A Gated heart, planar, single .......................... 0.98 5.84 NA 0.34 7.16 NA XXX 78472 ......... 26 ....... A Gated heart, planar, single .......................... 0.98 0.34 0.34 0.04 1.36 1.36 XXX 78472 ......... TC ...... A Gated heart, planar, single .......................... 0.00 5.50 NA 0.30 5.80 NA XXX 78473 ......... ............ A Gated heart, multiple ................................... 1.47 8.75 NA 0.48 10.70 NA XXX 78473 ......... 26 ....... A Gated heart, multiple ................................... 1.47 0.51 0.51 0.06 2.04 2.04 XXX 78473 ......... TC ...... A Gated heart, multiple ................................... 0.00 8.24 NA 0.42 8.66 NA XXX
78478 ......... ............ A Heart wall motion add-on ............................ 0.62 1.78 NA 0.12 2.52 NA XXX 78478 ......... 26 ....... A Heart wall motion add-on ............................ 0.62 0.22 0.22 0.02 0.86 0.86 XXX 78478 ......... TC ...... A Heart wall motion add-on ............................ 0.00 1.55 NA 0.10 1.65 NA XXX 78480 ......... ............ A Heart function add-on .................................. 0.62 1.78 NA 0.12 2.52 NA XXX 78480 ......... 26 ....... A Heart function add-on .................................. 0.62 0.22 0.22 0.02 0.86 0.86 XXX 78480 ......... TC ...... A Heart function add-on .................................. 0.00 1.55 NA 0.10 1.65 NA XXX 78481 ......... ............ A Heart first pass, single ................................. 0.98 5.57 NA 0.32 6.87 NA XXX 78481 ......... 26 ....... A Heart first pass, single ................................. 0.98 0.36 0.36 0.04 1.38 1.38 XXX 78481 ......... TC ...... A Heart first pass, single ................................. 0.00 5.21 NA 0.28 5.49 NA XXX 78483 ......... ............ A Heart first pass, multiple .............................. 1.47 8.39 NA 0.46 10.32 NA XXX 78483 ......... 26 ....... A Heart first pass, multiple .............................. 1.47 0.54 0.54 0.05 2.06 2.06 XXX 78483 ......... TC ...... A Heart first pass, multiple .............................. 0.00 7.86 NA 0.41 8.27 NA XXX 78494 ......... ............ A Heart image, spect ...................................... 1.19 7.47 NA 0.35 9.01 NA XXX 78494 ......... 26 ....... A Heart image, spect ...................................... 1.19 0.42 0.42 0.05 1.66 1.66 XXX 78494 ......... TC ...... A Heart image, spect ...................................... 0.00 7.06 NA 0.30 7.36 NA XXX 78496 ......... ............ A Heart first pass add-on ................................ 0.50 7.24 NA 0.32 8.06 NA ZZZ 78496 ......... 26 ....... A Heart first pass add-on ................................ 0.50 0.18 0.18 0.02 0.70 0.70 ZZZ 78496 ......... TC ...... A Heart first pass add-on ................................ 0.00 7.06 NA 0.30 7.36 NA ZZZ 78580 ......... ............ A Lung perfusion imaging ............................... 0.74 3.67 NA 0.21 4.62 NA XXX 78580 ......... 26 ....... A Lung perfusion imaging ............................... 0.74 0.25 0.25 0.03 1.02 1.02 XXX 78580 ......... TC ...... A Lung perfusion imaging ............................... 0.00 3.43 NA 0.18 3.61 NA XXX 78584 ......... ............ A Lung V/Q image single breath ..................... 0.99 3.52 NA 0.21 4.72 NA XXX 78584 ......... 26 ....... A Lung V/Q image single breath ..................... 0.99 0.32 0.32 0.04 1.35 1.35 XXX 78584 ......... TC ...... A Lung V/Q image single breath ..................... 0.00 3.19 NA 0.17 3.36 NA XXX 78585 ......... ............ A Lung V/Q imaging ........................................ 1.09 5.99 NA 0.35 7.43 NA XXX 78585 ......... 26 ....... A Lung V/Q imaging ........................................ 1.09 0.36 0.36 0.05 1.50 1.50 XXX 78585 ......... TC ...... A Lung V/Q imaging ........................................ 0.00 5.63 NA 0.30 5.93 NA XXX 78586 ......... ............ A Aerosol lung image, single .......................... 0.40 2.72 NA 0.16 3.28 NA XXX 78586 ......... 26 ....... A Aerosol lung image, single .......................... 0.40 0.13 0.13 0.02 0.55 0.55 XXX 78586 ......... TC ...... A Aerosol lung image, single .......................... 0.00 2.59 NA 0.14 2.73 NA XXX 78587 ......... ............ A Aerosol lung image, multiple ....................... 0.49 2.96 NA 0.16 3.61 NA XXX 78587 ......... 26 ....... A Aerosol lung image, multiple ....................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 78587 ......... TC ...... A Aerosol lung image, multiple ....................... 0.00 2.80 NA 0.14 2.94 NA XXX 78588 ......... ............ A Perfusion lung image ................................... 1.09 3.56 NA 0.23 4.88 NA XXX 78588 ......... 26 ....... A Perfusion lung image ................................... 1.09 0.36 0.36 0.05 1.50 1.50 XXX 78588 ......... TC ...... A Perfusion lung image ................................... 0.00 3.19 NA 0.18 3.37 NA XXX 78591 ......... ............ A Vent image, 1 breath, 1 proj ........................ 0.40 2.98 NA 0.16 3.54 NA XXX 78591 ......... 26 ....... A Vent image, 1 breath, 1 proj ........................ 0.40 0.13 0.13 0.02 0.55 0.55 XXX 78591 ......... TC ...... A Vent image, 1 breath, 1 proj ........................ 0.00 2.85 NA 0.14 2.99 NA XXX


## 47673

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

78593 ......... ............ A Vent image, 1 proj, gas ............................... 0.49 3.61 NA 0.20 4.30 NA XXX 78593 ......... 26 ....... A Vent image, 1 proj, gas ............................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 78593 ......... TC ...... A Vent image, 1 proj, gas ............................... 0.00 3.45 NA 0.18 3.63 NA XXX 78594 ......... ............ A Vent image, mult proj, gas .......................... 0.53 5.15 NA 0.27 5.95 NA XXX 78594 ......... 26 ....... A Vent image, mult proj, gas .......................... 0.53 0.18 0.18 0.02 0.73 0.73 XXX 78594 ......... TC ...... A Vent image, mult proj, gas .......................... 0.00 4.97 NA 0.25 5.22 NA XXX 78596 ......... ............ A Lung differential function ............................. 1.27 7.48 NA 0.43 9.18 NA XXX 78596 ......... 26 ....... A Lung differential function ............................. 1.27 0.42 0.42 0.06 1.75 1.75 XXX 78596 ......... TC ...... A Lung differential function ............................. 0.00 7.06 NA 0.37 7.43 NA XXX 78600 ......... ............ A Brain imaging, ltd static ............................... 0.44 3.03 NA 0.16 3.63 NA XXX 78600 ......... 26 ....... A Brain imaging, ltd static ............................... 0.44 0.15 0.15 0.02 0.61 0.61 XXX 78600 ......... TC ...... A Brain imaging, ltd static ............................... 0.00 2.88 NA 0.14 3.02 NA XXX 78601 ......... ............ A Brain imaging, ltd w/flow .............................. 0.51 3.57 NA 0.20 4.28 NA XXX 78601 ......... 26 ....... A Brain imaging, ltd w/flow .............................. 0.51 0.17 0.17 0.02 0.70 0.70 XXX 78601 ......... TC ...... A Brain imaging, ltd w/flow .............................. 0.00 3.40 NA 0.18 3.58 NA XXX 78605 ......... ............ A Brain imaging, complete .............................. 0.53 3.58 NA 0.20 4.31 NA XXX 78605 ......... 26 ....... A Brain imaging, complete .............................. 0.53 0.18 0.18 0.02 0.73 0.73 XXX 78605 ......... TC ...... A Brain imaging, complete .............................. 0.00 3.40 NA 0.18 3.58 NA XXX 78606 ......... ............ A Brain imaging, compl w/flow ........................ 0.64 4.07 NA 0.24 4.95 NA XXX 78606 ......... 26 ....... A Brain imaging, compl w/flow ........................ 0.64 0.21 0.21 0.03 0.88 0.88 XXX 78606 ......... TC ...... A Brain imaging, compl w/flow ........................ 0.00 3.86 NA 0.21 4.07 NA XXX 78607 ......... ............ A Brain imaging (3D) ....................................... 1.23 6.97 NA 0.40 8.60 NA XXX 78607 ......... 26 ....... A Brain imaging (3D) ....................................... 1.23 0.43 0.43 0.05 1.71 1.71 XXX 78607 ......... TC ...... A Brain imaging (3D) ....................................... 0.00 6.54 NA 0.35 6.89 NA XXX 78610 ......... ............ A Brain flow imaging only ............................... 0.30 1.68 NA 0.11 2.09 NA XXX 78610 ......... 26 ....... A Brain flow imaging only ............................... 0.30 0.11 0.11 0.01 0.42 0.42 XXX 78610 ......... TC ...... A Brain flow imaging only ............................... 0.00 1.57 NA 0.10 1.67 NA XXX 78615 ......... ............ A Cerebral vascular flow image ...................... 0.42 3.99 NA 0.23 4.64 NA XXX 78615 ......... 26 ....... A Cerebral vascular flow image ...................... 0.42 0.15 0.15 0.02 0.59 0.59 XXX 78615 ......... TC ...... A Cerebral vascular flow image ...................... 0.00 3.84 NA 0.21 4.05 NA XXX 78630 ......... ............ A Cerebrospinal fluid scan .............................. 0.68 5.26 NA 0.30 6.24 NA XXX 78630 ......... 26 ....... A Cerebrospinal fluid scan .............................. 0.68 0.23 0.23 0.03 0.94 0.94 XXX 78630 ......... TC ...... A Cerebrospinal fluid scan .............................. 0.00 5.03 NA 0.27 5.30 NA XXX 78635 ......... ............ A CSF ventriculography .................................. 0.61 2.77 NA 0.16 3.54 NA XXX 78635 ......... 26 ....... A CSF ventriculography .................................. 0.61 0.23 0.23 0.02 0.86 0.86 XXX 78635 ......... TC ...... A CSF ventriculography .................................. 0.00 2.54 NA 0.14 2.68 NA XXX 78645 ......... ............ A CSF shunt evaluation .................................. 0.57 3.62 NA 0.20 4.39 NA XXX 78645 ......... 26 ....... A CSF shunt evaluation .................................. 0.57 0.19 0.19 0.02 0.78 0.78 XXX 78645 ......... TC ...... A CSF shunt evaluation .................................. 0.00 3.43 NA 0.18 3.61 NA XXX 78647 ......... ............ A Cerebrospinal fluid scan .............................. 0.90 6.21 NA 0.35 7.46 NA XXX 78647 ......... 26 ....... A Cerebrospinal fluid scan .............................. 0.90 0.31 0.31 0.04 1.25 1.25 XXX 78647 ......... TC ...... A Cerebrospinal fluid scan .............................. 0.00 5.90 NA 0.31 6.21 NA XXX 78650 ......... ............ A CSF leakage imaging .................................. 0.61 4.84 NA 0.27 5.72 NA XXX 78650 ......... 26 ....... A CSF leakage imaging .................................. 0.61 0.21 0.21 0.03 0.85 0.85 XXX 78650 ......... TC ...... A CSF leakage imaging .................................. 0.00 4.63 NA 0.24 4.87 NA XXX 78660 ......... ............ A Nuclear exam of tear flow ........................... 0.53 2.29 NA 0.14 2.96 NA XXX 78660 ......... 26 ....... A Nuclear exam of tear flow ........................... 0.53 0.18 0.18 0.02 0.73 0.73 XXX 78660 ......... TC ...... A Nuclear exam of tear flow ........................... 0.00 2.11 NA 0.12 2.23 NA XXX 78700 ......... ............ A Kidney imaging, static .................................. 0.45 3.19 NA 0.18 3.82 NA XXX 78700 ......... 26 ....... A Kidney imaging, static .................................. 0.45 0.15 0.15 0.02 0.62 0.62 XXX 78700 ......... TC ...... A Kidney imaging, static .................................. 0.00 3.04 NA 0.16 3.20 NA XXX 78701 ......... ............ A Kidney imaging with flow ............................. 0.49 3.71 NA 0.20 4.40 NA XXX 78701 ......... 26 ....... A Kidney imaging with flow ............................. 0.49 0.16 0.16 0.02 0.67 0.67 XXX 78701 ......... TC ...... A Kidney imaging with flow ............................. 0.00 3.55 NA 0.18 3.73 NA XXX 78704 ......... ............ A Imaging renogram ........................................ 0.74 4.19 NA 0.24 5.17 NA XXX 78704 ......... 26 ....... A Imaging renogram ........................................ 0.74 0.25 0.25 0.03 1.02 1.02 XXX 78704 ......... TC ...... A Imaging renogram ........................................ 0.00 3.95 NA 0.21 4.16 NA XXX 78707 ......... ............ A Kidney flow/function image .......................... 0.96 4.78 NA 0.27 6.01 NA XXX 78707 ......... 26 ....... A Kidney flow/function image .......................... 0.96 0.32 0.32 0.04 1.32 1.32 XXX 78707 ......... TC ...... A Kidney flow/function image .......................... 0.00 4.46 NA 0.23 4.69 NA XXX 78708 ......... ............ A Kidney flow/function image .......................... 1.21 4.87 NA 0.28 6.36 NA XXX 78708 ......... 26 ....... A Kidney flow/function image .......................... 1.21 0.41 0.41 0.05 1.67 1.67 XXX 78708 ......... TC ...... A Kidney flow/function image .......................... 0.00 4.46 NA 0.23 4.69 NA XXX 78709 ......... ............ A Kidney flow/function image .......................... 1.41 4.93 NA 0.29 6.63 NA XXX 78709 ......... 26 ....... A Kidney flow/function image .......................... 1.41 0.47 0.47 0.06 1.94 1.94 XXX 78709 ......... TC ...... A Kidney flow/function image .......................... 0.00 4.46 NA 0.23 4.69 NA XXX 78710 ......... ............ A Kidney imaging (3D) .................................... 0.66 6.12 NA 0.34 7.12 NA XXX 78710 ......... 26 ....... A Kidney imaging (3D) .................................... 0.66 0.22 0.22 0.03 0.91 0.91 XXX 78710 ......... TC ...... A Kidney imaging (3D) .................................... 0.00 5.90 NA 0.31 6.21 NA XXX 78715 ......... ............ A Renal vascular flow exam ........................... 0.30 1.68 NA 0.11 2.09 NA XXX 78715 ......... 26 ....... A Renal vascular flow exam ........................... 0.30 0.11 0.11 0.01 0.42 0.42 XXX 78715 ......... TC ...... A Renal vascular flow exam ........................... 0.00 1.57 NA 0.10 1.67 NA XXX 78725 ......... ............ A Kidney function study .................................. 0.38 1.90 NA 0.13 2.41 NA XXX 78725 ......... 26 ....... A Kidney function study .................................. 0.38 0.13 0.13 0.02 0.53 0.53 XXX 78725 ......... TC ...... A Kidney function study .................................. 0.00 1.78 NA 0.11 1.89 NA XXX


## 47674

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

78730 ......... ............ A Urinary bladder retention ............................. 0.36 1.58 NA 0.10 2.04 NA XXX 78730 ......... 26 ....... A Urinary bladder retention ............................. 0.36 0.12 0.12 0.02 0.50 0.50 XXX 78730 ......... TC ...... A Urinary bladder retention ............................. 0.00 1.46 NA 0.08 1.54 NA XXX 78740 ......... ............ A Ureteral reflux study .................................... 0.57 2.30 NA 0.15 3.02 NA XXX 78740 ......... 26 ....... A Ureteral reflux study .................................... 0.57 0.19 0.19 0.03 0.79 0.79 XXX 78740 ......... TC ...... A Ureteral reflux study .................................... 0.00 2.11 NA 0.12 2.23 NA XXX 78760 ......... ............ A Testicular imaging ........................................ 0.66 2.89 NA 0.17 3.72 NA XXX 78760 ......... 26 ....... A Testicular imaging ........................................ 0.66 0.22 0.22 0.03 0.91 0.91 XXX 78760 ......... TC ...... A Testicular imaging ........................................ 0.00 2.67 NA 0.14 2.81 NA XXX 78761 ......... ............ A Testicular imaging/flow ................................ 0.71 3.43 NA 0.20 4.34 NA XXX 78761 ......... 26 ....... A Testicular imaging/flow ................................ 0.71 0.24 0.24 0.03 0.98 0.98 XXX 78761 ......... TC ...... A Testicular imaging/flow ................................ 0.00 3.19 NA 0.17 3.36 NA XXX 78800 ......... ............ A Tumor imaging, limited area ........................ 0.66 3.62 NA 0.22 4.50 NA XXX 78800 ......... 26 ....... A Tumor imaging, limited area ........................ 0.66 0.22 0.22 0.04 0.92 0.92 XXX 78800 ......... TC ...... A Tumor imaging, limited area ........................ 0.00 3.40 NA 0.18 3.58 NA XXX 78801 ......... ............ A Tumor imaging, mult areas .......................... 0.79 4.48 NA 0.27 5.54 NA XXX 78801 ......... 26 ....... A Tumor imaging, mult areas .......................... 0.79 0.27 0.27 0.05 1.11 1.11 XXX 78801 ......... TC ...... A Tumor imaging, mult areas .......................... 0.00 4.22 NA 0.22 4.44 NA XXX 78802 ......... ............ A Tumor imaging, whole body ........................ 0.86 5.81 NA 0.34 7.01 NA XXX 78802 ......... 26 ....... A Tumor imaging, whole body ........................ 0.86 0.29 0.29 0.04 1.19 1.19 XXX 78802 ......... TC ...... A Tumor imaging, whole body ........................ 0.00 5.52 NA 0.30 5.82 NA XXX 78803 ......... ............ A Tumor imaging (3D) ..................................... 1.09 6.93 NA 0.40 8.42 NA XXX 78803 ......... 26 ....... A Tumor imaging (3D) ..................................... 1.09 0.38 0.38 0.05 1.52 1.52 XXX 78803 ......... TC ...... A Tumor imaging (3D) ..................................... 0.00 6.54 NA 0.35 6.89 NA XXX 78804 ......... ............ A Tumor imaging, whole body ........................ 1.07 11.41 NA 0.34 12.82 NA XXX 78804 ......... 26 ....... A Tumor imaging, whole body ........................ 1.07 0.37 0.37 0.04 1.48 1.48 XXX 78804 ......... TC ...... A Tumor imaging, whole body ........................ 0.00 11.04 NA 0.30 11.34 NA XXX 78805 ......... ............ A Abscess imaging, ltd area ........................... 0.73 3.65 NA 0.21 4.59 NA XXX 78805 ......... 26 ....... A Abscess imaging, ltd area ........................... 0.73 0.25 0.25 0.03 1.01 1.01 XXX 78805 ......... TC ...... A Abscess imaging, ltd area ........................... 0.00 3.40 NA 0.18 3.58 NA XXX 78806 ......... ............ A Abscess imaging, whole body ..................... 0.86 6.71 NA 0.39 7.96 NA XXX 78806 ......... 26 ....... A Abscess imaging, whole body ..................... 0.86 0.29 0.29 0.04 1.19 1.19 XXX 78806 ......... TC ...... A Abscess imaging, whole body ..................... 0.00 6.42 NA 0.35 6.77 NA XXX 78807 ......... ............ A Nuclear localization/abscess ....................... 1.09 6.93 NA 0.40 8.42 NA XXX 78807 ......... 26 ....... A Nuclear localization/abscess ....................... 1.09 0.39 0.39 0.05 1.53 1.53 XXX 78807 ......... TC ...... A Nuclear localization/abscess ....................... 0.00 6.54 NA 0.35 6.89 NA XXX 78890 ......... ............ B Nuclear medicine data proc ......................... 0.05 1.32 NA 0.07 1.44 NA XXX 78890 ......... 26 ....... B Nuclear medicine data proc ......................... 0.05 0.02 0.02 0.01 0.08 0.08 XXX 78890 ......... TC ...... B Nuclear medicine data proc ......................... 0.00 1.30 NA 0.06 1.36 NA XXX 78891 ......... ............ B Nuclear med data proc ................................ 0.10 2.65 NA 0.14 2.89 NA XXX 78891 ......... 26 ....... B Nuclear med data proc ................................ 0.10 0.04 0.04 0.01 0.15 0.15 XXX 78891 ......... TC ...... B Nuclear med data proc ................................ 0.00 2.62 NA 0.13 2.75 NA XXX 79000 ......... ............ A Init hyperthyroid therapy .............................. 1.80 3.22 NA 0.22 5.24 NA XXX 79000 ......... 26 ....... A Init hyperthyroid therapy .............................. 1.80 0.60 0.60 0.08 2.48 2.48 XXX 79000 ......... TC ...... A Init hyperthyroid therapy .............................. 0.00 2.62 NA 0.14 2.76 NA XXX 79001 ......... ............ A Repeat hyperthyroid therapy ....................... 1.05 1.66 NA 0.12 2.83 NA XXX 79001 ......... 26 ....... A Repeat hyperthyroid therapy ....................... 1.05 0.36 0.36 0.05 1.46 1.46 XXX 79001 ......... TC ...... A Repeat hyperthyroid therapy ....................... 0.00 1.30 NA 0.07 1.37 NA XXX 79020 ......... ............ A Thyroid ablation ........................................... 1.81 3.21 NA 0.22 5.24 NA XXX 79020 ......... 26 ....... A Thyroid ablation ........................................... 1.81 0.60 0.60 0.08 2.49 2.49 XXX 79020 ......... TC ...... A Thyroid ablation ........................................... 0.00 2.62 NA 0.14 2.76 NA XXX 79030 ......... ............ A Thyroid ablation, carcinoma ........................ 2.10 3.32 NA 0.23 5.65 NA XXX 79030 ......... 26 ....... A Thyroid ablation, carcinoma ........................ 2.10 0.71 0.71 0.09 2.90 2.90 XXX 79030 ......... TC ...... A Thyroid ablation, carcinoma ........................ 0.00 2.62 NA 0.14 2.76 NA XXX 79035 ......... ............ A Thyroid metastatic therapy .......................... 2.52 3.49 NA 0.25 6.26 NA XXX 79035 ......... 26 ....... A Thyroid metastatic therapy .......................... 2.52 0.87 0.87 0.11 3.50 3.50 XXX 79035 ......... TC ...... A Thyroid metastatic therapy .......................... 0.00 2.62 NA 0.14 2.76 NA XXX 79100 ......... ............ A Hematopoetic nuclear therapy ..................... 1.32 3.08 NA 0.20 4.60 NA XXX 79100 ......... 26 ....... A Hematopoetic nuclear therapy ..................... 1.32 0.46 0.46 0.06 1.84 1.84 XXX 79100 ......... TC ...... A Hematopoetic nuclear therapy ..................... 0.00 2.62 NA 0.14 2.76 NA XXX 79200 ......... ............ A Intracavitary nuclear trmt ............................. 1.99 3.30 NA 0.23 5.52 NA XXX 79200 ......... 26 ....... A Intracavitary nuclear trmt ............................. 1.99 0.69 0.69 0.09 2.77 2.77 XXX 79200 ......... TC ...... A Intracavitary nuclear trmt ............................. 0.00 2.62 NA 0.14 2.76 NA XXX 79300 ......... 26 ....... A Interstitial nuclear therapy ........................... 1.60 0.56 0.56 0.08 2.24 2.24 XXX 79400 ......... ............ A Nonhemato nuclear therapy ........................ 1.96 3.29 NA 0.23 5.48 NA XXX 79400 ......... 26 ....... A Nonhemato nuclear therapy ........................ 1.96 0.67 0.67 0.09 2.72 2.72 XXX 79400 ......... TC ...... A Nonhemato nuclear therapy ........................ 0.00 2.62 NA 0.14 2.76 NA XXX 79403 ......... ............ A Hematopoetic nuclear therapy ..................... 2.25 5.16 NA 0.24 7.65 NA XXX 79403 ......... 26 ....... A Hematopoetic nuclear therapy ..................... 2.25 0.89 0.89 0.10 3.24 3.24 XXX 79403 ......... TC ...... A Hematopoetic nuclear therapy ..................... 0.00 4.27 NA 0.14 4.41 NA XXX
79420 ......... 26 ....... A Intravascular nuclear ther ............................ 1.51 0.49 0.49 0.07 2.07 2.07 XXX 79440 ......... ............ A Nuclear joint therapy .................................... 1.99 3.34 NA 0.24 5.57 NA XXX 79440 ......... 26 ....... A Nuclear joint therapy .................................... 1.99 0.72 0.72 0.10 2.81 2.81 XXX 79440 ......... TC ...... A Nuclear joint therapy .................................... 0.00 2.62 NA 0.14 2.76 NA XXX 80500 ......... ............ A Lab pathology consultation .......................... 0.37 0.21 0.16 0.01 0.59 0.54 XXX


## 47675

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

80502 ......... ............ A Lab pathology consultation .......................... 1.33 0.55 0.55 0.06 1.94 1.94 XXX 83020 ......... 26 ....... A Hemoglobin electrophoresis ........................ 0.37 0.15 0.15 0.01 0.53 0.53 XXX 83912 ......... 26 ....... A Genetic examination .................................... 0.37 0.12 0.12 0.01 0.50 0.50 XXX 84165 ......... 26 ....... A Electrophoreisis of proteins ......................... 0.37 0.14 0.14 0.01 0.52 0.52 XXX 84181 ......... 26 ....... A Western blot test .......................................... 0.37 0.14 0.14 0.02 0.53 0.53 XXX 84182 ......... 26 ....... A Protein, western blot test ............................. 0.37 0.16 0.16 0.01 0.54 0.54 XXX 85060 ......... ............ A Blood smear interpretation .......................... 0.45 0.18 0.18 0.02 0.65 0.65 XXX 85097 ......... ............ A Bone marrow interpretation ......................... 0.94 2.02 0.42 0.04 3.00 1.40 XXX 85390 ......... 26 ....... A Fibrinolysins screen ..................................... 0.37 0.13 0.13 0.02 0.52 0.52 XXX 85396 ......... ............ A Clotting assay, whole blood ......................... 0.37 NA 0.16 0.04 NA 0.57 XXX 85576 ......... 26 ....... A Blood platelet aggregation ........................... 0.37 0.16 0.16 0.02 0.55 0.55 XXX 86077 ......... ............ A Physician blood bank service ...................... 0.94 0.40 0.40 0.04 1.38 1.38 XXX 86078 ......... ............ A Physician blood bank service ...................... 0.94 0.47 0.41 0.04 1.45 1.39 XXX 86079 ......... ............ A Physician blood bank service ...................... 0.94 0.45 0.41 0.04 1.43 1.39 XXX 86255 ......... 26 ....... A Fluorescent antibody, screen ...................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 86256 ......... 26 ....... A Fluorescent antibody, titer ........................... 0.37 0.15 0.15 0.01 0.53 0.53 XXX 86320 ......... 26 ....... A Serum immunoelectrophoresis .................... 0.37 0.15 0.15 0.01 0.53 0.53 XXX 86325 ......... 26 ....... A Other immunoelectrophoresis ...................... 0.37 0.13 0.13 0.01 0.51 0.51 XXX 86327 ......... 26 ....... A Immunoelectrophoresis assay ..................... 0.42 0.18 0.18 0.02 0.62 0.62 XXX 86334 ......... 26 ....... A Immunofixation procedure ........................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 86490 ......... ............ A Coccidioidomycosis skin test ....................... 0.00 0.29 NA 0.02 0.31 NA XXX 86510 ......... ............ A Histoplasmosis skin test .............................. 0.00 0.32 NA 0.02 0.34 NA XXX 86580 ......... ............ A TB intradermal test ...................................... 0.00 0.25 NA 0.02 0.27 NA XXX 86585 ......... ............ A TB tine test .................................................. 0.00 0.20 NA 0.01 0.21 NA XXX 87164 ......... 26 ....... A Dark field examination ................................. 0.37 0.12 0.12 0.01 0.50 0.50 XXX 87207 ......... 26 ....... A Smear, special stain .................................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 88104 ......... ............ A Cytopathology, fluids ................................... 0.56 0.86 NA 0.04 1.46 NA XXX 88104 ......... 26 ....... A Cytopathology, fluids ................................... 0.56 0.24 0.24 0.02 0.82 0.82 XXX 88104 ......... TC ...... A Cytopathology, fluids ................................... 0.00 0.62 NA 0.02 0.64 NA XXX 88106 ......... ............ A Cytopathology, fluids ................................... 0.56 1.37 NA 0.04 1.97 NA XXX 88106 ......... 26 ....... A Cytopathology, fluids ................................... 0.56 0.24 0.24 0.02 0.82 0.82 XXX 88106 ......... TC ...... A Cytopathology, fluids ................................... 0.00 1.13 NA 0.02 1.15 NA XXX 88107 ......... ............ A Cytopathology, fluids ................................... 0.76 1.56 NA 0.05 2.37 NA XXX 88107 ......... 26 ....... A Cytopathology, fluids ................................... 0.76 0.33 0.33 0.03 1.12 1.12 XXX 88107 ......... TC ...... A Cytopathology, fluids ................................... 0.00 1.23 NA 0.02 1.25 NA XXX 88108 ......... ............ A Cytopath, concentrate tech .......................... 0.56 1.22 NA 0.04 1.82 NA XXX 88108 ......... 26 ....... A Cytopath, concentrate tech .......................... 0.56 0.24 0.24 0.02 0.82 0.82 XXX 88108 ......... TC ...... A Cytopath, concentrate tech .......................... 0.00 0.98 NA 0.02 1.00 NA XXX 88112 ......... ............ A Cytopath, cell enhance tech ........................ 1.18 1.98 NA 0.04 3.20 NA XXX 88112 ......... 26 ....... A Cytopath, cell enhance tech ........................ 1.18 0.51 0.51 0.02 1.71 1.71 XXX 88112 ......... TC ...... A Cytopath, cell enhance tech ........................ 0.00 1.47 NA 0.02 1.49 NA XXX 88125 ......... ............ A Forensic cytopathology ................................ 0.26 0.09 NA 0.02 0.37 NA XXX 88125 ......... 26 ....... A Forensic cytopathology ................................ 0.26 0.11 0.11 0.01 0.38 0.38 XXX 88125 ......... TC ...... A Forensic cytopathology ................................ 0.00 -0.03 NA 0.01 -0.02 NA XXX 88141 ......... ............ A Cytopath, c/v, interpret ................................ 0.42 0.15 0.15 0.02 0.59 0.59 XXX 88160 ......... ............ A Cytopath smear, other source ..................... 0.50 0.85 NA 0.04 1.39 NA XXX 88160 ......... 26 ....... A Cytopath smear, other source ..................... 0.50 0.22 0.22 0.02 0.74 0.74 XXX 88160 ......... TC ...... A Cytopath smear, other source ..................... 0.00 0.63 NA 0.02 0.65 NA XXX 88161 ......... ............ A Cytopath smear, other source ..................... 0.50 0.95 NA 0.04 1.49 NA XXX 88161 ......... 26 ....... A Cytopath smear, other source ..................... 0.50 0.21 0.21 0.02 0.73 0.73 XXX 88161 ......... TC ...... A Cytopath smear, other source ..................... 0.00 0.74 NA 0.02 0.76 NA XXX 88162 ......... ............ A Cytopath smear, other source ..................... 0.76 1.04 NA 0.05 1.85 NA XXX 88162 ......... 26 ....... A Cytopath smear, other source ..................... 0.76 0.33 0.33 0.03 1.12 1.12 XXX 88162 ......... TC ...... A Cytopath smear, other source ..................... 0.00 0.71 NA 0.02 0.73 NA XXX 88172 ......... ............ A Cytopathology eval of fna ............................ 0.60 0.74 NA 0.04 1.38 NA XXX 88172 ......... 26 ....... A Cytopathology eval of fna ............................ 0.60 0.26 0.26 0.02 0.88 0.88 XXX 88172 ......... TC ...... A Cytopathology eval of fna ............................ 0.00 0.48 NA 0.02 0.50 NA XXX 88173 ......... ............ A Cytopath eval, fna, report ............................ 1.39 2.18 NA 0.07 3.64 NA XXX 88173 ......... 26 ....... A Cytopath eval, fna, report ............................ 1.39 0.60 0.60 0.05 2.04 2.04 XXX 88173 ......... TC ...... A Cytopath eval, fna, report ............................ 0.00 1.58 NA 0.02 1.60 NA XXX 88180 ......... ............ A Cell marker study ......................................... 0.36 1.27 NA 0.03 1.66 NA XXX 88180 ......... 26 ....... A Cell marker study ......................................... 0.36 0.16 0.16 0.01 0.53 0.53 XXX 88180 ......... TC ...... A Cell marker study ......................................... 0.00 1.11 NA 0.02 1.13 NA XXX 88182 ......... ............ A Cell marker study ......................................... 0.77 2.04 NA 0.07 2.88 NA XXX 88182 ......... 26 ....... A Cell marker study ......................................... 0.77 0.33 0.33 0.03 1.13 1.13 XXX 88182 ......... TC ...... A Cell marker study ......................................... 0.00 1.70 NA 0.04 1.74 NA XXX 88291 ......... ............ A Cyto/molecular report .................................. 0.52 0.18 0.18 0.03 0.73 0.73 XXX 88300 ......... ............ A Surgical path, gross ..................................... 0.08 0.46 NA 0.01 0.55 NA XXX 88300 ......... 26 ....... A Surgical path, gross ..................................... 0.08 0.03 0.03 0.00 0.11 0.11 XXX 88300 ......... TC ...... A Surgical path, gross ..................................... 0.00 0.42 NA 0.01 0.43 NA XXX 88302 ......... ............ A Tissue exam by pathologist ......................... 0.13 1.03 NA 0.02 1.18 NA XXX 88302 ......... 26 ....... A Tissue exam by pathologist ......................... 0.13 0.06 0.06 0.00 0.19 0.19 XXX 88302 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 0.97 NA 0.02 0.99 NA XXX 88304 ......... ............ A Tissue exam by pathologist ......................... 0.22 1.34 NA 0.03 1.59 NA XXX 88304 ......... 26 ....... A Tissue exam by pathologist ......................... 0.22 0.10 0.10 0.01 0.33 0.33 XXX


## 47676

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

88304 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 1.24 NA 0.02 1.26 NA XXX 88305 ......... ............ A Tissue exam by pathologist ......................... 0.75 1.92 NA 0.07 2.74 NA XXX 88305 ......... 26 ....... A Tissue exam by pathologist ......................... 0.75 0.33 0.33 0.03 1.11 1.11 XXX 88305 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 1.59 NA 0.04 1.63 NA XXX 88307 ......... ............ A Tissue exam by pathologist ......................... 1.59 3.16 NA 0.12 4.87 NA XXX 88307 ......... 26 ....... A Tissue exam by pathologist ......................... 1.59 0.69 0.69 0.06 2.34 2.34 XXX 88307 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 2.47 NA 0.06 2.53 NA XXX 88309 ......... ............ A Tissue exam by pathologist ......................... 2.28 4.41 NA 0.15 6.84 NA XXX 88309 ......... 26 ....... A Tissue exam by pathologist ......................... 2.28 0.99 0.99 0.09 3.36 3.36 XXX 88309 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 3.43 NA 0.06 3.49 NA XXX 88311 ......... ............ A Decalcify tissue ............................................ 0.24 0.24 NA 0.02 0.50 NA XXX 88311 ......... 26 ....... A Decalcify tissue ............................................ 0.24 0.10 0.10 0.01 0.35 0.35 XXX 88311 ......... TC ...... A Decalcify tissue ............................................ 0.00 0.13 NA 0.01 0.14 NA XXX 88312 ......... ............ A Special stains ............................................... 0.54 1.52 NA 0.03 2.09 NA XXX 88312 ......... 26 ....... A Special stains ............................................... 0.54 0.23 0.23 0.02 0.79 0.79 XXX 88312 ......... TC ...... A Special stains ............................................... 0.00 1.28 NA 0.01 1.29 NA XXX 88313 ......... ............ A Special stains ............................................... 0.24 1.25 NA 0.02 1.51 NA XXX 88313 ......... 26 ....... A Special stains ............................................... 0.24 0.10 0.10 0.01 0.35 0.35 XXX 88313 ......... TC ...... A Special stains ............................................... 0.00 1.14 NA 0.01 1.15 NA XXX
88314 ......... ............ A Histochemical stain ...................................... 0.45 2.05 NA 0.04 2.54 NA XXX 88314 ......... 26 ....... A Histochemical stain ...................................... 0.45 0.19 0.19 0.02 0.66 0.66 XXX 88314 ......... TC ...... A Histochemical stain ...................................... 0.00 1.86 NA 0.02 1.88 NA XXX 88318 ......... ............ A Chemical histochemistry .............................. 0.42 1.66 NA 0.03 2.11 NA XXX 88318 ......... 26 ....... A Chemical histochemistry .............................. 0.42 0.18 0.18 0.02 0.62 0.62 XXX 88318 ......... TC ...... A Chemical histochemistry .............................. 0.00 1.48 NA 0.01 1.49 NA XXX 88319 ......... ............ A Enzyme histochemistry ................................ 0.53 3.44 NA 0.04 4.01 NA XXX 88319 ......... 26 ....... A Enzyme histochemistry ................................ 0.53 0.23 0.23 0.02 0.78 0.78 XXX 88319 ......... TC ...... A Enzyme histochemistry ................................ 0.00 3.21 NA 0.02 3.23 NA XXX
88321 ......... ............ A Microslide consultation ................................ 1.30 0.80 0.56 0.05 2.15 1.91 XXX 88323 ......... ............ A Microslide consultation ................................ 1.35 1.80 NA 0.07 3.22 NA XXX 88323 ......... 26 ....... A Microslide consultation ................................ 1.35 0.58 0.58 0.05 1.98 1.98 XXX 88323 ......... TC ...... A Microslide consultation ................................ 0.00 1.22 NA 0.02 1.24 NA XXX 88325 ......... ............ A Comprehensive review of data .................... 2.22 2.97 0.96 0.10 5.29 3.28 XXX 88329 ......... ............ A Path consult introp ....................................... 0.67 0.65 0.29 0.03 1.35 0.99 XXX 88331 ......... ............ A Path consult intraop, 1 bloc ......................... 1.19 1.11 NA 0.09 2.39 NA XXX 88331 ......... 26 ....... A Path consult intraop, 1 bloc ......................... 1.19 0.52 0.52 0.05 1.76 1.76 XXX 88331 ......... TC ...... A Path consult intraop, 1 bloc ......................... 0.00 0.60 NA 0.04 0.64 NA XXX 88332 ......... ............ A Path consult intraop, add-l ........................... 0.59 0.46 NA 0.04 1.09 NA XXX 88332 ......... 26 ....... A Path consult intraop, add-l ........................... 0.59 0.26 0.26 0.02 0.87 0.87 XXX 88332 ......... TC ...... A Path consult intraop, add-l ........................... 0.00 0.21 NA 0.02 0.23 NA XXX 88342 ......... ............ A Immunohistochemistry ................................. 0.85 1.48 NA 0.05 2.38 NA XXX 88342 ......... 26 ....... A Immunohistochemistry ................................. 0.85 0.37 0.37 0.03 1.25 1.25 XXX 88342 ......... TC ...... A Immunohistochemistry ................................. 0.00 1.11 NA 0.02 1.13 NA XXX 88346 ......... ............ A Immunofluorescent study ............................. 0.86 1.57 NA 0.05 2.48 NA XXX 88346 ......... 26 ....... A Immunofluorescent study ............................. 0.86 0.37 0.37 0.03 1.26 1.26 XXX 88346 ......... TC ...... A Immunofluorescent study ............................. 0.00 1.21 NA 0.02 1.23 NA XXX 88347 ......... ............ A Immunofluorescent study ............................. 0.86 1.27 NA 0.05 2.18 NA XXX 88347 ......... 26 ....... A Immunofluorescent study ............................. 0.86 0.35 0.35 0.03 1.24 1.24 XXX 88347 ......... TC ...... A Immunofluorescent study ............................. 0.00 0.92 NA 0.02 0.94 NA XXX 88348 ......... ............ A Electron microscopy .................................... 1.51 9.58 NA 0.13 11.22 NA XXX 88348 ......... 26 ....... A Electron microscopy .................................... 1.51 0.65 0.65 0.06 2.22 2.22 XXX 88348 ......... TC ...... A Electron microscopy .................................... 0.00 8.93 NA 0.07 9.00 NA XXX 88349 ......... ............ A Scanning electron microscopy ..................... 0.76 3.67 NA 0.09 4.52 NA XXX 88349 ......... 26 ....... A Scanning electron microscopy ..................... 0.76 0.33 0.33 0.03 1.12 1.12 XXX 88349 ......... TC ...... A Scanning electron microscopy ..................... 0.00 3.34 NA 0.06 3.40 NA XXX 88355 ......... ............ A Analysis, skeletal muscle ............................. 1.85 6.71 NA 0.13 8.69 NA XXX 88355 ......... 26 ....... A Analysis, skeletal muscle ............................. 1.85 0.80 0.80 0.07 2.72 2.72 XXX 88355 ......... TC ...... A Analysis, skeletal muscle ............................. 0.00 5.91 NA 0.06 5.97 NA XXX 88356 ......... ............ A Analysis, nerve ............................................ 3.02 3.80 NA 0.20 7.02 NA XXX 88356 ......... 26 ....... A Analysis, nerve ............................................ 3.02 1.27 1.27 0.13 4.42 4.42 XXX 88356 ......... TC ...... A Analysis, nerve ............................................ 0.00 2.53 NA 0.07 2.60 NA XXX 88358 ......... ............ A Analysis, tumor ............................................ 0.95 0.71 NA 0.18 1.84 NA XXX 88358 ......... 26 ....... A Analysis, tumor ............................................ 0.95 0.41 0.41 0.11 1.47 1.47 XXX 88358 ......... TC ...... A Analysis, tumor ............................................ 0.00 0.30 NA 0.07 0.37 NA XXX 88361 ......... ............ A Immunohistochemistry, tumor ...................... 0.94 2.59 NA 0.18 3.71 NA XXX 88361 ......... 26 ....... A Immunohistochemistry, tumor ...................... 0.94 0.40 0.40 0.11 1.45 1.45 XXX 88361 ......... TC ...... A Immunohistochemistry, tumor ...................... 0.00 2.19 NA 0.07 2.26 NA XXX 88362 ......... ............ A Nerve teasing preparations ......................... 2.17 4.73 NA 0.15 7.05 NA XXX 88362 ......... 26 ....... A Nerve teasing preparations ......................... 2.17 0.92 0.92 0.09 3.18 3.18 XXX 88362 ......... TC ...... A Nerve teasing preparations ......................... 0.00 3.80 NA 0.06 3.86 NA XXX 88365 ......... ............ A Tissue hybridization ..................................... 0.93 3.04 NA 0.06 4.03 NA XXX 88365 ......... 26 ....... A Tissue hybridization ..................................... 0.93 0.40 0.40 0.04 1.37 1.37 XXX 88365 ......... TC ...... A Tissue hybridization ..................................... 0.00 2.63 NA 0.02 2.65 NA XXX 88371 ......... 26 ....... A Protein, western blot tissue ......................... 0.37 0.13 0.13 0.02 0.52 0.52 XXX 88372 ......... 26 ....... A Protein analysis w/probe ............................. 0.37 0.16 0.16 0.01 0.54 0.54 XXX


## 47677

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

89060 ......... 26 ....... A Exam,synovial fluid crystals ......................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 89100 ......... ............ A Sample intestinal contents ........................... 0.60 1.85 0.21 0.03 2.48 0.84 XXX 89105 ......... ............ A Sample intestinal contents ........................... 0.50 2.24 0.17 0.02 2.76 0.69 XXX 89130 ......... ............ A Sample stomach contents ........................... 0.45 1.74 0.13 0.03 2.22 0.61 XXX 89132 ......... ............ A Sample stomach contents ........................... 0.19 1.54 0.06 0.01 1.74 0.26 XXX 89135 ......... ............ A Sample stomach contents ........................... 0.79 1.91 0.25 0.03 2.73 1.07 XXX 89136 ......... ............ A Sample stomach contents ........................... 0.21 1.78 0.09 0.01 2.00 0.31 XXX 89140 ......... ............ A Sample stomach contents ........................... 0.94 2.12 0.27 0.04 3.10 1.25 XXX 89141 ......... ............ A Sample stomach contents ........................... 0.85 2.82 0.34 0.03 3.70 1.22 XXX 89220 ......... ............ A Sputum specimen collection ........................ 0.00 NA NA 0.00 NA NA XXX 89230 ......... ............ A Collect sweat for test ................................... 0.00 NA NA 0.00 NA NA XXX
90471 ......... ............ A Immunization admin ..................................... 0.00 0.20 NA 0.01 0.21 NA XXX 90472 ......... ............ A Immunization admin, each add ................... 0.00 0.14 NA 0.01 0.15 NA ZZZ 90780 ......... ............ A IV infusion therapy, 1 hour .......................... 0.17 2.14 NA 0.07 2.38 NA XXX 90781 ......... ............ A IV infusion, additional hour .......................... 0.17 0.46 NA 0.04 0.67 NA ZZZ 90782 ......... ............ T Injection, sc/im ............................................. 0.17 0.31 NA 0.01 0.49 NA XXX 90783 ......... ............ T Injection, ia ................................................... 0.17 0.32 NA 0.02 0.51 NA XXX 90784 ......... ............ T Injection, iv ................................................... 0.17 0.80 NA 0.04 1.01 NA XXX 90788 ......... ............ T Injection of antibiotic .................................... 0.17 0.27 NA 0.01 0.45 NA XXX 90801 ......... ............ A Psy dx interview ........................................... 2.80 1.17 0.93 0.08 4.05 3.81 XXX 90802 ......... ............ A Intac psy dx interview .................................. 3.01 1.20 0.97 0.08 4.29 4.06 XXX 90804 ......... ............ A Psytx, office, 20-30 min ............................... 1.21 0.49 0.38 0.03 1.73 1.62 XXX 90805 ......... ............ A Psytx, off, 20-30 min w/e&m ....................... 1.37 0.50 0.42 0.04 1.91 1.83 XXX 90806 ......... ............ A Psytx, off, 45-50 min .................................... 1.86 0.70 0.60 0.05 2.61 2.51 XXX 90807 ......... ............ A Psytx, off, 45-50 min w/e&m ....................... 2.02 0.70 0.63 0.05 2.77 2.70 XXX 90808 ......... ............ A Psytx, office, 75-80 min ............................... 2.79 1.02 0.90 0.07 3.88 3.76 XXX 90809 ......... ............ A Psytx, off, 75-80, w/e&m ............................. 2.95 1.00 0.92 0.08 4.03 3.95 XXX 90810 ......... ............ A Intac psytx, off, 20-30 min ........................... 1.32 0.51 0.42 0.04 1.87 1.78 XXX 90811 ......... ............ A Intac psytx, 20-30, w/e&m ........................... 1.48 0.57 0.46 0.04 2.09 1.98 XXX 90812 ......... ............ A Intac psytx, off, 45-50 min ........................... 1.97 0.78 0.64 0.05 2.80 2.66 XXX 90813 ......... ............ A Intac psytx, 45-50 min w/e&m ..................... 2.13 0.77 0.67 0.05 2.95 2.85 XXX 90814 ......... ............ A Intac psytx, off, 75-80 min ........................... 2.90 1.10 0.98 0.07 4.07 3.95 XXX 90815 ......... ............ A Intac psytx, 75-80 w/e&m ............................ 3.06 1.05 0.95 0.07 4.18 4.08 XXX 90816 ......... ............ A Psytx, hosp, 20-30 min ................................ 1.25 NA 0.46 0.03 NA 1.74 XXX 90817 ......... ............ A Psytx, hosp, 20-30 min w/e&m .................... 1.41 NA 0.46 0.04 NA 1.91 XXX 90818 ......... ............ A Psytx, hosp, 45-50 min ................................ 1.89 NA 0.69 0.05 NA 2.63 XXX 90819 ......... ............ A Psytx, hosp, 45-50 min w/e&m .................... 2.05 NA 0.65 0.05 NA 2.75 XXX 90821 ......... ............ A Psytx, hosp, 75-80 min ................................ 2.83 NA 1.00 0.07 NA 3.90 XXX 90822 ......... ............ A Psytx, hosp, 75-80 min w/e&m .................... 2.99 NA 0.94 0.09 NA 4.02 XXX 90823 ......... ............ A Intac psytx, hosp, 20-30 min ....................... 1.36 NA 0.48 0.03 NA 1.87 XXX 90824 ......... ............ A Intac psytx, hsp 20-30 w/e&m ..................... 1.52 NA 0.49 0.04 NA 2.05 XXX 90826 ......... ............ A Intac psytx, hosp, 45-50 min ....................... 2.01 NA 0.72 0.05 NA 2.78 XXX 90827 ......... ............ A Intac psytx, hsp 45-50 w/e&m ..................... 2.16 NA 0.68 0.05 NA 2.89 XXX 90828 ......... ............ A Intac psytx, hosp, 75-80 min ....................... 2.94 NA 1.06 0.07 NA 4.07 XXX 90829 ......... ............ A Intac psytx, hsp 75-80 w/e&m ..................... 3.10 NA 0.98 0.07 NA 4.15 XXX 90845 ......... ............ A Psychoanalysis ............................................ 1.79 0.58 0.55 0.04 2.41 2.38 XXX 90846 ......... ............ R Family psytx w/o patient .............................. 1.83 0.65 0.64 0.05 2.53 2.52 XXX 90847 ......... ............ R Family psytx w/patient ................................. 2.21 0.81 0.76 0.06 3.08 3.03 XXX 90849 ......... ............ R Multiple family group psytx .......................... 0.59 0.27 0.24 0.02 0.88 0.85 XXX 90853 ......... ............ A Group psychotherapy .................................. 0.59 0.25 0.23 0.02 0.86 0.84 XXX 90857 ......... ............ A Intac group psytx ......................................... 0.63 0.29 0.25 0.02 0.94 0.90 XXX 90862 ......... ............ A Medication management ............................. 0.95 0.40 0.32 0.03 1.38 1.30 XXX 90865 ......... ............ A Narcosynthesis ............................................ 2.84 1.38 0.91 0.11 4.33 3.86 XXX 90870 ......... ............ A Electroconvulsive therapy ............................ 1.88 1.43 0.59 0.05 3.36 2.52 000 90880 ......... ............ A Hypnotherapy ............................................... 2.19 1.04 0.69 0.06 3.29 2.94 XXX 90885 ......... ............ B Psy evaluation of records ............................ 0.97 0.37 0.37 0.02 1.36 1.36 XXX 90887 ......... ............ B Consultation with family ............................... 1.48 0.82 0.56 0.04 2.34 2.08 XXX 90901 ......... ............ A Biofeedback train, any meth ........................ 0.41 0.65 0.14 0.02 1.08 0.57 000 90911 ......... ............ A Biofeedback peri/uro/rectal .......................... 0.89 1.56 0.31 0.06 2.51 1.26 000 90918 ......... ............ A ESRD related services, month .................... 11.16 7.29 7.29 0.36 18.81 18.81 XXX 90919 ......... ............ A ESRD related services, month .................... 8.53 4.04 4.04 0.29 12.86 12.86 XXX 90920 ......... ............ A ESRD related services, month .................... 7.26 3.78 3.78 0.23 11.27 11.27 XXX 90921 ......... ............ A ESRD related services, month .................... 4.46 2.45 2.45 0.14 7.05 7.05 XXX 90922 ......... ............ A ESRD related services, day ........................ 0.37 0.21 0.21 0.01 0.59 0.59 XXX 90923 ......... ............ A Esrd related services, day ........................... 0.28 0.13 0.13 0.01 0.42 0.42 XXX 90924 ......... ............ A Esrd related services, day ........................... 0.24 0.12 0.12 0.01 0.37 0.37 XXX 90925 ......... ............ A Esrd related services, day ........................... 0.15 0.08 0.08 0.01 0.24 0.24 XXX 90935 ......... ............ A Hemodialysis, one evaluation ...................... 1.22 NA 0.67 0.04 NA 1.93 000 90937 ......... ............ A Hemodialysis, repeated eval ....................... 2.11 NA 0.97 0.08 NA 3.16 000 90945 ......... ............ A Dialysis, one evaluation ............................... 1.28 NA 0.69 0.05 NA 2.02 000 90947 ......... ............ A Dialysis, repeated eval ................................ 2.16 NA 1.00 0.08 NA 3.24 000 90997 ......... ............ A Hemoperfusion ............................................. 1.84 NA 0.66 0.06 NA 2.56 000 91000 ......... ............ A Esophageal intubation ................................. 0.73 0.32 NA 0.04 1.09 NA 000 91000 ......... 26 ....... A Esophageal intubation ................................. 0.73 0.24 0.24 0.03 1.00 1.00 000 91000 ......... TC ...... A Esophageal intubation ................................. 0.00 0.08 NA 0.01 0.09 NA 000


## 47678

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

91010 ......... ............ A Esophagus motility study ............................. 1.25 4.45 NA 0.12 5.82 NA 000 91010 ......... 26 ....... A Esophagus motility study ............................. 1.25 0.44 0.44 0.06 1.75 1.75 000 91010 ......... TC ...... A Esophagus motility study ............................. 0.00 4.01 NA 0.06 4.07 NA 000 91011 ......... ............ A Esophagus motility study ............................. 1.50 5.27 NA 0.13 6.90 NA 000 91011 ......... 26 ....... A Esophagus motility study ............................. 1.50 0.53 0.53 0.07 2.10 2.10 000 91011 ......... TC ...... A Esophagus motility study ............................. 0.00 4.74 NA 0.06 4.80 NA 000 91012 ......... ............ A Esophagus motility study ............................. 1.46 5.79 NA 0.14 7.39 NA 000 91012 ......... 26 ....... A Esophagus motility study ............................. 1.46 0.51 0.51 0.07 2.04 2.04 000 91012 ......... TC ...... A Esophagus motility study ............................. 0.00 5.28 NA 0.07 5.35 NA 000 91020 ......... ............ A Gastric motility ............................................. 1.44 4.58 NA 0.13 6.15 NA 000 91020 ......... 26 ....... A Gastric motility ............................................. 1.44 0.49 0.49 0.07 2.00 2.00 000 91020 ......... TC ...... A Gastric motility ............................................. 0.00 4.10 NA 0.06 4.16 NA 000 91030 ......... ............ A Acid perfusion of esophagus ....................... 0.91 2.45 NA 0.06 3.42 NA 000 91030 ......... 26 ....... A Acid perfusion of esophagus ....................... 0.91 0.32 0.32 0.04 1.27 1.27 000 91030 ......... TC ...... A Acid perfusion of esophagus ....................... 0.00 2.13 NA 0.02 2.15 NA 000 91032 ......... ............ A Esophagus, acid reflux test ......................... 1.21 4.16 NA 0.12 5.49 NA 000 91032 ......... 26 ....... A Esophagus, acid reflux test ......................... 1.21 0.42 0.42 0.06 1.69 1.69 000 91032 ......... TC ...... A Esophagus, acid reflux test ......................... 0.00 3.74 NA 0.06 3.80 NA 000 91033 ......... ............ A Prolonged acid reflux test ............................ 1.30 4.24 NA 0.18 5.72 NA 000 91033 ......... 26 ....... A Prolonged acid reflux test ............................ 1.30 0.45 0.45 0.07 1.82 1.82 000 91033 ......... TC ...... A Prolonged acid reflux test ............................ 0.00 3.78 NA 0.11 3.89 NA 000 91052 ......... ............ A Gastric analysis test .................................... 0.79 2.47 NA 0.06 3.32 NA 000 91052 ......... 26 ....... A Gastric analysis test .................................... 0.79 0.28 0.28 0.04 1.11 1.11 000 91052 ......... TC ...... A Gastric analysis test .................................... 0.00 2.19 NA 0.02 2.21 NA 000 91055 ......... ............ A Gastric intubation for smear ........................ 0.94 2.94 NA 0.07 3.95 NA 000 91055 ......... 26 ....... A Gastric intubation for smear ........................ 0.94 0.27 0.27 0.05 1.26 1.26 000 91055 ......... TC ...... A Gastric intubation for smear ........................ 0.00 2.67 NA 0.02 2.69 NA 000 91060 ......... ............ A Gastric saline load test ................................ 0.45 1.98 NA 0.04 2.47 NA 000 91060 ......... 26 ....... A Gastric saline load test ................................ 0.45 0.14 0.14 0.02 0.61 0.61 000 91060 ......... TC ...... A Gastric saline load test ................................ 0.00 1.84 NA 0.02 1.86 NA 000 91065 ......... ............ A Breath hydrogen test ................................... 0.20 1.47 NA 0.03 1.70 NA 000 91065 ......... 26 ....... A Breath hydrogen test ................................... 0.20 0.07 0.07 0.01 0.28 0.28 000 91065 ......... TC ...... A Breath hydrogen test ................................... 0.00 1.40 NA 0.02 1.42 NA 000 91100 ......... ............ A Pass intestine bleeding tube ....................... 1.08 2.85 0.28 0.07 4.00 1.43 000 91105 ......... ............ A Gastric intubation treatment ........................ 0.37 2.13 0.09 0.03 2.53 0.49 000 91110 ......... ............ A Gi tract capsule endoscopy ......................... 3.64 22.19 NA 0.09 25.92 NA XXX 91110 ......... 26 ....... A Gi tract capsule endoscopy ......................... 3.64 1.27 1.27 0.02 4.93 4.93 XXX 91110 ......... TC ...... A Gi tract capsule endoscopy ......................... 0.00 20.92 NA 0.07 20.99 NA XXX 91122 ......... ............ A Anal pressure record ................................... 1.77 5.10 NA 0.20 7.07 NA 000 91122 ......... 26 ....... A Anal pressure record ................................... 1.77 0.60 0.60 0.12 2.49 2.49 000 91122 ......... TC ...... A Anal pressure record ................................... 0.00 4.50 NA 0.08 4.58 NA 000 91132 ......... 26 ....... A Electrogastrography ..................................... 0.52 0.18 0.18 0.03 0.73 0.73 XXX 91133 ......... 26 ....... A Electrogastrography w/test .......................... 0.66 0.23 0.23 0.03 0.92 0.92 XXX 92002 ......... ............ A Eye exam, new patient ................................ 0.88 0.97 0.34 0.02 1.87 1.24 XXX 92004 ......... ............ A Eye exam, new patient ................................ 1.67 1.70 0.67 0.05 3.42 2.39 XXX 92012 ......... ............ A Eye exam established pat ........................... 0.67 1.03 0.29 0.02 1.72 0.98 XXX 92014 ......... ............ A Eye exam & treatment ................................. 1.10 1.41 0.47 0.03 2.54 1.60 XXX 92018 ......... ............ A New eye exam & treatment ......................... 2.50 NA 1.07 0.07 NA 3.64 XXX 92019 ......... ............ A Eye exam & treatment ................................. 1.31 NA 0.56 0.04 NA 1.91 XXX 92020 ......... ............ A Special eye evaluation ................................. 0.37 0.34 0.16 0.01 0.72 0.54 XXX 92060 ......... ............ A Special eye evaluation ................................. 0.69 0.74 NA 0.03 1.46 NA XXX 92060 ......... 26 ....... A Special eye evaluation ................................. 0.69 0.29 0.29 0.02 1.00 1.00 XXX 92060 ......... TC ...... A Special eye evaluation ................................. 0.00 0.45 NA 0.01 0.46 NA XXX 92065 ......... ............ A Orthoptic/pleoptic training ............................ 0.37 0.55 NA 0.02 0.94 NA XXX 92065 ......... 26 ....... A Orthoptic/pleoptic training ............................ 0.37 0.15 0.15 0.01 0.53 0.53 XXX 92065 ......... TC ...... A Orthoptic/pleoptic training ............................ 0.00 0.40 NA 0.01 0.41 NA XXX 92070 ......... ............ A Fitting of contact lens .................................. 0.70 1.07 0.32 0.02 1.79 1.04 XXX 92081 ......... ............ A Visual field examination(s) ........................... 0.36 0.95 NA 0.02 1.33 NA XXX 92081 ......... 26 ....... A Visual field examination(s) ........................... 0.36 0.15 0.15 0.01 0.52 0.52 XXX 92081 ......... TC ...... A Visual field examination(s) ........................... 0.00 0.79 NA 0.01 0.80 NA XXX 92082 ......... ............ A Visual field examination(s) ........................... 0.44 1.23 NA 0.02 1.69 NA XXX 92082 ......... 26 ....... A Visual field examination(s) ........................... 0.44 0.19 0.19 0.01 0.64 0.64 XXX 92082 ......... TC ...... A Visual field examination(s) ........................... 0.00 1.05 NA 0.01 1.06 NA XXX 92083 ......... ............ A Visual field examination(s) ........................... 0.50 1.43 NA 0.02 1.95 NA XXX 92083 ......... 26 ....... A Visual field examination(s) ........................... 0.50 0.22 0.22 0.01 0.73 0.73 XXX 92083 ......... TC ...... A Visual field examination(s) ........................... 0.00 1.21 NA 0.01 1.22 NA XXX 92100 ......... ............ A Serial tonometry exam(s) ............................ 0.92 1.35 0.36 0.03 2.30 1.31 XXX 92120 ......... ............ A Tonography & eye evaluation ...................... 0.81 1.07 0.32 0.02 1.90 1.15 XXX 92130 ......... ............ A Water provocation tonography .................... 0.81 1.28 0.37 0.02 2.11 1.20 XXX 92135 ......... ............ A Opthalmic dx imaging .................................. 0.35 0.80 NA 0.02 1.17 NA XXX 92135 ......... 26 ....... A Opthalmic dx imaging .................................. 0.35 0.15 0.15 0.01 0.51 0.51 XXX 92135 ......... TC ...... A Opthalmic dx imaging .................................. 0.00 0.65 NA 0.01 0.66 NA XXX 92136 ......... ............ A Ophthalmic biometry .................................... 0.54 1.54 NA 0.08 2.16 NA XXX 92136 ......... 26 ....... A Ophthalmic biometry .................................... 0.54 0.24 0.24 0.01 0.79 0.79 XXX 92136 ......... TC ...... A Ophthalmic biometry .................................... 0.00 1.30 NA 0.07 1.37 NA XXX


## 47679

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

92140 ......... ............ A Glaucoma provocative tests ........................ 0.50 0.99 0.21 0.01 1.50 0.72 XXX 92225 ......... ............ A Special eye exam, initial .............................. 0.38 0.22 0.16 0.01 0.61 0.55 XXX 92226 ......... ............ A Special eye exam, subsequent ................... 0.33 0.21 0.14 0.01 0.55 0.48 XXX 92230 ......... ............ A Eye exam with photos ................................. 0.60 1.54 0.20 0.02 2.16 0.82 XXX 92235 ......... ............ A Eye exam with photos ................................. 0.81 2.61 NA 0.08 3.50 NA XXX 92235 ......... 26 ....... A Eye exam with photos ................................. 0.81 0.37 0.37 0.02 1.20 1.20 XXX 92235 ......... TC ...... A Eye exam with photos ................................. 0.00 2.25 NA 0.06 2.31 NA XXX 92240 ......... ............ A Icg angiography ........................................... 1.10 6.13 NA 0.09 7.32 NA XXX 92240 ......... 26 ....... A Icg angiography ........................................... 1.10 0.50 0.50 0.03 1.63 1.63 XXX 92240 ......... TC ...... A Icg angiography ........................................... 0.00 5.64 NA 0.06 5.70 NA XXX 92250 ......... ............ A Eye exam with photos ................................. 0.44 1.53 NA 0.02 1.99 NA XXX 92250 ......... 26 ....... A Eye exam with photos ................................. 0.44 0.19 0.19 0.01 0.64 0.64 XXX 92250 ......... TC ...... A Eye exam with photos ................................. 0.00 1.34 NA 0.01 1.35 NA XXX 92260 ......... ............ A Ophthalmoscopy/dynamometry ................... 0.20 0.26 0.09 0.01 0.47 0.30 XXX 92265 ......... ............ A Eye muscle evaluation ................................. 0.81 1.51 NA 0.06 2.38 NA XXX 92265 ......... 26 ....... A Eye muscle evaluation ................................. 0.81 0.28 0.28 0.04 1.13 1.13 XXX 92265 ......... TC ...... A Eye muscle evaluation ................................. 0.00 1.23 NA 0.02 1.25 NA XXX 92270 ......... ............ A Electro-oculography ..................................... 0.81 1.54 NA 0.05 2.40 NA XXX 92270 ......... 26 ....... A Electro-oculography ..................................... 0.81 0.33 0.33 0.03 1.17 1.17 XXX 92270 ......... TC ...... A Electro-oculography ..................................... 0.00 1.21 NA 0.02 1.23 NA XXX 92275 ......... ............ A Electroretinography ...................................... 1.01 1.94 NA 0.05 3.00 NA XXX 92275 ......... 26 ....... A Electroretinography ...................................... 1.01 0.43 0.43 0.03 1.47 1.47 XXX 92275 ......... TC ...... A Electroretinography ...................................... 0.00 1.52 NA 0.02 1.54 NA XXX 92283 ......... ............ A Color vision examination ............................. 0.17 0.84 NA 0.02 1.03 NA XXX 92283 ......... 26 ....... A Color vision examination ............................. 0.17 0.07 0.07 0.01 0.25 0.25 XXX 92283 ......... TC ...... A Color vision examination ............................. 0.00 0.77 NA 0.01 0.78 NA XXX 92284 ......... ............ A Dark adaptation eye exam .......................... 0.24 1.88 NA 0.02 2.14 NA XXX 92284 ......... 26 ....... A Dark adaptation eye exam .......................... 0.24 0.08 0.08 0.01 0.33 0.33 XXX 92284 ......... TC ...... A Dark adaptation eye exam .......................... 0.00 1.80 NA 0.01 1.81 NA XXX 92285 ......... ............ A Eye photography .......................................... 0.20 0.99 NA 0.02 1.21 NA XXX 92285 ......... 26 ....... A Eye photography .......................................... 0.20 0.09 0.09 0.01 0.30 0.30 XXX 92285 ......... TC ...... A Eye photography .......................................... 0.00 0.91 NA 0.01 0.92 NA XXX 92286 ......... ............ A Internal eye photography ............................. 0.66 3.07 NA 0.04 3.77 NA XXX 92286 ......... 26 ....... A Internal eye photography ............................. 0.66 0.29 0.29 0.02 0.97 0.97 XXX 92286 ......... TC ...... A Internal eye photography ............................. 0.00 2.78 NA 0.02 2.80 NA XXX 92287 ......... ............ A Internal eye photography ............................. 0.81 2.39 0.31 0.02 3.22 1.14 XXX 92311 ......... ............ A Contact lens fitting ....................................... 1.08 1.10 0.35 0.04 2.22 1.47 XXX 92312 ......... ............ A Contact lens fitting ....................................... 1.26 1.08 0.49 0.04 2.38 1.79 XXX 92313 ......... ............ A Contact lens fitting ....................................... 0.92 1.07 0.28 0.02 2.01 1.22 XXX 92315 ......... ............ A Prescription of contact lens ......................... 0.45 0.85 0.16 0.01 1.31 0.62 XXX 92316 ......... ............ A Prescription of contact lens ......................... 0.68 0.91 0.29 0.02 1.61 0.99 XXX 92317 ......... ............ A Prescription of contact lens ......................... 0.45 0.94 0.15 0.01 1.40 0.61 XXX 92325 ......... ............ A Modification of contact lens ......................... 0.00 0.40 NA 0.01 0.41 NA XXX 92326 ......... ............ A Replacement of contact lens ....................... 0.00 1.63 NA 0.06 1.69 NA XXX 92330 ......... ............ A Fitting of artificial eye ................................... 1.08 0.99 0.32 0.03 2.10 1.43 XXX 92335 ......... ............ A Fitting of artificial eye ................................... 0.45 0.91 0.16 0.02 1.38 0.63 XXX 92352 ......... ............ B Special spectacles fitting ............................. 0.37 0.68 0.14 0.01 1.06 0.52 XXX 92353 ......... ............ B Special spectacles fitting ............................. 0.50 0.73 0.19 0.02 1.25 0.71 XXX 92354 ......... ............ B Special spectacles fitting ............................. 0.00 8.84 NA 0.10 8.94 NA XXX 92355 ......... ............ B Special spectacles fitting ............................. 0.00 4.32 NA 0.01 4.33 NA XXX 92358 ......... ............ B Eye prosthesis service ................................. 0.00 0.97 NA 0.05 1.02 NA XXX 92371 ......... ............ B Repair & adjust spectacles .......................... 0.00 0.62 NA 0.02 0.64 NA XXX 92502 ......... ............ A Ear and throat examination ......................... 1.51 NA 1.11 0.05 NA 2.67 000 92504 ......... ............ A Ear microscopy examination ....................... 0.18 0.50 0.09 0.01 0.69 0.28 XXX 92506 ......... ............ A Speech/hearing evaluation .......................... 0.86 2.60 0.40 0.03 3.49 1.29 XXX 92507 ......... ............ A Speech/hearing therapy ............................... 0.52 1.12 0.23 0.02 1.66 0.77 XXX 92508 ......... ............ A Speech/hearing therapy ............................... 0.26 0.51 0.12 0.01 0.78 0.39 XXX 92511 ......... ............ A Nasopharyngoscopy .................................... 0.84 3.32 0.78 0.03 4.19 1.65 000 92512 ......... ............ A Nasal function studies ................................. 0.55 1.14 0.18 0.02 1.71 0.75 XXX 92516 ......... ............ A Facial nerve function test ............................ 0.43 1.17 0.22 0.02 1.62 0.67 XXX 92520 ......... ............ A Laryngeal function studies ........................... 0.76 0.51 0.39 0.03 1.30 1.18 XXX 92526 ......... ............ A Oral function therapy ................................... 0.55 1.64 0.20 0.02 2.21 0.77 XXX 92541 ......... ............ A Spontaneous nystagmus test ...................... 0.40 1.03 NA 0.04 1.47 NA XXX 92541 ......... 26 ....... A Spontaneous nystagmus test ...................... 0.40 0.19 0.19 0.02 0.61 0.61 XXX 92541 ......... TC ...... A Spontaneous nystagmus test ...................... 0.00 0.84 NA 0.02 0.86 NA XXX 92542 ......... ............ A Positional nystagmus test ............................ 0.33 1.14 NA 0.03 1.50 NA XXX 92542 ......... 26 ....... A Positional nystagmus test ............................ 0.33 0.16 0.16 0.01 0.50 0.50 XXX 92542 ......... TC ...... A Positional nystagmus test ............................ 0.00 0.98 NA 0.02 1.00 NA XXX 92543 ......... ............ A Caloric vestibular test .................................. 0.10 0.57 NA 0.01 0.68 NA XXX 92543 ......... 26 ....... A Caloric vestibular test .................................. 0.10 0.05 0.05 0.00 0.15 0.15 XXX 92543 ......... TC ...... A Caloric vestibular test .................................. 0.00 0.52 NA 0.01 0.53 NA XXX 92544 ......... ............ A Optokinetic nystagmus test ......................... 0.26 0.90 NA 0.03 1.19 NA XXX 92544 ......... 26 ....... A Optokinetic nystagmus test ......................... 0.26 0.12 0.12 0.01 0.39 0.39 XXX 92544 ......... TC ...... A Optokinetic nystagmus test ......................... 0.00 0.78 NA 0.02 0.80 NA XXX 92545 ......... ............ A Oscillating tracking test ................................ 0.23 0.80 NA 0.03 1.06 NA XXX


## 47680

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

92545 ......... 26 ....... A Oscillating tracking test ................................ 0.23 0.11 0.11 0.01 0.35 0.35 XXX 92545 ......... TC ...... A Oscillating tracking test ................................ 0.00 0.69 NA 0.02 0.71 NA XXX 92546 ......... ............ A Sinusoidal rotational test ............................. 0.29 1.99 NA 0.03 2.31 NA XXX 92546 ......... 26 ....... A Sinusoidal rotational test ............................. 0.29 0.13 0.13 0.01 0.43 0.43 XXX 92546 ......... TC ...... A Sinusoidal rotational test ............................. 0.00 1.86 NA 0.02 1.88 NA XXX 92547 ......... ............ A Supplemental electrical test ......................... 0.00 0.08 NA 0.06 0.14 NA ZZZ 92548 ......... ............ A Posturography .............................................. 0.50 2.26 NA 0.15 2.91 NA XXX 92548 ......... 26 ....... A Posturography .............................................. 0.50 0.26 0.26 0.02 0.78 0.78 XXX 92548 ......... TC ...... A Posturography .............................................. 0.00 2.00 NA 0.13 2.13 NA XXX 92552 ......... ............ A Pure tone audiometry, air ............................ 0.00 0.44 NA 0.04 0.48 NA XXX 92553 ......... ............ A Audiometry, air & bone ................................ 0.00 0.66 NA 0.06 0.72 NA XXX 92555 ......... ............ A Speech threshold audiometry ...................... 0.00 0.38 NA 0.04 0.42 NA XXX 92556 ......... ............ A Speech audiometry, complete ..................... 0.00 0.57 NA 0.06 0.63 NA XXX 92557 ......... ............ A Comprehensive hearing test ........................ 0.00 1.19 NA 0.12 1.31 NA XXX 92561 ......... ............ A Bekesy audiometry, diagnosis ..................... 0.00 0.71 NA 0.06 0.77 NA XXX 92562 ......... ............ A Loudness balance test ................................. 0.00 0.41 NA 0.04 0.45 NA XXX 92563 ......... ............ A Tone decay hearing test .............................. 0.00 0.38 NA 0.04 0.42 NA XXX 92564 ......... ............ A Sisi hearing test ........................................... 0.00 0.47 NA 0.05 0.52 NA XXX 92565 ......... ............ A Stenger test, pure tone ................................ 0.00 0.40 NA 0.04 0.44 NA XXX 92567 ......... ............ A Tympanometry ............................................. 0.00 0.52 NA 0.06 0.58 NA XXX 92568 ......... ............ A Acoustic reflex testing .................................. 0.00 0.38 NA 0.04 0.42 NA XXX 92569 ......... ............ A Acoustic reflex decay test ............................ 0.00 0.41 NA 0.04 0.45 NA XXX 92571 ......... ............ A Filtered speech hearing test ........................ 0.00 0.39 NA 0.04 0.43 NA XXX 92572 ......... ............ A Staggered spondaic word test ..................... 0.00 0.09 NA 0.01 0.10 NA XXX
92573 ......... ............ A Lombard test ................................................ 0.00 0.35 NA 0.04 0.39 NA XXX 92575 ......... ............ A Sensorineural acuity test ............................. 0.00 0.30 NA 0.02 0.32 NA XXX 92576 ......... ............ A Synthetic sentence test ............................... 0.00 0.44 NA 0.05 0.49 NA XXX 92577 ......... ............ A Stenger test, speech .................................... 0.00 0.71 NA 0.07 0.78 NA XXX 92579 ......... ............ A Visual audiometry (vra) ................................ 0.00 0.72 NA 0.06 0.78 NA XXX 92582 ......... ............ A Conditioning play audiometry ...................... 0.00 0.72 NA 0.06 0.78 NA XXX 92583 ......... ............ A Select picture audiometry ............................ 0.00 0.89 NA 0.08 0.97 NA XXX 92584 ......... ............ A Electrocochleography .................................. 0.00 2.47 NA 0.21 2.68 NA XXX 92585 ......... ............ A Auditor evoke potent, compre ..................... 0.50 2.06 NA 0.17 2.73 NA XXX 92585 ......... 26 ....... A Auditor evoke potent, compre ..................... 0.50 0.21 0.21 0.03 0.74 0.74 XXX 92585 ......... TC ...... A Auditor evoke potent, compre ..................... 0.00 1.84 NA 0.14 1.98 NA XXX 92586 ......... ............ A Auditor evoke potent, limit ........................... 0.00 1.84 NA 0.14 1.98 NA XXX 92587 ......... ............ A Evoked auditory test .................................... 0.13 1.37 NA 0.11 1.61 NA XXX 92587 ......... 26 ....... A Evoked auditory test .................................... 0.13 0.06 0.06 0.00 0.19 0.19 XXX 92587 ......... TC ...... A Evoked auditory test .................................... 0.00 1.30 NA 0.11 1.41 NA XXX 92588 ......... ............ A Evoked auditory test .................................... 0.36 1.63 NA 0.14 2.13 NA XXX 92588 ......... 26 ....... A Evoked auditory test .................................... 0.36 0.16 0.16 0.01 0.53 0.53 XXX 92588 ......... TC ...... A Evoked auditory test .................................... 0.00 1.47 NA 0.13 1.60 NA XXX 92589 ......... ............ A Auditory function test(s) ............................... 0.00 0.53 NA 0.06 0.59 NA XXX 92596 ......... ............ A Ear protector evaluation .............................. 0.00 0.59 NA 0.06 0.65 NA XXX 92597 ......... ............ A Oral speech device eval .............................. 0.86 1.69 0.45 0.05 2.60 1.36 XXX 92601 ......... ............ A Cochlear implt f/up exam < 7 ...................... 0.00 3.51 NA 0.05 3.56 NA XXX 92602 ......... ............ A Reprogram cochlear implt < 7 ..................... 0.00 2.38 NA 0.05 2.43 NA XXX 92603 ......... ............ A Cochlear implt f/up exam 7 > ...................... 0.00 2.15 NA 0.05 2.20 NA XXX 92604 ......... ............ A Reprogram cochlear implt 7 > ..................... 0.00 1.35 NA 0.05 1.40 NA XXX 92607 ......... ............ A Ex for speech device rx, 1hr ....................... 0.00 3.08 NA 0.04 3.12 NA XXX 92608 ......... ............ A Ex for speech device rx addl ....................... 0.00 0.56 NA 0.04 0.60 NA XXX 92609 ......... ............ A Use of speech device service ..................... 0.00 1.65 NA 0.03 1.68 NA XXX 92610 ......... ............ A Evaluate swallowing function ....................... 0.00 3.43 NA 0.06 3.49 NA XXX 92611 ......... ............ A Motion fluoroscopy/swallow ......................... 0.00 3.43 NA 0.07 3.50 NA XXX 92612 ......... ............ A Endoscopy swallow tst (fees) ...................... 1.27 2.75 0.66 0.08 4.10 2.01 XXX 92613 ......... ............ A Endoscopy swallow tst (fees) ...................... 0.71 0.40 0.39 0.05 1.16 1.15 XXX 92614 ......... ............ A Laryngoscopic sensory test ......................... 1.27 2.00 0.66 0.08 3.35 2.01 XXX 92615 ......... ............ A Eval laryngoscopy sense tst ........................ 0.63 0.35 0.35 0.05 1.03 1.03 XXX 92616 ......... ............ A Fees w/laryngeal sense test ........................ 1.88 2.67 0.99 0.08 4.63 2.95 XXX 92617 ......... ............ A Interprt fees/laryngeal test ........................... 0.79 0.44 0.44 0.05 1.28 1.28 XXX 92950 ......... ............ A Heart/lung resuscitation cpr ......................... 3.79 4.25 0.97 0.26 8.30 5.02 000 92953 ......... ............ A Temporary external pacing .......................... 0.23 NA 0.07 0.01 NA 0.31 000 92960 ......... ............ A Cardioversion electric, ext ........................... 2.25 6.45 1.17 0.08 8.78 3.50 000 92961 ......... ............ A Cardioversion, electric, int ........................... 4.59 NA 2.07 0.27 NA 6.93 000 92970 ......... ............ A Cardioassist, internal ................................... 3.51 NA 1.05 0.19 NA 4.75 000 92971 ......... ............ A Cardioassist, external .................................. 1.77 NA 0.85 0.06 NA 2.68 000 92973 ......... ............ A Percut coronary thrombectomy ................... 3.28 NA 1.29 0.11 NA 4.68 ZZZ 92974 ......... ............ A Cath place, cardio brachytx ......................... 3.00 NA 1.18 0.10 NA 4.28 ZZZ 92975 ......... ............ A Dissolve clot, heart vessel ........................... 7.24 NA 2.80 0.23 NA 10.27 000 92977 ......... ............ A Dissolve clot, heart vessel ........................... 0.00 8.04 NA 0.46 8.50 NA XXX 92978 ......... ............ A Intravasc us, heart add-on ........................... 1.80 5.26 NA 0.30 7.36 NA ZZZ 92978 ......... 26 ....... A Intravasc us, heart add-on ........................... 1.80 0.71 0.71 0.06 2.57 2.57 ZZZ 92978 ......... TC ...... A Intravasc us, heart add-on ........................... 0.00 4.56 NA 0.24 4.80 NA ZZZ 92979 ......... ............ A Intravasc us, heart add-on ........................... 1.44 2.85 NA 0.20 4.49 NA ZZZ 92979 ......... 26 ....... A Intravasc us, heart add-on ........................... 1.44 0.56 0.56 0.07 2.07 2.07 ZZZ


## 47681

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

92979 ......... TC ...... A Intravasc us, heart add-on ........................... 0.00 2.29 NA 0.13 2.42 NA ZZZ 92980 ......... ............ A Insert intracoronary stent ............................. 14.82 NA 6.03 1.04 NA 21.89 000 92981 ......... ............ A Insert intracoronary stent ............................. 4.16 NA 1.63 0.29 NA 6.08 ZZZ 92982 ......... ............ A Coronary artery dilation ............................... 10.96 NA 4.52 0.77 NA 16.25 000 92984 ......... ............ A Coronary artery dilation ............................... 2.97 NA 1.16 0.21 NA 4.34 ZZZ 92986 ......... ............ A Revision of aortic valve ............................... 21.77 NA 11.85 1.52 NA 35.14 090 92987 ......... ............ A Revision of mitral valve ............................... 22.67 NA 12.23 1.58 NA 36.48 090 92990 ......... ............ A Revision of pulmonary valve ....................... 17.31 NA 9.83 1.21 NA 28.35 090 92995 ......... ............ A Coronary atherectomy ................................. 12.07 NA 4.95 0.84 NA 17.86 000 92996 ......... ............ A Coronary atherectomy add-on ..................... 3.26 NA 1.27 0.23 NA 4.76 ZZZ 92997 ......... ............ A Pul art balloon repr, percut .......................... 11.98 NA 4.81 0.84 NA 17.63 000 92998 ......... ............ A Pul art balloon repr, percut .......................... 5.99 NA 2.20 0.42 NA 8.61 ZZZ 93000 ......... ............ A Electrocardiogram, complete ....................... 0.17 0.51 NA 0.03 0.71 NA XXX 93005 ......... ............ A Electrocardiogram, tracing ........................... 0.00 0.45 NA 0.02 0.47 NA XXX 93010 ......... ............ A Electrocardiogram report ............................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX 93012 ......... ............ A Transmission of ecg .................................... 0.00 6.00 NA 0.18 6.18 NA XXX 93014 ......... ............ A Report on transmitted ecg ........................... 0.52 0.19 0.19 0.02 0.73 0.73 XXX 93015 ......... ............ A Cardiovascular stress test ........................... 0.75 1.96 NA 0.14 2.85 NA XXX 93016 ......... ............ A Cardiovascular stress test ........................... 0.45 0.17 0.17 0.02 0.64 0.64 XXX 93017 ......... ............ A Cardiovascular stress test ........................... 0.00 1.68 NA 0.11 1.79 NA XXX 93018 ......... ............ A Cardiovascular stress test ........................... 0.30 0.11 0.11 0.01 0.42 0.42 XXX 93024 ......... ............ A Cardiac drug stress test .............................. 1.17 1.57 NA 0.13 2.87 NA XXX 93024 ......... 26 ....... A Cardiac drug stress test .............................. 1.17 0.45 0.45 0.05 1.67 1.67 XXX 93024 ......... TC ...... A Cardiac drug stress test .............................. 0.00 1.12 NA 0.08 1.20 NA XXX
93025 ......... ............ A Microvolt t-wave assess .............................. 0.75 7.84 NA 0.14 8.73 NA XXX 93025 ......... 26 ....... A Microvolt t-wave assess .............................. 0.75 0.29 0.29 0.03 1.07 1.07 XXX 93025 ......... TC ...... A Microvolt t-wave assess .............................. 0.00 7.55 NA 0.11 7.66 NA XXX 93040 ......... ............ A Rhythm ECG with report ............................. 0.16 0.19 NA 0.02 0.37 NA XXX 93041 ......... ............ A Rhythm ECG, tracing ................................... 0.00 0.14 NA 0.01 0.15 NA XXX 93042 ......... ............ A Rhythm ECG, report .................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 93224 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.52 3.61 NA 0.24 4.37 NA XXX 93225 ......... ............ A ECG monitor/record, 24 hrs ........................ 0.00 1.24 NA 0.08 1.32 NA XXX 93226 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.00 2.18 NA 0.14 2.32 NA XXX 93227 ......... ............ A ECG monitor/review, 24 hrs ........................ 0.52 0.19 0.19 0.02 0.73 0.73 XXX 93230 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.52 3.88 NA 0.26 4.66 NA XXX 93231 ......... ............ A Ecg monitor/record, 24 hrs .......................... 0.00 1.52 NA 0.11 1.63 NA XXX 93232 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.00 2.17 NA 0.13 2.30 NA XXX 93233 ......... ............ A ECG monitor/review, 24 hrs ........................ 0.52 0.19 0.19 0.02 0.73 0.73 XXX 93235 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.45 2.78 NA 0.16 3.39 NA XXX 93236 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.00 2.62 NA 0.14 2.76 NA XXX 93237 ......... ............ A ECG monitor/review, 24 hrs ........................ 0.45 0.16 0.16 0.02 0.63 0.63 XXX 93268 ......... ............ A ECG record/review ...................................... 0.52 7.43 NA 0.28 8.23 NA XXX 93270 ......... ............ A ECG recording ............................................. 0.00 1.24 NA 0.08 1.32 NA XXX 93271 ......... ............ A Ecg/monitoring and analysis ........................ 0.00 6.00 NA 0.18 6.18 NA XXX 93272 ......... ............ A Ecg/review, interpret only ............................ 0.52 0.19 0.19 0.02 0.73 0.73 XXX 93278 ......... ............ A ECG/signal-averaged ................................... 0.25 1.24 NA 0.12 1.61 NA XXX 93278 ......... 26 ....... A ECG/signal-averaged ................................... 0.25 0.10 0.10 0.01 0.36 0.36 XXX 93278 ......... TC ...... A ECG/signal-averaged ................................... 0.00 1.15 NA 0.11 1.26 NA XXX
93303 ......... ............ A Echo transthoracic ....................................... 1.30 4.33 NA 0.28 5.91 NA XXX 93303 ......... 26 ....... A Echo transthoracic ....................................... 1.30 0.48 0.48 0.05 1.83 1.83 XXX 93303 ......... TC ...... A Echo transthoracic ....................................... 0.00 3.85 NA 0.23 4.08 NA XXX
93304 ......... ............ A Echo transthoracic ....................................... 0.75 2.22 NA 0.16 3.13 NA XXX 93304 ......... 26 ....... A Echo transthoracic ....................................... 0.75 0.28 0.28 0.03 1.06 1.06 XXX 93304 ......... TC ...... A Echo transthoracic ....................................... 0.00 1.94 NA 0.13 2.07 NA XXX 93307 ......... ............ A Echo exam of heart ..................................... 0.92 4.20 NA 0.26 5.38 NA XXX 93307 ......... 26 ....... A Echo exam of heart ..................................... 0.92 0.35 0.35 0.03 1.30 1.30 XXX 93307 ......... TC ...... A Echo exam of heart ..................................... 0.00 3.85 NA 0.23 4.08 NA XXX 93308 ......... ............ A Echo exam of heart ..................................... 0.53 2.14 NA 0.15 2.82 NA XXX 93308 ......... 26 ....... A Echo exam of heart ..................................... 0.53 0.20 0.20 0.02 0.75 0.75 XXX 93308 ......... TC ...... A Echo exam of heart ..................................... 0.00 1.94 NA 0.13 2.07 NA XXX 93312 ......... ............ A Echo transesophageal ................................. 2.20 4.56 NA 0.37 7.13 NA XXX 93312 ......... 26 ....... A Echo transesophageal ................................. 2.20 0.79 0.79 0.08 3.07 3.07 XXX 93312 ......... TC ...... A Echo transesophageal ................................. 0.00 3.77 NA 0.29 4.06 NA XXX 93313 ......... ............ A Echo transesophageal ................................. 0.95 NA 0.21 0.06 NA 1.22 XXX 93314 ......... ............ A Echo transesophageal ................................. 1.25 4.24 NA 0.34 5.83 NA XXX 93314 ......... 26 ....... A Echo transesophageal ................................. 1.25 0.47 0.47 0.05 1.77 1.77 XXX 93314 ......... TC ...... A Echo transesophageal ................................. 0.00 3.77 NA 0.29 4.06 NA XXX 93315 ......... 26 ....... A Echo transesophageal ................................. 2.78 1.01 1.01 0.13 3.92 3.92 XXX 93316 ......... ............ A Echo transesophageal ................................. 0.95 NA 0.23 0.05 NA 1.23 XXX 93317 ......... 26 ....... A Echo transesophageal ................................. 1.83 0.66 0.66 0.09 2.58 2.58 XXX 93318 ......... 26 ....... A Echo transesophageal intraop ..................... 2.20 0.48 0.48 0.13 2.81 2.81 XXX 93320 ......... ............ A Doppler echo exam, heart ........................... 0.38 1.85 NA 0.13 2.36 NA ZZZ 93320 ......... 26 ....... A Doppler echo exam, heart ........................... 0.38 0.15 0.15 0.01 0.54 0.54 ZZZ 93320 ......... TC ...... A Doppler echo exam, heart ........................... 0.00 1.71 NA 0.12 1.83 NA ZZZ 93321 ......... ............ A Doppler echo exam, heart ........................... 0.15 1.17 NA 0.09 1.41 NA ZZZ


## 47682

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

93321 ......... 26 ....... A Doppler echo exam, heart ........................... 0.15 0.06 0.06 0.01 0.22 0.22 ZZZ 93321 ......... TC ...... A Doppler echo exam, heart ........................... 0.00 1.11 NA 0.08 1.19 NA ZZZ 93325 ......... ............ A Doppler color flow add-on ........................... 0.07 2.92 NA 0.21 3.20 NA ZZZ 93325 ......... 26 ....... A Doppler color flow add-on ........................... 0.07 0.03 0.03 0.00 0.10 0.10 ZZZ 93325 ......... TC ...... A Doppler color flow add-on ........................... 0.00 2.90 NA 0.21 3.11 NA ZZZ
93350 ......... ............ A Echo transthoracic ....................................... 1.48 2.32 NA 0.18 3.98 NA XXX 93350 ......... 26 ....... A Echo transthoracic ....................................... 1.48 0.57 0.57 0.05 2.10 2.10 XXX 93350 ......... TC ...... A Echo transthoracic ....................................... 0.00 1.76 NA 0.13 1.89 NA XXX 93501 ......... ............ A Right heart catheterization ........................... 3.02 18.02 NA 1.26 22.30 NA 000 93501 ......... 26 ....... A Right heart catheterization ........................... 3.02 1.15 1.15 0.21 4.38 4.38 000 93501 ......... TC ...... A Right heart catheterization ........................... 0.00 16.87 NA 1.05 17.92 NA 000 93503 ......... ............ A Insert/place heart catheter ........................... 2.91 NA 0.68 0.20 NA 3.79 000 93505 ......... ............ A Biopsy of heart lining ................................... 4.37 3.66 NA 0.48 8.51 NA 000 93505 ......... 26 ....... A Biopsy of heart lining ................................... 4.37 1.68 1.68 0.32 6.37 6.37 000 93505 ......... TC ...... A Biopsy of heart lining ................................... 0.00 1.98 NA 0.16 2.14 NA 000 93508 ......... ............ A Cath placement, angiography ...................... 4.09 14.65 NA 0.94 19.68 NA 000 93508 ......... 26 ....... A Cath placement, angiography ...................... 4.09 2.07 2.07 0.29 6.45 6.45 000 93508 ......... TC ...... A Cath placement, angiography ...................... 0.00 12.58 NA 0.65 13.23 NA 000 93510 ......... ............ A Left heart catheterization ............................. 4.32 39.06 NA 2.60 45.98 NA 000 93510 ......... 26 ....... A Left heart catheterization ............................. 4.32 2.17 2.17 0.30 6.79 6.79 000 93510 ......... TC ...... A Left heart catheterization ............................. 0.00 36.89 NA 2.30 39.19 NA 000 93511 ......... ............ A Left heart catheterization ............................. 5.02 38.35 NA 2.58 45.95 NA 000 93511 ......... 26 ....... A Left heart catheterization ............................. 5.02 2.44 2.44 0.35 7.81 7.81 000 93511 ......... TC ...... A Left heart catheterization ............................. 0.00 35.91 NA 2.23 38.14 NA 000 93514 ......... ............ A Left heart catheterization ............................. 7.04 39.03 NA 2.72 48.79 NA 000 93514 ......... 26 ....... A Left heart catheterization ............................. 7.04 3.12 3.12 0.49 10.65 10.65 000 93514 ......... TC ...... A Left heart catheterization ............................. 0.00 35.91 NA 2.23 38.14 NA 000 93524 ......... ............ A Left heart catheterization ............................. 6.94 50.10 NA 3.42 60.46 NA 000 93524 ......... 26 ....... A Left heart catheterization ............................. 6.94 3.17 3.17 0.49 10.60 10.60 000 93524 ......... TC ...... A Left heart catheterization ............................. 0.00 46.93 NA 2.93 49.86 NA 000
93526 ......... ............ A Rt & Lt heart catheters ................................ 5.98 51.02 NA 3.44 60.44 NA 000 93526 ......... 26 ....... A Rt & Lt heart catheters ................................ 5.98 2.81 2.81 0.42 9.21 9.21 000 93526 ......... TC ...... A Rt & Lt heart catheters ................................ 0.00 48.21 NA 3.02 51.23 NA 000
93527 ......... ............ A Rt & Lt heart catheters ................................ 7.27 50.24 NA 3.44 60.95 NA 000 93527 ......... 26 ....... A Rt & Lt heart catheters ................................ 7.27 3.31 3.31 0.51 11.09 11.09 000 93527 ......... TC ...... A Rt & Lt heart catheters ................................ 0.00 46.93 NA 2.93 49.86 NA 000
93528 ......... ............ A Rt & Lt heart catheters ................................ 8.99 50.95 NA 3.56 63.50 NA 000 93528 ......... 26 ....... A Rt & Lt heart catheters ................................ 8.99 4.02 4.02 0.63 13.64 13.64 000 93528 ......... TC ...... A Rt & Lt heart catheters ................................ 0.00 46.93 NA 2.93 49.86 NA 000 93529 ......... ............ A Rt, lt heart catheterization ........................... 4.79 49.20 NA 3.26 57.25 NA 000 93529 ......... 26 ....... A Rt, lt heart catheterization ........................... 4.79 2.27 2.27 0.33 7.39 7.39 000 93529 ......... TC ...... A Rt, lt heart catheterization ........................... 0.00 46.93 NA 2.93 49.86 NA 000 93530 ......... ............ A Rt heart cath, congenital ............................. 4.22 18.80 NA 1.35 24.37 NA 000 93530 ......... 26 ....... A Rt heart cath, congenital ............................. 4.22 1.93 1.93 0.30 6.45 6.45 000 93530 ......... TC ...... A Rt heart cath, congenital ............................. 0.00 16.87 NA 1.05 17.92 NA 000 93531 ......... ............ A R & l heart cath, congenital ......................... 8.34 51.79 NA 3.60 63.73 NA 000 93531 ......... 26 ....... A R & l heart cath, congenital ......................... 8.34 3.58 3.58 0.58 12.50 12.50 000 93531 ......... TC ...... A R & l heart cath, congenital ......................... 0.00 48.21 NA 3.02 51.23 NA 000 93532 ......... ............ A R & l heart cath, congenital ......................... 9.99 51.17 NA 3.63 64.79 NA 000 93532 ......... 26 ....... A R & l heart cath, congenital ......................... 9.99 4.25 4.25 0.70 14.94 14.94 000 93532 ......... TC ...... A R & l heart cath, congenital ......................... 0.00 46.93 NA 2.93 49.86 NA 000 93533 ......... ............ A R & l heart cath, congenital ......................... 6.69 49.72 NA 3.40 59.81 NA 000 93533 ......... 26 ....... A R & l heart cath, congenital ......................... 6.69 2.80 2.80 0.47 9.96 9.96 000 93533 ......... TC ...... A R & l heart cath, congenital ......................... 0.00 46.93 NA 2.93 49.86 NA 000 93539 ......... ............ A Injection, cardiac cath .................................. 0.40 NA 0.16 0.01 NA 0.57 000 93540 ......... ............ A Injection, cardiac cath .................................. 0.43 NA 0.17 0.01 NA 0.61 000 93541 ......... ............ A Injection for lung angiogram ........................ 0.29 NA 0.11 0.01 NA 0.41 000 93542 ......... ............ A Injection for heart x-rays .............................. 0.29 NA 0.11 0.01 NA 0.41 000 93543 ......... ............ A Injection for heart x-rays .............................. 0.29 NA 0.11 0.01 NA 0.41 000 93544 ......... ............ A Injection for aortography .............................. 0.25 NA 0.10 0.01 NA 0.36 000 93545 ......... ............ A Inject for coronary x-rays ............................. 0.40 NA 0.16 0.01 NA 0.57 000 93555 ......... ............ A Imaging, cardiac cath .................................. 0.81 6.58 NA 0.37 7.76 NA XXX 93555 ......... 26 ....... A Imaging, cardiac cath .................................. 0.81 0.32 0.32 0.03 1.16 1.16 XXX 93555 ......... TC ...... A Imaging, cardiac cath .................................. 0.00 6.26 NA 0.34 6.60 NA XXX 93556 ......... ............ A Imaging, cardiac cath .................................. 0.83 10.20 NA 0.54 11.57 NA XXX 93556 ......... 26 ....... A Imaging, cardiac cath .................................. 0.83 0.32 0.32 0.03 1.18 1.18 XXX 93556 ......... TC ...... A Imaging, cardiac cath .................................. 0.00 9.87 NA 0.51 10.38 NA XXX 93561 ......... ............ A Cardiac output measurement ...................... 0.50 0.68 NA 0.09 1.27 NA 000 93561 ......... 26 ....... A Cardiac output measurement ...................... 0.50 0.16 0.16 0.03 0.69 0.69 000 93561 ......... TC ...... A Cardiac output measurement ...................... 0.00 0.52 NA 0.06 0.58 NA 000 93562 ......... ............ A Cardiac output measurement ...................... 0.16 0.37 NA 0.05 0.58 NA 000 93562 ......... 26 ....... A Cardiac output measurement ...................... 0.16 0.05 0.05 0.01 0.22 0.22 000 93562 ......... TC ...... A Cardiac output measurement ...................... 0.00 0.32 NA 0.04 0.36 NA 000 93571 ......... ............ A Heart flow reserve measure ........................ 1.80 5.24 NA 0.30 7.34 NA ZZZ 93571 ......... 26 ....... A Heart flow reserve measure ........................ 1.80 0.68 0.68 0.06 2.54 2.54 ZZZ


## 47683

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

93571 ......... TC ...... A Heart flow reserve measure ........................ 0.00 4.56 NA 0.24 4.80 NA ZZZ 93572 ......... ............ A Heart flow reserve measure ........................ 1.44 2.79 NA 0.18 4.41 NA ZZZ 93572 ......... 26 ....... A Heart flow reserve measure ........................ 1.44 0.50 0.50 0.05 1.99 1.99 ZZZ 93572 ......... TC ...... A Heart flow reserve measure ........................ 0.00 2.29 NA 0.13 2.42 NA ZZZ 93580 ......... ............ A Transcath closure of asd ............................. 17.97 NA 7.37 1.37 NA 26.71 000 93581 ......... ............ A Transcath closure of vsd ............................. 24.39 NA 9.38 1.37 NA 35.14 000 93600 ......... ............ A Bundle of His recording ............................... 2.12 2.78 NA 0.29 5.19 NA 000 93600 ......... 26 ....... A Bundle of His recording ............................... 2.12 0.83 0.83 0.16 3.11 3.11 000 93600 ......... TC ...... A Bundle of His recording ............................... 0.00 1.95 NA 0.13 2.08 NA 000 93602 ......... ............ A Intra-atrial recording ..................................... 2.12 1.93 NA 0.24 4.29 NA 000 93602 ......... 26 ....... A Intra-atrial recording ..................................... 2.12 0.82 0.82 0.17 3.11 3.11 000 93602 ......... TC ...... A Intra-atrial recording ..................................... 0.00 1.11 NA 0.07 1.18 NA 000 93603 ......... ............ A Right ventricular recording ........................... 2.12 2.49 NA 0.29 4.90 NA 000 93603 ......... 26 ....... A Right ventricular recording ........................... 2.12 0.81 0.81 0.18 3.11 3.11 000 93603 ......... TC ...... A Right ventricular recording ........................... 0.00 1.68 NA 0.11 1.79 NA 000 93609 ......... ............ A Map tachycardia, add-on ............................. 4.99 4.65 NA 0.50 10.14 NA ZZZ 93609 ......... 26 ....... A Map tachycardia, add-on ............................. 4.99 1.94 1.94 0.33 7.26 7.26 ZZZ 93609 ......... TC ...... A Map tachycardia, add-on ............................. 0.00 2.71 NA 0.17 2.88 NA ZZZ 93610 ......... ............ A Intra-atrial pacing ......................................... 3.02 2.51 NA 0.35 5.88 NA 000 93610 ......... 26 ....... A Intra-atrial pacing ......................................... 3.02 1.16 1.16 0.25 4.43 4.43 000 93610 ......... TC ...... A Intra-atrial pacing ......................................... 0.00 1.35 NA 0.10 1.45 NA 000 93612 ......... ............ A Intraventricular pacing ................................. 3.02 2.77 NA 0.36 6.15 NA 000 93612 ......... 26 ....... A Intraventricular pacing ................................. 3.02 1.16 1.16 0.25 4.43 4.43 000 93612 ......... TC ...... A Intraventricular pacing ................................. 0.00 1.61 NA 0.11 1.72 NA 000 93613 ......... ............ A Electrophys map 3d, add-on ....................... 6.99 NA 2.75 0.63 NA 10.37 ZZZ 93615 ......... ............ A Esophageal recording .................................. 0.99 0.58 NA 0.05 1.62 NA 000 93615 ......... 26 ....... A Esophageal recording .................................. 0.99 0.27 0.27 0.03 1.29 1.29 000 93615 ......... TC ...... A Esophageal recording .................................. 0.00 0.32 NA 0.02 0.34 NA 000 93616 ......... ............ A Esophageal recording .................................. 1.49 0.74 NA 0.10 2.33 NA 000 93616 ......... 26 ....... A Esophageal recording .................................. 1.49 0.43 0.43 0.08 2.00 2.00 000 93616 ......... TC ...... A Esophageal recording .................................. 0.00 0.32 NA 0.02 0.34 NA 000 93618 ......... ............ A Heart rhythm pacing .................................... 4.25 5.62 NA 0.54 10.41 NA 000 93618 ......... 26 ....... A Heart rhythm pacing .................................... 4.25 1.66 1.66 0.30 6.21 6.21 000 93618 ......... TC ...... A Heart rhythm pacing .................................... 0.00 3.96 NA 0.24 4.20 NA 000 93619 ......... ............ A Electrophysiology evaluation ....................... 7.31 10.87 NA 0.98 19.16 NA 000 93619 ......... 26 ....... A Electrophysiology evaluation ....................... 7.31 3.18 3.18 0.51 11.00 11.00 000 93619 ......... TC ...... A Electrophysiology evaluation ....................... 0.00 7.69 NA 0.47 8.16 NA 000 93620 ......... 26 ....... A Electrophysiology evaluation ....................... 11.57 4.83 4.83 0.81 17.21 17.21 000 93621 ......... 26 ....... A Electrophysiology evaluation ....................... 2.10 0.82 0.82 0.15 3.07 3.07 ZZZ 93622 ......... 26 ....... A Electrophysiology evaluation ....................... 3.10 1.20 1.20 0.22 4.52 4.52 ZZZ 93623 ......... 26 ....... A Stimulation, pacing heart ............................. 2.85 1.11 1.11 0.20 4.16 4.16 ZZZ 93624 ......... ............ A Electrophysiologic study .............................. 4.80 4.17 NA 0.47 9.44 NA 000 93624 ......... 26 ....... A Electrophysiologic study .............................. 4.80 2.19 2.19 0.34 7.33 7.33 000 93624 ......... TC ...... A Electrophysiologic study .............................. 0.00 1.98 NA 0.13 2.11 NA 000 93631 ......... ............ A Heart pacing, mapping ................................ 7.59 8.90 NA 1.47 17.96 NA 000 93631 ......... 26 ....... A Heart pacing, mapping ................................ 7.59 2.76 2.76 0.85 11.20 11.20 000 93631 ......... TC ...... A Heart pacing, mapping ................................ 0.00 6.14 NA 0.62 6.76 NA 000
93640 ......... ............ A Evaluation heart device ............................... 3.51 8.52 NA 0.67 12.70 NA 000 93640 ......... 26 ....... A Evaluation heart device ............................... 3.51 1.36 1.36 0.25 5.12 5.12 000 93640 ......... TC ...... A Evaluation heart device ............................... 0.00 7.16 NA 0.42 7.58 NA 000 93641 ......... ............ A Electrophysiology evaluation ....................... 5.92 9.46 NA 0.84 16.22 NA 000 93641 ......... 26 ....... A Electrophysiology evaluation ....................... 5.92 2.30 2.30 0.42 8.64 8.64 000 93641 ......... TC ...... A Electrophysiology evaluation ....................... 0.00 7.16 NA 0.42 7.58 NA 000 93642 ......... ............ A Electrophysiology evaluation ....................... 4.88 9.37 NA 0.58 14.83 NA 000 93642 ......... 26 ....... A Electrophysiology evaluation ....................... 4.88 2.21 2.21 0.16 7.25 7.25 000 93642 ......... TC ...... A Electrophysiology evaluation ....................... 0.00 7.16 NA 0.42 7.58 NA 000 93650 ......... ............ A Ablate heart dysrhythm focus ...................... 10.49 NA 4.42 0.74 NA 15.65 000 93651 ......... ............ A Ablate heart dysrhythm focus ...................... 16.23 NA 6.31 1.13 NA 23.67 000 93652 ......... ............ A Ablate heart dysrhythm focus ...................... 17.65 NA 6.86 1.23 NA 25.74 000 93660 ......... ............ A Tilt table evaluation ...................................... 1.89 2.42 NA 0.08 4.39 NA 000 93660 ......... 26 ....... A Tilt table evaluation ...................................... 1.89 0.74 0.74 0.06 2.69 2.69 000 93660 ......... TC ...... A Tilt table evaluation ...................................... 0.00 1.68 NA 0.02 1.70 NA 000 93662 ......... 26 ....... A Intracardiac ecg (ice) ................................... 2.80 1.10 1.10 0.09 3.99 3.99 ZZZ 93701 ......... ............ A Bioimpedance, thoracic ............................... 0.17 1.00 NA 0.02 1.19 NA XXX 93701 ......... 26 ....... A Bioimpedance, thoracic ............................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 93701 ......... TC ...... A Bioimpedance, thoracic ............................... 0.00 0.94 NA 0.01 0.95 NA XXX 93720 ......... ............ A Total body plethysmography ....................... 0.17 1.16 NA 0.07 1.40 NA XXX 93721 ......... ............ A Plethysmography tracing ............................. 0.00 0.70 NA 0.06 0.76 NA XXX 93722 ......... ............ A Plethysmography report ............................... 0.17 0.05 0.05 0.01 0.23 0.23 XXX 93724 ......... ............ A Analyze pacemaker system ......................... 4.88 5.86 NA 0.43 11.17 NA 000 93724 ......... 26 ....... A Analyze pacemaker system ......................... 4.88 1.91 1.91 0.19 6.98 6.98 000 93724 ......... TC ...... A Analyze pacemaker system ......................... 0.00 3.96 NA 0.24 4.20 NA 000 93727 ......... ............ A Analyze ilr system ........................................ 0.52 0.20 0.20 0.02 0.74 0.74 XXX 93731 ......... ............ A Analyze pacemaker system ......................... 0.45 0.67 NA 0.06 1.18 NA XXX 93731 ......... 26 ....... A Analyze pacemaker system ......................... 0.45 0.17 0.17 0.02 0.64 0.64 XXX


## 47684

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

93731 ......... TC ...... A Analyze pacemaker system ......................... 0.00 0.49 NA 0.04 0.53 NA XXX 93732 ......... ............ A Analyze pacemaker system ......................... 0.92 0.86 NA 0.07 1.85 NA XXX 93732 ......... 26 ....... A Analyze pacemaker system ......................... 0.92 0.35 0.35 0.03 1.30 1.30 XXX 93732 ......... TC ...... A Analyze pacemaker system ......................... 0.00 0.51 NA 0.04 0.55 NA XXX 93733 ......... ............ A Telephone analy, pacemaker ...................... 0.17 0.79 NA 0.07 1.03 NA XXX 93733 ......... 26 ....... A Telephone analy, pacemaker ...................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 93733 ......... TC ...... A Telephone analy, pacemaker ...................... 0.00 0.72 NA 0.06 0.78 NA XXX 93734 ......... ............ A Analyze pacemaker system ......................... 0.38 0.49 NA 0.03 0.90 NA XXX 93734 ......... 26 ....... A Analyze pacemaker system ......................... 0.38 0.14 0.14 0.01 0.53 0.53 XXX 93734 ......... TC ...... A Analyze pacemaker system ......................... 0.00 0.35 NA 0.02 0.37 NA XXX 93735 ......... ............ A Analyze pacemaker system ......................... 0.74 0.73 NA 0.07 1.54 NA XXX 93735 ......... 26 ....... A Analyze pacemaker system ......................... 0.74 0.28 0.28 0.03 1.05 1.05 XXX 93735 ......... TC ...... A Analyze pacemaker system ......................... 0.00 0.44 NA 0.04 0.48 NA XXX 93736 ......... ............ A Telephonic analy, pacemaker ...................... 0.15 0.69 NA 0.07 0.91 NA XXX 93736 ......... 26 ....... A Telephonic analy, pacemaker ...................... 0.15 0.06 0.06 0.01 0.22 0.22 XXX 93736 ......... TC ...... A Telephonic analy, pacemaker ...................... 0.00 0.63 NA 0.06 0.69 NA XXX 93740 ......... ............ B Temperature gradient studies ...................... 0.16 0.19 NA 0.02 0.37 NA XXX 93740 ......... 26 ....... B Temperature gradient studies ...................... 0.16 0.04 0.04 0.01 0.21 0.21 XXX 93740 ......... TC ...... B Temperature gradient studies ...................... 0.00 0.15 NA 0.01 0.16 NA XXX 93741 ......... ............ A Analyze ht pace device sngl ........................ 0.80 0.98 NA 0.07 1.85 NA XXX 93741 ......... 26 ....... A Analyze ht pace device sngl ........................ 0.80 0.31 0.31 0.03 1.14 1.14 XXX 93741 ......... TC ...... A Analyze ht pace device sngl ........................ 0.00 0.67 NA 0.04 0.71 NA XXX 93742 ......... ............ A Analyze ht pace device sngl ........................ 0.91 1.02 NA 0.07 2.00 NA XXX 93742 ......... 26 ....... A Analyze ht pace device sngl ........................ 0.91 0.36 0.36 0.03 1.30 1.30 XXX 93742 ......... TC ...... A Analyze ht pace device sngl ........................ 0.00 0.67 NA 0.04 0.71 NA XXX 93743 ......... ............ A Analyze ht pace device dual ....................... 1.03 1.13 NA 0.08 2.24 NA XXX 93743 ......... 26 ....... A Analyze ht pace device dual ....................... 1.03 0.40 0.40 0.04 1.47 1.47 XXX 93743 ......... TC ...... A Analyze ht pace device dual ....................... 0.00 0.73 NA 0.04 0.77 NA XXX 93744 ......... ............ A Analyze ht pace device dual ....................... 1.18 1.12 NA 0.08 2.38 NA XXX 93744 ......... 26 ....... A Analyze ht pace device dual ....................... 1.18 0.46 0.46 0.04 1.68 1.68 XXX 93744 ......... TC ...... A Analyze ht pace device dual ....................... 0.00 0.67 NA 0.04 0.71 NA XXX 93770 ......... ............ B Measure venous pressure ........................... 0.16 0.08 NA 0.02 0.26 NA XXX 93770 ......... 26 ....... B Measure venous pressure ........................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 93770 ......... TC ...... B Measure venous pressure ........................... 0.00 0.03 NA 0.01 0.04 NA XXX 93784 ......... ............ A Ambulatory BP monitoring ........................... 0.38 1.55 NA 0.03 1.96 NA XXX 93786 ......... ............ A Ambulatory BP recording ............................. 0.00 0.91 NA 0.01 0.92 NA XXX 93788 ......... ............ A Ambulatory BP analysis ............................... 0.00 0.51 NA 0.01 0.52 NA XXX 93790 ......... ............ A Review/report BP recording ......................... 0.38 0.13 0.13 0.01 0.52 0.52 XXX 93797 ......... ............ A Cardiac rehab .............................................. 0.18 0.30 0.07 0.01 0.49 0.26 000 93798 ......... ............ A Cardiac rehab/monitor ................................. 0.28 0.47 0.11 0.01 0.76 0.40 000 93875 ......... ............ A Extracranial study ........................................ 0.22 2.10 NA 0.12 2.44 NA XXX 93875 ......... 26 ....... A Extracranial study ........................................ 0.22 0.08 0.08 0.01 0.31 0.31 XXX 93875 ......... TC ...... A Extracranial study ........................................ 0.00 2.02 NA 0.11 2.13 NA XXX 93880 ......... ............ A Extracranial study ........................................ 0.60 5.06 NA 0.39 6.05 NA XXX 93880 ......... 26 ....... A Extracranial study ........................................ 0.60 0.20 0.20 0.04 0.84 0.84 XXX 93880 ......... TC ...... A Extracranial study ........................................ 0.00 4.85 NA 0.35 5.20 NA XXX 93882 ......... ............ A Extracranial study ........................................ 0.40 3.31 NA 0.26 3.97 NA XXX 93882 ......... 26 ....... A Extracranial study ........................................ 0.40 0.14 0.14 0.04 0.58 0.58 XXX 93882 ......... TC ...... A Extracranial study ........................................ 0.00 3.17 NA 0.22 3.39 NA XXX 93886 ......... ............ A Intracranial study ......................................... 0.94 6.05 NA 0.45 7.44 NA XXX 93886 ......... 26 ....... A Intracranial study ......................................... 0.94 0.37 0.37 0.06 1.37 1.37 XXX 93886 ......... TC ...... A Intracranial study ......................................... 0.00 5.68 NA 0.39 6.07 NA XXX 93888 ......... ............ A Intracranial study ......................................... 0.62 3.85 NA 0.32 4.79 NA XXX 93888 ......... 26 ....... A Intracranial study ......................................... 0.62 0.23 0.23 0.05 0.90 0.90 XXX 93888 ......... TC ...... A Intracranial study ......................................... 0.00 3.62 NA 0.27 3.89 NA XXX 93922 ......... ............ A Extremity study ............................................ 0.25 2.43 NA 0.15 2.83 NA XXX 93922 ......... 26 ....... A Extremity study ............................................ 0.25 0.08 0.08 0.02 0.35 0.35 XXX 93922 ......... TC ...... A Extremity study ............................................ 0.00 2.34 NA 0.13 2.47 NA XXX 93923 ......... ............ A Extremity study ............................................ 0.45 3.68 NA 0.26 4.39 NA XXX 93923 ......... 26 ....... A Extremity study ............................................ 0.45 0.15 0.15 0.04 0.64 0.64 XXX 93923 ......... TC ...... A Extremity study ............................................ 0.00 3.53 NA 0.22 3.75 NA XXX 93924 ......... ............ A Extremity study ............................................ 0.50 4.42 NA 0.30 5.22 NA XXX 93924 ......... 26 ....... A Extremity study ............................................ 0.50 0.17 0.17 0.05 0.72 0.72 XXX 93924 ......... TC ...... A Extremity study ............................................ 0.00 4.25 NA 0.25 4.50 NA XXX 93925 ......... ............ A Lower extremity study .................................. 0.58 6.11 NA 0.39 7.08 NA XXX 93925 ......... 26 ....... A Lower extremity study .................................. 0.58 0.20 0.20 0.04 0.82 0.82 XXX 93925 ......... TC ...... A Lower extremity study .................................. 0.00 5.91 NA 0.35 6.26 NA XXX 93926 ......... ............ A Lower extremity study .................................. 0.39 3.82 NA 0.27 4.48 NA XXX 93926 ......... 26 ....... A Lower extremity study .................................. 0.39 0.13 0.13 0.04 0.56 0.56 XXX 93926 ......... TC ...... A Lower extremity study .................................. 0.00 3.69 NA 0.23 3.92 NA XXX 93930 ......... ............ A Upper extremity study .................................. 0.46 4.85 NA 0.41 5.72 NA XXX 93930 ......... 26 ....... A Upper extremity study .................................. 0.46 0.16 0.16 0.04 0.66 0.66 XXX 93930 ......... TC ...... A Upper extremity study .................................. 0.00 4.69 NA 0.37 5.06 NA XXX 93931 ......... ............ A Upper extremity study .................................. 0.31 3.22 NA 0.27 3.80 NA XXX 93931 ......... 26 ....... A Upper extremity study .................................. 0.31 0.10 0.10 0.03 0.44 0.44 XXX


## 47685

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

93931 ......... TC ...... A Upper extremity study .................................. 0.00 3.12 NA 0.24 3.36 NA XXX 93965 ......... ............ A Extremity study ............................................ 0.35 2.48 NA 0.14 2.97 NA XXX 93965 ......... 26 ....... A Extremity study ............................................ 0.35 0.12 0.12 0.02 0.49 0.49 XXX 93965 ......... TC ...... A Extremity study ............................................ 0.00 2.36 NA 0.12 2.48 NA XXX 93970 ......... ............ A Extremity study ............................................ 0.68 4.77 NA 0.45 5.90 NA XXX 93970 ......... 26 ....... A Extremity study ............................................ 0.68 0.23 0.23 0.05 0.96 0.96 XXX 93970 ......... TC ...... A Extremity study ............................................ 0.00 4.54 NA 0.40 4.94 NA XXX 93971 ......... ............ A Extremity study ............................................ 0.45 3.28 NA 0.30 4.03 NA XXX 93971 ......... 26 ....... A Extremity study ............................................ 0.45 0.15 0.15 0.03 0.63 0.63 XXX 93971 ......... TC ...... A Extremity study ............................................ 0.00 3.13 NA 0.27 3.40 NA XXX 93975 ......... ............ A Vascular study ............................................. 1.80 6.91 NA 0.56 9.27 NA XXX 93975 ......... 26 ....... A Vascular study ............................................. 1.80 0.60 0.60 0.13 2.53 2.53 XXX 93975 ......... TC ...... A Vascular study ............................................. 0.00 6.32 NA 0.43 6.75 NA XXX 93976 ......... ............ A Vascular study ............................................. 1.21 3.92 NA 0.36 5.49 NA XXX 93976 ......... 26 ....... A Vascular study ............................................. 1.21 0.40 0.40 0.06 1.67 1.67 XXX 93976 ......... TC ...... A Vascular study ............................................. 0.00 3.52 NA 0.30 3.82 NA XXX 93978 ......... ............ A Vascular study ............................................. 0.65 4.17 NA 0.43 5.25 NA XXX 93978 ......... 26 ....... A Vascular study ............................................. 0.65 0.22 0.22 0.06 0.93 0.93 XXX 93978 ......... TC ...... A Vascular study ............................................. 0.00 3.95 NA 0.37 4.32 NA XXX 93979 ......... ............ A Vascular study ............................................. 0.44 3.00 NA 0.28 3.72 NA XXX 93979 ......... 26 ....... A Vascular study ............................................. 0.44 0.15 0.15 0.04 0.63 0.63 XXX 93979 ......... TC ...... A Vascular study ............................................. 0.00 2.85 NA 0.24 3.09 NA XXX 93980 ......... ............ A Penile vascular study ................................... 1.25 2.88 NA 0.43 4.56 NA XXX 93980 ......... 26 ....... A Penile vascular study ................................... 1.25 0.41 0.41 0.09 1.75 1.75 XXX 93980 ......... TC ...... A Penile vascular study ................................... 0.00 2.48 NA 0.34 2.82 NA XXX 93981 ......... ............ A Penile vascular study ................................... 0.44 2.96 NA 0.33 3.73 NA XXX 93981 ......... 26 ....... A Penile vascular study ................................... 0.44 0.14 0.14 0.02 0.60 0.60 XXX 93981 ......... TC ...... A Penile vascular study ................................... 0.00 2.81 NA 0.31 3.12 NA XXX 93990 ......... ............ A Doppler flow testing ..................................... 0.25 3.76 NA 0.26 4.27 NA XXX 93990 ......... 26 ....... A Doppler flow testing ..................................... 0.25 0.09 0.09 0.03 0.37 0.37 XXX 93990 ......... TC ...... A Doppler flow testing ..................................... 0.00 3.67 NA 0.23 3.90 NA XXX 94010 ......... ............ A Breathing capacity test ................................ 0.17 0.69 NA 0.03 0.89 NA XXX 94010 ......... 26 ....... A Breathing capacity test ................................ 0.17 0.05 0.05 0.01 0.23 0.23 XXX 94010 ......... TC ...... A Breathing capacity test ................................ 0.00 0.63 NA 0.02 0.65 NA XXX 94014 ......... ............ A Patient recorded spirometry ........................ 0.52 0.77 NA 0.04 1.33 NA XXX 94015 ......... ............ A Patient recorded spirometry ........................ 0.00 0.60 NA 0.01 0.61 NA XXX 94016 ......... ............ A Review patient spirometry ........................... 0.52 0.16 0.16 0.03 0.71 0.71 XXX 94060 ......... ............ A Evaluation of wheezing ................................ 0.31 1.10 NA 0.07 1.48 NA XXX 94060 ......... 26 ....... A Evaluation of wheezing ................................ 0.31 0.09 0.09 0.01 0.41 0.41 XXX 94060 ......... TC ...... A Evaluation of wheezing ................................ 0.00 1.01 NA 0.06 1.07 NA XXX 94070 ......... ............ A Evaluation of wheezing ................................ 0.60 0.84 NA 0.13 1.57 NA XXX 94070 ......... 26 ....... A Evaluation of wheezing ................................ 0.60 0.18 0.18 0.03 0.81 0.81 XXX 94070 ......... TC ...... A Evaluation of wheezing ................................ 0.00 0.66 NA 0.10 0.76 NA XXX 94150 ......... ............ B Vital capacity test ......................................... 0.07 0.48 NA 0.02 0.57 NA XXX 94150 ......... 26 ....... B Vital capacity test ......................................... 0.07 0.03 0.03 0.01 0.11 0.11 XXX 94150 ......... TC ...... B Vital capacity test ......................................... 0.00 0.45 NA 0.01 0.46 NA XXX 94200 ......... ............ A Lung function test (MBC/MVV) .................... 0.11 0.46 NA 0.03 0.60 NA XXX 94200 ......... 26 ....... A Lung function test (MBC/MVV) .................... 0.11 0.03 0.03 0.01 0.15 0.15 XXX 94200 ......... TC ...... A Lung function test (MBC/MVV) .................... 0.00 0.42 NA 0.02 0.44 NA XXX 94240 ......... ............ A Residual lung capacity ................................. 0.26 0.67 NA 0.06 0.99 NA XXX 94240 ......... 26 ....... A Residual lung capacity ................................. 0.26 0.08 0.08 0.01 0.35 0.35 XXX 94240 ......... TC ...... A Residual lung capacity ................................. 0.00 0.59 NA 0.05 0.64 NA XXX 94250 ......... ............ A Expired gas collection .................................. 0.11 0.65 NA 0.02 0.78 NA XXX 94250 ......... 26 ....... A Expired gas collection .................................. 0.11 0.03 0.03 0.01 0.15 0.15 XXX 94250 ......... TC ...... A Expired gas collection .................................. 0.00 0.62 NA 0.01 0.63 NA XXX 94260 ......... ............ A Thoracic gas volume ................................... 0.13 0.59 NA 0.05 0.77 NA XXX 94260 ......... 26 ....... A Thoracic gas volume ................................... 0.13 0.04 0.04 0.01 0.18 0.18 XXX 94260 ......... TC ...... A Thoracic gas volume ................................... 0.00 0.55 NA 0.04 0.59 NA XXX 94350 ......... ............ A Lung nitrogen washout curve ...................... 0.26 0.77 NA 0.05 1.08 NA XXX 94350 ......... 26 ....... A Lung nitrogen washout curve ...................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 94350 ......... TC ...... A Lung nitrogen washout curve ...................... 0.00 0.70 NA 0.04 0.74 NA XXX 94360 ......... ............ A Measure airflow resistance .......................... 0.26 0.71 NA 0.07 1.04 NA XXX 94360 ......... 26 ....... A Measure airflow resistance .......................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 94360 ......... TC ...... A Measure airflow resistance .......................... 0.00 0.63 NA 0.06 0.69 NA XXX 94370 ......... ............ A Breath airway closing volume ...................... 0.26 0.74 NA 0.03 1.03 NA XXX 94370 ......... 26 ....... A Breath airway closing volume ...................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 94370 ......... TC ...... A Breath airway closing volume ...................... 0.00 0.66 NA 0.02 0.68 NA XXX 94375 ......... ............ A Respiratory flow volume loop ...................... 0.31 0.62 NA 0.03 0.96 NA XXX 94375 ......... 26 ....... A Respiratory flow volume loop ...................... 0.31 0.09 0.09 0.01 0.41 0.41 XXX 94375 ......... TC ...... A Respiratory flow volume loop ...................... 0.00 0.53 NA 0.02 0.55 NA XXX 94400 ......... ............ A CO2 breathing response curve ................... 0.40 0.86 NA 0.09 1.35 NA XXX 94400 ......... 26 ....... A CO2 breathing response curve ................... 0.40 0.12 0.12 0.03 0.55 0.55 XXX 94400 ......... TC ...... A CO2 breathing response curve ................... 0.00 0.74 NA 0.06 0.80 NA XXX 94450 ......... ............ A Hypoxia response curve .............................. 0.40 0.87 NA 0.04 1.31 NA XXX 94450 ......... 26 ....... A Hypoxia response curve .............................. 0.40 0.12 0.12 0.02 0.54 0.54 XXX


## 47686

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

94450 ......... TC ...... A Hypoxia response curve .............................. 0.00 0.75 NA 0.02 0.77 NA XXX 94620 ......... ............ A Pulmonary stress test/simple ....................... 0.64 2.54 NA 0.13 3.31 NA XXX 94620 ......... 26 ....... A Pulmonary stress test/simple ....................... 0.64 0.20 0.20 0.03 0.87 0.87 XXX 94620 ......... TC ...... A Pulmonary stress test/simple ....................... 0.00 2.34 NA 0.10 2.44 NA XXX 94621 ......... ............ A Pulm stress test/complex ............................. 1.42 2.24 NA 0.16 3.82 NA XXX 94621 ......... 26 ....... A Pulm stress test/complex ............................. 1.42 0.43 0.43 0.06 1.91 1.91 XXX 94621 ......... TC ...... A Pulm stress test/complex ............................. 0.00 1.80 NA 0.10 1.90 NA XXX 94640 ......... ............ A Airway inhalation treatment ......................... 0.00 0.31 NA 0.02 0.33 NA XXX 94656 ......... ............ A Initial ventilator mgmt ................................... 1.22 1.18 0.31 0.07 2.47 1.60 XXX 94657 ......... ............ A Continued ventilator mgmt ........................... 0.83 1.00 0.25 0.04 1.87 1.12 XXX 94660 ......... ............ A Pos airway pressure, CPAP ........................ 0.76 0.66 0.23 0.04 1.46 1.03 XXX 94662 ......... ............ A Neg press ventilation, cnp ........................... 0.76 NA 0.23 0.06 NA 1.05 XXX 94664 ......... ............ A Evaluate pt use of inhaler ............................ 0.00 0.32 NA 0.04 0.36 NA XXX 94667 ......... ............ A Chest wall manipulation ............................... 0.00 0.54 NA 0.05 0.59 NA XXX 94668 ......... ............ A Chest wall manipulation ............................... 0.00 0.46 NA 0.02 0.48 NA XXX 94680 ......... ............ A Exhaled air analysis, o2 .............................. 0.26 1.89 NA 0.07 2.22 NA XXX 94680 ......... 26 ....... A Exhaled air analysis, o2 .............................. 0.26 0.08 0.08 0.01 0.35 0.35 XXX 94680 ......... TC ...... A Exhaled air analysis, o2 .............................. 0.00 1.81 NA 0.06 1.87 NA XXX 94681 ......... ............ A Exhaled air analysis, o2/co2 ........................ 0.20 2.58 NA 0.13 2.91 NA XXX 94681 ......... 26 ....... A Exhaled air analysis, o2/co2 ........................ 0.20 0.06 0.06 0.01 0.27 0.27 XXX 94681 ......... TC ...... A Exhaled air analysis, o2/co2 ........................ 0.00 2.52 NA 0.12 2.64 NA XXX 94690 ......... ............ A Exhaled air analysis ..................................... 0.07 2.02 NA 0.04 2.13 NA XXX 94690 ......... 26 ....... A Exhaled air analysis ..................................... 0.07 0.02 0.02 0.00 0.09 0.09 XXX 94690 ......... TC ...... A Exhaled air analysis ..................................... 0.00 2.00 NA 0.04 2.04 NA XXX 94720 ......... ............ A Monoxide diffusing capacity ........................ 0.26 1.02 NA 0.07 1.35 NA XXX 94720 ......... 26 ....... A Monoxide diffusing capacity ........................ 0.26 0.08 0.08 0.01 0.35 0.35 XXX 94720 ......... TC ...... A Monoxide diffusing capacity ........................ 0.00 0.94 NA 0.06 1.00 NA XXX 94725 ......... ............ A Membrane diffusion capacity ....................... 0.26 2.94 NA 0.13 3.33 NA XXX 94725 ......... 26 ....... A Membrane diffusion capacity ....................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 94725 ......... TC ...... A Membrane diffusion capacity ....................... 0.00 2.86 NA 0.12 2.98 NA XXX 94750 ......... ............ A Pulmonary compliance study ....................... 0.23 1.35 NA 0.05 1.63 NA XXX 94750 ......... 26 ....... A Pulmonary compliance study ....................... 0.23 0.07 0.07 0.01 0.31 0.31 XXX 94750 ......... TC ...... A Pulmonary compliance study ....................... 0.00 1.29 NA 0.04 1.33 NA XXX 94760 ......... ............ T Measure blood oxygen level ........................ 0.00 0.04 NA 0.02 0.06 NA XXX 94761 ......... ............ T Measure blood oxygen level ........................ 0.00 0.07 NA 0.06 0.13 NA XXX 94762 ......... ............ A Measure blood oxygen level ........................ 0.00 0.49 NA 0.10 0.59 NA XXX 94770 ......... ............ A Exhaled carbon dioxide test ........................ 0.15 0.76 NA 0.08 0.99 NA XXX 94770 ......... 26 ....... A Exhaled carbon dioxide test ........................ 0.15 0.04 0.04 0.01 0.20 0.20 XXX 94770 ......... TC ...... A Exhaled carbon dioxide test ........................ 0.00 0.72 NA 0.07 0.79 NA XXX 95004 ......... ............ A Percut allergy skin tests .............................. 0.00 0.10 NA 0.01 0.11 NA XXX 95010 ......... ............ A Percut allergy titrate test .............................. 0.15 0.32 0.06 0.00 0.47 0.21 XXX 95015 ......... ............ A Id allergy titrate-drug/bug ............................. 0.15 0.14 0.06 0.01 0.30 0.22 XXX 95024 ......... ............ A Id allergy test, drug/bug ............................... 0.00 0.14 NA 0.01 0.15 NA XXX 95027 ......... ............ A Id allergy titrate-airborne .............................. 0.00 0.14 NA 0.01 0.15 NA XXX 95028 ......... ............ A Id allergy test-delayed type ......................... 0.00 0.23 NA 0.01 0.24 NA XXX 95044 ......... ............ A Allergy patch tests ....................................... 0.00 0.20 NA 0.01 0.21 NA XXX 95052 ......... ............ A Photo patch test ........................................... 0.00 0.25 NA 0.01 0.26 NA XXX 95056 ......... ............ A Photosensitivity tests ................................... 0.00 0.17 NA 0.01 0.18 NA XXX 95060 ......... ............ A Eye allergy tests .......................................... 0.00 0.35 NA 0.02 0.37 NA XXX 95065 ......... ............ A Nose allergy test .......................................... 0.00 0.20 NA 0.01 0.21 NA XXX 95070 ......... ............ A Bronchial allergy tests ................................. 0.00 2.28 NA 0.02 2.30 NA XXX 95071 ......... ............ A Bronchial allergy tests ................................. 0.00 2.91 NA 0.02 2.93 NA XXX 95075 ......... ............ A Ingestion challenge test ............................... 0.95 0.83 0.38 0.03 1.81 1.36 XXX 95078 ......... ............ A Provocative testing ...................................... 0.00 0.25 NA 0.02 0.27 NA XXX 95115 ......... ............ A Immunotherapy, one injection ..................... 0.00 0.39 NA 0.02 0.41 NA 000 95117 ......... ............ A Immunotherapy injections ............................ 0.00 0.50 NA 0.02 0.52 NA 000 95144 ......... ............ A Antigen therapy services ............................. 0.06 0.19 0.02 0.00 0.25 0.08 000 95145 ......... ............ A Antigen therapy services ............................. 0.06 0.32 0.02 0.00 0.38 0.08 000 95146 ......... ............ A Antigen therapy services ............................. 0.06 0.44 0.03 0.00 0.50 0.09 000 95147 ......... ............ A Antigen therapy services ............................. 0.06 0.42 0.02 0.00 0.48 0.08 000 95148 ......... ............ A Antigen therapy services ............................. 0.06 0.58 0.03 0.00 0.64 0.09 000 95149 ......... ............ A Antigen therapy services ............................. 0.06 0.80 0.03 0.00 0.86 0.09 000 95165 ......... ............ A Antigen therapy services ............................. 0.06 0.19 0.02 0.00 0.25 0.08 000 95170 ......... ............ A Antigen therapy services ............................. 0.06 0.13 0.02 0.00 0.19 0.08 000 95180 ......... ............ A Rapid desensitization ................................... 2.01 2.05 0.93 0.05 4.11 2.99 000 95250 ......... ............ A Glucose monitoring, cont ............................. 0.00 4.22 NA 0.01 4.23 NA XXX 95805 ......... ............ A Multiple sleep latency test ........................... 1.88 18.00 NA 0.43 20.31 NA XXX 95805 ......... 26 ....... A Multiple sleep latency test ........................... 1.88 0.66 0.66 0.09 2.63 2.63 XXX 95805 ......... TC ...... A Multiple sleep latency test ........................... 0.00 17.35 NA 0.34 17.69 NA XXX 95806 ......... ............ A Sleep study, unattended .............................. 1.66 3.40 NA 0.39 5.45 NA XXX 95806 ......... 26 ....... A Sleep study, unattended .............................. 1.66 0.53 0.53 0.08 2.27 2.27 XXX 95806 ......... TC ...... A Sleep study, unattended .............................. 0.00 2.87 NA 0.31 3.18 NA XXX 95807 ......... ............ A Sleep study, attended .................................. 1.66 12.10 NA 0.50 14.26 NA XXX 95807 ......... 26 ....... A Sleep study, attended .................................. 1.66 0.53 0.53 0.08 2.27 2.27 XXX 95807 ......... TC ...... A Sleep study, attended .................................. 0.00 11.57 NA 0.42 11.99 NA XXX


## 47687

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

95808 ......... ............ A Polysomnography, 1-3 ................................. 2.65 13.54 NA 0.55 16.74 NA XXX 95808 ......... 26 ....... A Polysomnography, 1-3 ................................. 2.65 0.92 0.92 0.13 3.70 3.70 XXX 95808 ......... TC ...... A Polysomnography, 1-3 ................................. 0.00 12.62 NA 0.42 13.04 NA XXX 95810 ......... ............ A Polysomnography, 4 or more ...................... 3.52 18.02 NA 0.59 22.13 NA XXX 95810 ......... 26 ....... A Polysomnography, 4 or more ...................... 3.52 1.18 1.18 0.17 4.87 4.87 XXX 95810 ......... TC ...... A Polysomnography, 4 or more ...................... 0.00 16.84 NA 0.42 17.26 NA XXX 95811 ......... ............ A Polysomnography w/cpap ............................ 3.79 19.53 NA 0.61 23.93 NA XXX 95811 ......... 26 ....... A Polysomnography w/cpap ............................ 3.79 1.27 1.27 0.18 5.24 5.24 XXX 95811 ......... TC ...... A Polysomnography w/cpap ............................ 0.00 18.26 NA 0.43 18.69 NA XXX 95812 ......... ............ A Eeg, 41-60 minutes ..................................... 1.08 4.03 NA 0.17 5.28 NA XXX 95812 ......... 26 ....... A Eeg, 41-60 minutes ..................................... 1.08 0.45 0.45 0.06 1.59 1.59 XXX 95812 ......... TC ...... A Eeg, 41-60 minutes ..................................... 0.00 3.58 NA 0.11 3.69 NA XXX 95813 ......... ............ A Eeg, over 1 hour .......................................... 1.73 5.04 NA 0.21 6.98 NA XXX 95813 ......... 26 ....... A Eeg, over 1 hour .......................................... 1.73 0.70 0.70 0.10 2.53 2.53 XXX 95813 ......... TC ...... A Eeg, over 1 hour .......................................... 0.00 4.35 NA 0.11 4.46 NA XXX 95816 ......... ............ A Eeg, awake and drowsy .............................. 1.08 4.78 NA 0.16 6.02 NA XXX 95816 ......... 26 ....... A Eeg, awake and drowsy .............................. 1.08 0.46 0.46 0.06 1.60 1.60 XXX 95816 ......... TC ...... A Eeg, awake and drowsy .............................. 0.00 4.32 NA 0.10 4.42 NA XXX 95819 ......... ............ A Eeg, awake and asleep ............................... 1.08 2.76 NA 0.16 4.00 NA XXX 95819 ......... 26 ....... A Eeg, awake and asleep ............................... 1.08 0.46 0.46 0.06 1.60 1.60 XXX 95819 ......... TC ...... A Eeg, awake and asleep ............................... 0.00 2.30 NA 0.10 2.40 NA XXX 95822 ......... ............ A Eeg, coma or sleep only .............................. 1.08 4.63 NA 0.19 5.90 NA XXX 95822 ......... 26 ....... A Eeg, coma or sleep only .............................. 1.08 0.46 0.46 0.06 1.60 1.60 XXX 95822 ......... TC ...... A Eeg, coma or sleep only .............................. 0.00 4.18 NA 0.13 4.31 NA XXX 95824 ......... 26 ....... A Eeg, cerebral death only ............................. 0.74 0.31 0.31 0.04 1.09 1.09 XXX 95827 ......... ............ A Eeg, all night recording ................................ 1.08 2.69 NA 0.20 3.97 NA XXX 95827 ......... 26 ....... A Eeg, all night recording ................................ 1.08 0.41 0.41 0.06 1.55 1.55 XXX 95827 ......... TC ...... A Eeg, all night recording ................................ 0.00 2.29 NA 0.14 2.43 NA XXX 95829 ......... ............ A Surgery electrocorticogram .......................... 6.20 31.16 NA 0.51 37.87 NA XXX 95829 ......... 26 ....... A Surgery electrocorticogram .......................... 6.20 2.31 2.31 0.49 9.00 9.00 XXX 95829 ......... TC ...... A Surgery electrocorticogram .......................... 0.00 28.85 NA 0.02 28.87 NA XXX 95830 ......... ............ A Insert electrodes for EEG ............................ 1.70 3.29 0.73 0.10 5.09 2.53 XXX 95831 ......... ............ A Limb muscle testing, manual ....................... 0.28 0.46 0.13 0.02 0.76 0.43 XXX 95832 ......... ............ A Hand muscle testing, manual ...................... 0.29 0.33 0.12 0.02 0.64 0.43 XXX 95833 ......... ............ A Body muscle testing, manual ...................... 0.47 0.59 0.23 0.02 1.08 0.72 XXX 95834 ......... ............ A Body muscle testing, manual ...................... 0.60 0.64 0.28 0.03 1.27 0.91 XXX 95851 ......... ............ A Range of motion measurements ................. 0.16 0.37 0.08 0.01 0.54 0.25 XXX 95852 ......... ............ A Range of motion measurements ................. 0.11 0.26 0.05 0.01 0.38 0.17 XXX 95857 ......... ............ A Tensilon test ................................................ 0.53 0.60 0.23 0.03 1.16 0.79 XXX 95858 ......... ............ A Tensilon test & myogram ............................. 1.56 1.06 NA 0.12 2.74 NA XXX 95858 ......... 26 ....... A Tensilon test & myogram ............................. 1.56 0.67 0.67 0.08 2.31 2.31 XXX 95858 ......... TC ...... A Tensilon test & myogram ............................. 0.00 0.40 NA 0.04 0.44 NA XXX 95860 ......... ............ A Muscle test, one limb ................................... 0.96 1.43 NA 0.07 2.46 NA XXX 95860 ......... 26 ....... A Muscle test, one limb ................................... 0.96 0.42 0.42 0.05 1.43 1.43 XXX 95860 ......... TC ...... A Muscle test, one limb ................................... 0.00 1.01 NA 0.02 1.03 NA XXX 95861 ......... ............ A Muscle test, 2 limbs ..................................... 1.54 1.41 NA 0.14 3.09 NA XXX 95861 ......... 26 ....... A Muscle test, 2 limbs ..................................... 1.54 0.67 0.67 0.08 2.29 2.29 XXX 95861 ......... TC ...... A Muscle test, 2 limbs ..................................... 0.00 0.73 NA 0.06 0.79 NA XXX 95863 ......... ............ A Muscle test, 3 limbs ..................................... 1.87 1.74 NA 0.15 3.76 NA XXX 95863 ......... 26 ....... A Muscle test, 3 limbs ..................................... 1.87 0.80 0.80 0.09 2.76 2.76 XXX 95863 ......... TC ...... A Muscle test, 3 limbs ..................................... 0.00 0.94 NA 0.06 1.00 NA XXX 95864 ......... ............ A Muscle test, 4 limbs ..................................... 1.99 2.64 NA 0.22 4.85 NA XXX 95864 ......... 26 ....... A Muscle test, 4 limbs ..................................... 1.99 0.87 0.87 0.10 2.96 2.96 XXX 95864 ......... TC ...... A Muscle test, 4 limbs ..................................... 0.00 1.78 NA 0.12 1.90 NA XXX
95867 ......... ............ A Muscle test cran nerv unilat ........................ 0.79 0.92 NA 0.08 1.79 NA XXX 95867 ......... 26 ....... A Muscle test cran nerv unilat ........................ 0.79 0.35 0.35 0.04 1.18 1.18 XXX 95867 ......... TC ...... A Muscle test cran nerv unilat ........................ 0.00 0.58 NA 0.04 0.62 NA XXX
95868 ......... ............ A Muscle test cran nerve bilat ........................ 1.18 1.21 NA 0.11 2.50 NA XXX 95868 ......... 26 ....... A Muscle test cran nerve bilat ........................ 1.18 0.51 0.51 0.06 1.75 1.75 XXX 95868 ......... TC ...... A Muscle test cran nerve bilat ........................ 0.00 0.69 NA 0.05 0.74 NA XXX 95869 ......... ............ A Muscle test, thor paraspinal ........................ 0.37 0.37 NA 0.04 0.78 NA XXX 95869 ......... 26 ....... A Muscle test, thor paraspinal ........................ 0.37 0.16 0.16 0.02 0.55 0.55 XXX 95869 ......... TC ...... A Muscle test, thor paraspinal ........................ 0.00 0.21 NA 0.02 0.23 NA XXX 95870 ......... ............ A Muscle test, nonparaspinal .......................... 0.37 0.37 NA 0.04 0.78 NA XXX 95870 ......... 26 ....... A Muscle test, nonparaspinal .......................... 0.37 0.16 0.16 0.02 0.55 0.55 XXX 95870 ......... TC ...... A Muscle test, nonparaspinal .......................... 0.00 0.21 NA 0.02 0.23 NA XXX 95872 ......... ............ A Muscle test, one fiber .................................. 1.50 1.23 NA 0.14 2.87 NA XXX 95872 ......... 26 ....... A Muscle test, one fiber .................................. 1.50 0.63 0.63 0.09 2.22 2.22 XXX 95872 ......... TC ...... A Muscle test, one fiber .................................. 0.00 0.60 NA 0.05 0.65 NA XXX
95875 ......... ............ A Limb exercise test ........................................ 1.10 1.45 NA 0.14 2.69 NA XXX
95875 ......... 26 ....... A Limb exercise test ........................................ 1.10 0.47 0.47 0.08 1.65 1.65 XXX 95875 ......... TC ...... A Limb exercise test ........................................ 0.00 0.98 NA 0.06 1.04 NA XXX
95900 ......... ............ A Motor nerve conduction test ........................ 0.42 1.26 NA 0.04 1.72 NA XXX
95900 ......... 26 ....... A Motor nerve conduction test ........................ 0.42 0.18 0.18 0.02 0.62 0.62 XXX 95900 ......... TC ...... A Motor nerve conduction test ........................ 0.00 1.08 NA 0.02 1.10 NA XXX


## 47688

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

95903 ......... ............ A Motor nerve conduction test ........................ 0.60 1.20 NA 0.05 1.85 NA XXX 95903 ......... 26 ....... A Motor nerve conduction test ........................ 0.60 0.26 0.26 0.03 0.89 0.89 XXX 95903 ......... TC ...... A Motor nerve conduction test ........................ 0.00 0.94 NA 0.02 0.96 NA XXX 95904 ......... ............ A Sense nerve conduction test ....................... 0.34 1.09 NA 0.04 1.47 NA XXX 95904 ......... 26 ....... A Sense nerve conduction test ....................... 0.34 0.15 0.15 0.02 0.51 0.51 XXX 95904 ......... TC ...... A Sense nerve conduction test ....................... 0.00 0.95 NA 0.02 0.97 NA XXX 95920 ......... ............ A Intraop nerve test add-on ............................ 2.11 2.23 NA 0.24 4.58 NA ZZZ 95920 ......... 26 ....... A Intraop nerve test add-on ............................ 2.11 0.93 0.93 0.17 3.21 3.21 ZZZ 95920 ......... TC ...... A Intraop nerve test add-on ............................ 0.00 1.30 NA 0.07 1.37 NA ZZZ 95921 ......... ............ A Autonomic nerv function test ....................... 0.90 0.70 NA 0.06 1.66 NA XXX 95921 ......... 26 ....... A Autonomic nerv function test ....................... 0.90 0.33 0.33 0.04 1.27 1.27 XXX 95921 ......... TC ...... A Autonomic nerv function test ....................... 0.00 0.38 NA 0.02 0.40 NA XXX 95922 ......... ............ A Autonomic nerv function test ....................... 0.96 0.78 NA 0.07 1.81 NA XXX 95922 ......... 26 ....... A Autonomic nerv function test ....................... 0.96 0.40 0.40 0.05 1.41 1.41 XXX 95922 ......... TC ...... A Autonomic nerv function test ....................... 0.00 0.38 NA 0.02 0.40 NA XXX 95923 ......... ............ A Autonomic nerv function test ....................... 0.90 1.95 NA 0.07 2.92 NA XXX 95923 ......... 26 ....... A Autonomic nerv function test ....................... 0.90 0.38 0.38 0.05 1.33 1.33 XXX 95923 ......... TC ...... A Autonomic nerv function test ....................... 0.00 1.57 NA 0.02 1.59 NA XXX 95925 ......... ............ A Somatosensory testing ................................ 0.54 1.13 NA 0.09 1.76 NA XXX 95925 ......... 26 ....... A Somatosensory testing ................................ 0.54 0.22 0.22 0.03 0.79 0.79 XXX 95925 ......... TC ...... A Somatosensory testing ................................ 0.00 0.91 NA 0.06 0.97 NA XXX 95926 ......... ............ A Somatosensory testing ................................ 0.54 1.14 NA 0.09 1.77 NA XXX 95926 ......... 26 ....... A Somatosensory testing ................................ 0.54 0.23 0.23 0.03 0.80 0.80 XXX 95926 ......... TC ...... A Somatosensory testing ................................ 0.00 0.91 NA 0.06 0.97 NA XXX 95927 ......... ............ A Somatosensory testing ................................ 0.54 1.16 NA 0.09 1.79 NA XXX 95927 ......... 26 ....... A Somatosensory testing ................................ 0.54 0.25 0.25 0.03 0.82 0.82 XXX 95927 ......... TC ...... A Somatosensory testing ................................ 0.00 0.91 NA 0.06 0.97 NA XXX 95930 ......... ............ A Visual evoked potential test ......................... 0.35 2.25 NA 0.03 2.63 NA XXX 95930 ......... 26 ....... A Visual evoked potential test ......................... 0.35 0.15 0.15 0.02 0.52 0.52 XXX 95930 ......... TC ...... A Visual evoked potential test ......................... 0.00 2.10 NA 0.01 2.11 NA XXX 95933 ......... ............ A Blink reflex test ............................................ 0.59 1.02 NA 0.10 1.71 NA XXX 95933 ......... 26 ....... A Blink reflex test ............................................ 0.59 0.24 0.24 0.04 0.87 0.87 XXX 95933 ......... TC ...... A Blink reflex test ............................................ 0.00 0.78 NA 0.06 0.84 NA XXX 95934 ......... ............ A H-reflex test ................................................. 0.51 0.43 NA 0.04 0.98 NA XXX 95934 ......... 26 ....... A H-reflex test ................................................. 0.51 0.22 0.22 0.02 0.75 0.75 XXX 95934 ......... TC ...... A H-reflex test ................................................. 0.00 0.21 NA 0.02 0.23 NA XXX 95936 ......... ............ A H-reflex test ................................................. 0.55 0.45 NA 0.05 1.05 NA XXX 95936 ......... 26 ....... A H-reflex test ................................................. 0.55 0.24 0.24 0.03 0.82 0.82 XXX 95936 ......... TC ...... A H-reflex test ................................................. 0.00 0.21 NA 0.02 0.23 NA XXX 95937 ......... ............ A Neuromuscular junction test ........................ 0.65 0.60 NA 0.08 1.33 NA XXX 95937 ......... 26 ....... A Neuromuscular junction test ........................ 0.65 0.27 0.27 0.06 0.98 0.98 XXX 95937 ......... TC ...... A Neuromuscular junction test ........................ 0.00 0.34 NA 0.02 0.36 NA XXX 95950 ......... ............ A Ambulatory eeg monitoring .......................... 1.51 4.98 NA 0.51 7.00 NA XXX 95950 ......... 26 ....... A Ambulatory eeg monitoring .......................... 1.51 0.63 0.63 0.08 2.22 2.22 XXX 95950 ......... TC ...... A Ambulatory eeg monitoring .......................... 0.00 4.35 NA 0.43 4.78 NA XXX 95951 ......... 26 ....... A EEG monitoring/videorecord ........................ 5.99 2.54 2.54 0.34 8.87 8.87 XXX 95953 ......... ............ A EEG monitoring/computer ........................... 3.08 7.61 NA 0.61 11.30 NA XXX 95953 ......... 26 ....... A EEG monitoring/computer ........................... 3.08 1.29 1.29 0.18 4.55 4.55 XXX 95953 ......... TC ...... A EEG monitoring/computer ........................... 0.00 6.32 NA 0.43 6.75 NA XXX 95954 ......... ............ A EEG monitoring/giving drugs ....................... 2.45 4.28 NA 0.19 6.92 NA XXX 95954 ......... 26 ....... A EEG monitoring/giving drugs ....................... 2.45 1.04 1.04 0.13 3.62 3.62 XXX 95954 ......... TC ...... A EEG monitoring/giving drugs ....................... 0.00 3.24 NA 0.06 3.30 NA XXX 95955 ......... ............ A EEG during surgery ..................................... 1.01 2.32 NA 0.23 3.56 NA XXX 95955 ......... 26 ....... A EEG during surgery ..................................... 1.01 0.36 0.36 0.06 1.43 1.43 XXX 95955 ......... TC ...... A EEG during surgery ..................................... 0.00 1.96 NA 0.17 2.13 NA XXX 95956 ......... ............ A Eeg monitoring, cable/radio ......................... 3.08 15.93 NA 0.60 19.61 NA XXX 95956 ......... 26 ....... A Eeg monitoring, cable/radio ......................... 3.08 1.30 1.30 0.17 4.55 4.55 XXX 95956 ......... TC ...... A Eeg monitoring, cable/radio ......................... 0.00 14.63 NA 0.43 15.06 NA XXX 95957 ......... ............ A EEG digital analysis ..................................... 1.98 2.55 NA 0.23 4.76 NA XXX 95957 ......... 26 ....... A EEG digital analysis ..................................... 1.98 0.85 0.85 0.11 2.94 2.94 XXX 95957 ......... TC ...... A EEG digital analysis ..................................... 0.00 1.70 NA 0.12 1.82 NA XXX 95958 ......... ............ A EEG monitoring/function test ....................... 4.24 3.47 NA 0.39 8.10 NA XXX 95958 ......... 26 ....... A EEG monitoring/function test ....................... 4.24 1.73 1.73 0.26 6.23 6.23 XXX 95958 ......... TC ...... A EEG monitoring/function test ....................... 0.00 1.74 NA 0.13 1.87 NA XXX 95961 ......... ............ A Electrode stimulation, brain ......................... 2.97 2.62 NA 0.53 6.12 NA XXX 95961 ......... 26 ....... A Electrode stimulation, brain ......................... 2.97 1.32 1.32 0.46 4.75 4.75 XXX 95961 ......... TC ...... A Electrode stimulation, brain ......................... 0.00 1.30 NA 0.07 1.37 NA XXX 95962 ......... ............ A Electrode stim, brain add-on ....................... 3.21 2.69 NA 0.38 6.28 NA ZZZ 95962 ......... 26 ....... A Electrode stim, brain add-on ....................... 3.21 1.39 1.39 0.31 4.91 4.91 ZZZ 95962 ......... TC ...... A Electrode stim, brain add-on ....................... 0.00 1.30 NA 0.07 1.37 NA ZZZ 95965 ......... 26 ....... A Meg, spontaneous ....................................... 7.99 3.41 3.41 0.41 11.81 11.81 XXX 95966 ......... 26 ....... A Meg, evoked, single ..................................... 3.99 1.71 1.71 0.21 5.91 5.91 XXX 95967 ......... 26 ....... A Meg, evoked, each add-l ............................. 3.49 1.18 1.18 0.16 4.83 4.83 ZZZ 95970 ......... ............ A Analyze neurostim, no prog ......................... 0.45 0.86 0.14 0.03 1.34 0.62 XXX 95971 ......... ............ A Analyze neurostim, simple ........................... 0.78 0.68 0.22 0.07 1.53 1.07 XXX


## 47689

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

95972 ......... ............ A Analyze neurostim, complex ........................ 1.50 1.21 0.49 0.14 2.85 2.13 XXX 95973 ......... ............ A Analyze neurostim, complex ........................ 0.92 0.62 0.34 0.07 1.61 1.33 ZZZ 95974 ......... ............ A Cranial neurostim, complex ......................... 3.00 1.70 1.29 0.18 4.88 4.47 XXX 95975 ......... ............ A Cranial neurostim, complex ......................... 1.70 0.89 0.73 0.11 2.70 2.54 ZZZ 95990 ......... ............ A Spin/brain pump refil & main ....................... 0.00 1.50 NA 0.06 1.56 NA XXX 95991 ......... ............ A Spin/brain pump refil & main ....................... 0.77 1.53 0.17 0.06 2.36 1.00 XXX 96000 ......... ............ A Motion analysis, video/3d ............................ 1.80 NA 0.53 0.05 NA 2.38 XXX 96001 ......... ............ A Motion test w/ft press meas ........................ 2.15 NA 0.66 0.06 NA 2.87 XXX 96002 ......... ............ A Dynamic surface emg .................................. 0.41 NA 0.15 0.01 NA 0.57 XXX 96003 ......... ............ A Dynamic fine wire emg ................................ 0.37 NA 0.12 0.04 NA 0.53 XXX 96004 ......... ............ A Phys review of motion tests ........................ 2.14 0.94 0.94 0.07 3.15 3.15 XXX 96100 ......... ............ A Psychological testing ................................... 0.00 1.76 NA 0.18 1.94 NA XXX 96105 ......... ............ A Assessment of aphasia ............................... 0.00 1.76 NA 0.18 1.94 NA XXX 96110 ......... ............ A Developmental test, lim ............................... 0.00 0.18 NA 0.18 0.36 NA XXX 96111 ......... ............ A Developmental test, extend ......................... 2.60 1.05 NA 0.18 3.83 NA XXX 96115 ......... ............ A Neurobehavior status exam ......................... 0.00 1.76 NA 0.18 1.94 NA XXX 96117 ......... ............ A Neuropsych test battery ............................... 0.00 1.76 NA 0.18 1.94 NA XXX 96150 ......... ............ A Assess lth/behave, init ................................. 0.50 0.18 0.18 0.01 0.69 0.69 XXX 96151 ......... ............ A Assess hlth/behave, subseq ........................ 0.48 0.18 0.17 0.01 0.67 0.66 XXX 96152 ......... ............ A Intervene hlth/behave, indiv ......................... 0.46 0.17 0.16 0.01 0.64 0.63 XXX 96153 ......... ............ A Intervene hlth/behave, group ....................... 0.10 0.04 0.03 0.00 0.14 0.13 XXX 96154 ......... ............ A Interv hlth/behav, fam w/pt .......................... 0.45 0.17 0.16 0.01 0.63 0.62 XXX 96400 ......... ............ A Chemotherapy, sc/im ................................... 0.17 1.13 NA 0.01 1.31 NA XXX
96405 ......... ............ A Intralesional chemo admin ........................... 0.52 2.33 0.24 0.03 2.88 0.79 000 96406 ......... ............ A Intralesional chemo admin ........................... 0.80 3.11 0.29 0.03 3.94 1.12 000 96408 ......... ............ A Chemotherapy, push technique ................... 0.17 2.92 NA 0.06 3.15 NA XXX 96410 ......... ............ A Chemotherapy,infusion method ................... 0.17 4.15 NA 0.08 4.40 NA XXX 96412 ......... ............ A Chemo, infuse method add-on .................... 0.17 0.73 NA 0.07 0.97 NA ZZZ 96414 ......... ............ A Chemo, infuse method add-on .................... 0.17 5.23 NA 0.08 5.48 NA XXX 96420 ......... ............ A Chemotherapy, push technique ................... 0.17 2.82 NA 0.08 3.07 NA XXX 96422 ......... ............ A Chemotherapy,infusion method ................... 0.17 5.18 NA 0.08 5.43 NA XXX 96423 ......... ............ A Chemo, infuse method add-on .................... 0.17 2.00 NA 0.02 2.19 NA ZZZ 96425 ......... ............ A Chemotherapy,infusion method ................... 0.17 4.74 NA 0.08 4.99 NA XXX 96440 ......... ............ A Chemotherapy, intracavitary ........................ 2.37 8.44 1.24 0.16 10.97 3.77 000 96445 ......... ............ A Chemotherapy, intracavitary ........................ 2.20 8.56 1.19 0.12 10.88 3.51 000 96450 ......... ............ A Chemotherapy, into CNS ............................. 1.89 7.37 1.09 0.09 9.35 3.07 000 96520 ......... ............ A Port pump refill & main ................................ 0.17 3.94 NA 0.06 4.17 NA XXX 96530 ......... ............ A Syst pump refill & main ............................... 0.17 2.86 NA 0.06 3.09 NA XXX 96542 ......... ............ A Chemotherapy injection ............................... 1.42 4.45 0.65 0.07 5.94 2.14 XXX 96567 ......... ............ A Photodynamic tx, skin .................................. 0.00 0.94 NA 0.04 0.98 NA XXX 96570 ......... ............ A Photodynamic tx, 30 min ............................. 1.10 NA 0.37 0.11 NA 1.58 ZZZ 96571 ......... ............ A Photodynamic tx, addl 15 min ..................... 0.55 NA 0.19 0.03 NA 0.77 ZZZ 96900 ......... ............ A Ultraviolet light therapy ................................ 0.00 0.44 NA 0.02 0.46 NA XXX 96902 ......... ............ B Trichogram ................................................... 0.41 0.18 0.15 0.01 0.60 0.57 XXX 96910 ......... ............ A Photochemotherapy with UV-B ................... 0.00 0.99 NA 0.04 1.03 NA XXX 96912 ......... ............ A Photochemotherapy with UV-A ................... 0.00 1.26 NA 0.05 1.31 NA XXX 96913 ......... ............ A Photochemotherapy, UV-A or B .................. 0.00 1.68 NA 0.10 1.78 NA XXX 96920 ......... ............ A Laser tx, skin < 250 sq cm .......................... 1.15 2.52 0.56 0.11 3.78 1.82 000 96921 ......... ............ A Laser tx, skin 250-500 sq cm ...................... 1.17 2.60 0.57 0.11 3.88 1.85 000 96922 ......... ............ A Laser tx, skin > 500 sq cm .......................... 2.10 3.48 0.62 0.19 5.77 2.91 000 97001 ......... ............ A Pt evaluation ................................................ 1.20 0.75 0.45 0.06 2.01 1.71 XXX 97002 ......... ............ A Pt re-evaluation ............................................ 0.60 0.45 0.23 0.02 1.07 0.85 XXX 97003 ......... ............ A Ot evaluation ................................................ 1.20 0.88 0.40 0.07 2.15 1.67 XXX 97004 ......... ............ A Ot re-evaluation ........................................... 0.60 0.67 0.19 0.02 1.29 0.81 XXX 97010 ......... ............ B Hot or cold packs therapy ........................... 0.06 0.05 NA 0.01 0.12 NA XXX 97012 ......... ............ A Mechanical traction therapy ......................... 0.25 0.13 NA 0.01 0.39 NA XXX 97016 ......... ............ A Vasopneumatic device therapy ................... 0.18 0.18 NA 0.01 0.37 NA XXX 97018 ......... ............ A Paraffin bath therapy ................................... 0.06 0.10 NA 0.00 0.16 NA XXX 97020 ......... ............ A Microwave therapy ....................................... 0.06 0.05 NA 0.00 0.11 NA XXX 97022 ......... ............ A Whirlpool therapy ......................................... 0.17 0.21 NA 0.01 0.39 NA XXX 97024 ......... ............ A Diathermy treatment .................................... 0.06 0.07 NA 0.00 0.13 NA XXX 97026 ......... ............ A Infrared therapy ........................................... 0.06 0.06 NA 0.00 0.12 NA XXX 97028 ......... ............ A Ultraviolet therapy ........................................ 0.08 0.07 NA 0.00 0.15 NA XXX
97032 ......... ............ A Electrical stimulation .................................... 0.25 0.16 NA 0.01 0.42 NA XXX 97033 ......... ............ A Electric current therapy ................................ 0.26 0.27 NA 0.01 0.54 NA XXX 97034 ......... ............ A Contrast bath therapy .................................. 0.21 0.15 NA 0.01 0.37 NA XXX 97035 ......... ............ A Ultrasound therapy ...................................... 0.21 0.10 NA 0.01 0.32 NA XXX 97036 ......... ............ A Hydrotherapy ............................................... 0.28 0.32 NA 0.01 0.61 NA XXX 97039 ......... ............ A Physical therapy treatment .......................... 0.20 0.10 NA 0.01 0.31 NA XXX 97110 ......... ............ A Therapeutic exercises .................................. 0.45 0.27 NA 0.02 0.74 NA XXX
97112 ......... ............ A Neuromuscular reeducation ......................... 0.45 0.31 NA 0.02 0.78 NA XXX 97113 ......... ............ A Aquatic therapy/exercises ............................ 0.44 0.39 NA 0.02 0.85 NA XXX 97116 ......... ............ A Gait training therapy .................................... 0.40 0.24 NA 0.01 0.65 NA XXX 97124 ......... ............ A Massage therapy ......................................... 0.35 0.23 NA 0.01 0.59 NA XXX 97139 ......... ............ A Physical medicine procedure ....................... 0.21 0.20 NA 0.01 0.42 NA XXX


## 47690

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

97140 ......... ............ A Manual therapy ............................................ 0.43 0.25 NA 0.02 0.70 NA XXX 97150 ......... ............ A Group therapeutic procedures ..................... 0.27 0.18 NA 0.02 0.47 NA XXX 97504 ......... ............ A Orthotic training ........................................... 0.45 0.33 NA 0.03 0.81 NA XXX 97520 ......... ............ A Prosthetic training ........................................ 0.45 0.27 NA 0.02 0.74 NA XXX 97530 ......... ............ A Therapeutic activities ................................... 0.44 0.32 NA 0.02 0.78 NA XXX 97532 ......... ............ A Cognitive skills development ....................... 0.44 0.20 NA 0.01 0.65 NA XXX 97533 ......... ............ A Sensory integration ...................................... 0.44 0.24 NA 0.01 0.69 NA XXX 97535 ......... ............ A Self care mngment training ......................... 0.45 0.33 NA 0.01 0.79 NA XXX 97537 ......... ............ A Community/work reintegration ..................... 0.45 0.26 NA 0.01 0.72 NA XXX 97542 ......... ............ A Wheelchair mngment training ...................... 0.45 0.28 NA 0.01 0.74 NA XXX 97601 ......... ............ A Wound(s) care, selective ............................. 0.50 0.49 NA 0.03 1.02 NA XXX
97703 ......... ............ A Prosthetic checkout ..................................... 0.25 0.41 NA 0.02 0.68 NA XXX 97750 ......... ............ A Physical performance test ........................... 0.45 0.32 NA 0.02 0.79 NA XXX 97755 ......... ............ A Assistive technology assess ........................ 0.62 0.28 NA 0.02 0.92 NA XXX 97802 ......... ............ A Medical nutrition, indiv, in ............................ 0.00 0.47 NA 0.01 0.48 NA XXX 97803 ......... ............ A Med nutrition, indiv, subseq ......................... 0.00 0.47 NA 0.01 0.48 NA XXX 97804 ......... ............ A Medical nutrition, group ............................... 0.00 0.18 NA 0.01 0.19 NA XXX 98925 ......... ............ A Osteopathic manipulation ............................ 0.45 0.32 0.14 0.02 0.79 0.61 000 98926 ......... ............ A Osteopathic manipulation ............................ 0.65 0.42 0.25 0.03 1.10 0.93 000 98927 ......... ............ A Osteopathic manipulation ............................ 0.87 0.51 0.29 0.03 1.41 1.19 000 98928 ......... ............ A Osteopathic manipulation ............................ 1.03 0.60 0.34 0.04 1.67 1.41 000 98929 ......... ............ A Osteopathic manipulation ............................ 1.19 0.68 0.37 0.05 1.92 1.61 000 98940 ......... ............ A Chiropractic manipulation ............................ 0.45 0.23 0.12 0.01 0.69 0.58 000 98941 ......... ............ A Chiropractic manipulation ............................ 0.65 0.30 0.17 0.02 0.97 0.84 000 98942 ......... ............ A Chiropractic manipulation ............................ 0.87 0.36 0.23 0.02 1.25 1.12 000 99141 ......... ............ B Sedation, iv/im or inhalant ........................... 0.80 1.89 0.38 0.05 2.74 1.23 XXX 99142 ......... ............ B Sedation, oral/rectal/nasal ........................... 0.60 0.96 0.31 0.04 1.60 0.95 XXX 99170 ......... ............ A Anogenital exam, child ................................ 1.75 1.80 0.55 0.10 3.65 2.40 000 99175 ......... ............ A Induction of vomiting .................................... 0.00 1.39 NA 0.10 1.49 NA XXX 99183 ......... ............ A Hyperbaric oxygen therapy .......................... 2.34 4.07 0.72 0.16 6.57 3.22 XXX 99185 ......... ............ A Regional hypothermia .................................. 0.00 0.64 NA 0.04 0.68 NA XXX 99186 ......... ............ A Total body hypothermia ............................... 0.00 1.78 NA 0.45 2.23 NA XXX 99195 ......... ............ A Phlebotomy .................................................. 0.00 0.44 NA 0.02 0.46 NA XXX 99201 ......... ............ A Office/outpatient visit, new ........................... 0.45 0.50 0.15 0.03 0.98 0.63 XXX 99202 ......... ............ A Office/outpatient visit, new ........................... 0.88 0.79 0.31 0.05 1.72 1.24 XXX 99203 ......... ............ A Office/outpatient visit, new ........................... 1.34 1.14 0.48 0.09 2.57 1.91 XXX 99204 ......... ............ A Office/outpatient visit, new ........................... 2.00 1.51 0.71 0.12 3.63 2.83 XXX 99205 ......... ............ A Office/outpatient visit, new ........................... 2.67 1.79 0.94 0.15 4.61 3.76 XXX 99211 ......... ............ A Office/outpatient visit, est ............................ 0.17 0.40 0.06 0.01 0.58 0.24 XXX 99212 ......... ............ A Office/outpatient visit, est ............................ 0.45 0.54 0.16 0.03 1.02 0.64 XXX 99213 ......... ............ A Office/outpatient visit, est ............................ 0.67 0.70 0.23 0.03 1.40 0.93 XXX 99214 ......... ............ A Office/outpatient visit, est ............................ 1.10 1.04 0.40 0.05 2.19 1.55 XXX 99215 ......... ............ A Office/outpatient visit, est ............................ 1.77 1.34 0.65 0.09 3.20 2.51 XXX 99217 ......... ............ A Observation care discharge ......................... 1.28 NA 0.53 0.06 NA 1.87 XXX 99218 ......... ............ A Observation care ......................................... 1.28 NA 0.44 0.06 NA 1.78 XXX 99219 ......... ............ A Observation care ......................................... 2.14 NA 0.72 0.10 NA 2.96 XXX 99220 ......... ............ A Observation care ......................................... 2.99 NA 1.02 0.14 NA 4.15 XXX 99221 ......... ............ A Initial hospital care ....................................... 1.28 NA 0.45 0.07 NA 1.80 XXX 99222 ......... ............ A Initial hospital care ....................................... 2.14 NA 0.74 0.10 NA 2.98 XXX 99223 ......... ............ A Initial hospital care ....................................... 2.99 NA 1.03 0.13 NA 4.15 XXX 99231 ......... ............ A Subsequent hospital care ............................ 0.64 NA 0.23 0.03 NA 0.90 XXX 99232 ......... ............ A Subsequent hospital care ............................ 1.06 NA 0.37 0.05 NA 1.48 XXX 99233 ......... ............ A Subsequent hospital care ............................ 1.51 NA 0.52 0.07 NA 2.10 XXX 99234 ......... ............ A Observ/hosp same date .............................. 2.56 NA 0.88 0.13 NA 3.57 XXX 99235 ......... ............ A Observ/hosp same date .............................. 3.41 NA 1.15 0.16 NA 4.72 XXX 99236 ......... ............ A Observ/hosp same date .............................. 4.26 NA 1.44 0.20 NA 5.90 XXX 99238 ......... ............ A Hospital discharge day ................................ 1.28 NA 0.54 0.05 NA 1.87 XXX 99239 ......... ............ A Hospital discharge day ................................ 1.75 NA 0.60 0.07 NA 2.42 XXX 99241 ......... ............ A Office consultation ....................................... 0.64 0.64 0.22 0.05 1.33 0.91 XXX 99242 ......... ............ A Office consultation ....................................... 1.29 1.05 0.46 0.10 2.44 1.85 XXX 99243 ......... ............ A Office consultation ....................................... 1.72 1.39 0.63 0.13 3.24 2.48 XXX 99244 ......... ............ A Office consultation ....................................... 2.58 1.82 0.92 0.16 4.56 3.66 XXX 99245 ......... ............ A Office consultation ....................................... 3.42 2.29 1.24 0.21 5.92 4.87 XXX 99251 ......... ............ A Initial inpatient consult ................................. 0.66 NA 0.24 0.05 NA 0.95 XXX 99252 ......... ............ A Initial inpatient consult ................................. 1.32 NA 0.50 0.10 NA 1.92 XXX 99253 ......... ............ A Initial inpatient consult ................................. 1.82 NA 0.68 0.11 NA 2.61 XXX 99254 ......... ............ A Initial inpatient consult ................................. 2.64 NA 0.98 0.13 NA 3.75 XXX 99255 ......... ............ A Initial inpatient consult ................................. 3.64 NA 1.34 0.18 NA 5.16 XXX 99261 ......... ............ A Follow-up inpatient consult .......................... 0.42 NA 0.15 0.02 NA 0.59 XXX 99262 ......... ............ A Follow-up inpatient consult .......................... 0.85 NA 0.31 0.04 NA 1.20 XXX 99263 ......... ............ A Follow-up inpatient consult .......................... 1.27 NA 0.45 0.06 NA 1.78 XXX 99271 ......... ............ A Confirmatory consultation ............................ 0.45 0.56 0.16 0.03 1.04 0.64 XXX 99272 ......... ............ A Confirmatory consultation ............................ 0.84 0.83 0.31 0.06 1.73 1.21 XXX 99273 ......... ............ A Confirmatory consultation ............................ 1.19 1.12 0.45 0.10 2.41 1.74 XXX 99274 ......... ............ A Confirmatory consultation ............................ 1.73 1.38 0.64 0.12 3.23 2.49 XXX


## 47691

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

99275 ......... ............ A Confirmatory consultation ............................ 2.31 1.66 0.84 0.15 4.12 3.30 XXX 99281 ......... ............ A Emergency dept visit ................................... 0.33 NA 0.09 0.02 NA 0.44 XXX 99282 ......... ............ A Emergency dept visit ................................... 0.55 NA 0.14 0.04 NA 0.73 XXX 99283 ......... ............ A Emergency dept visit ................................... 1.24 NA 0.31 0.09 NA 1.64 XXX 99284 ......... ............ A Emergency dept visit ................................... 1.95 NA 0.47 0.14 NA 2.56 XXX 99285 ......... ............ A Emergency dept visit ................................... 3.06 NA 0.72 0.23 NA 4.01 XXX 99289 ......... ............ A Ped crit care transport ................................. 4.79 NA 1.45 0.17 NA 6.41 XXX 99290 ......... ............ A Ped crit care transport addl ......................... 2.40 NA 0.81 0.08 NA 3.29 ZZZ 99291 ......... ............ A Critical care, first hour ................................. 3.99 2.59 1.28 0.21 6.79 5.48 XXX 99292 ......... ............ A Critical care, add-l 30 min ........................... 2.00 0.91 0.63 0.11 3.02 2.74 ZZZ 99293 ......... ............ A Ped critical care, initial ................................. 15.98 NA 4.74 0.21 NA 20.93 XXX 99294 ......... ............ A Ped critical care, subseq ............................. 7.99 NA 2.39 0.21 NA 10.59 XXX 99295 ......... ............ A Neonate crit care, initial ............................... 18.46 NA 5.35 1.00 NA 24.81 XXX 99296 ......... ............ A Neonate critical care subseq ....................... 7.99 NA 2.53 0.34 NA 10.86 XXX 99298 ......... ............ A Ic for lbw infant < 1500 gm ......................... 2.75 NA 0.93 0.14 NA 3.82 XXX 99299 ......... ............ A Ic, lbw infant 1500-2500 gm ........................ 2.50 NA 0.85 0.12 NA 3.47 XXX 99301 ......... ............ A Nursing facility care ..................................... 1.20 0.50 0.50 0.05 1.75 1.75 XXX 99302 ......... ............ A Nursing facility care ..................................... 1.61 0.64 0.64 0.07 2.32 2.32 XXX 99303 ......... ............ A Nursing facility care ..................................... 2.01 0.76 0.76 0.09 2.86 2.86 XXX 99311 ......... ............ A Nursing fac care, subseq ............................. 0.60 0.28 0.28 0.03 0.91 0.91 XXX 99312 ......... ............ A Nursing fac care, subseq ............................. 1.00 0.45 0.45 0.05 1.50 1.50 XXX 99313 ......... ............ A Nursing fac care, subseq ............................. 1.42 0.62 0.62 0.07 2.11 2.11 XXX 99315 ......... ............ A Nursing fac discharge day ........................... 1.13 0.46 0.46 0.05 1.64 1.64 XXX 99316 ......... ............ A Nursing fac discharge day ........................... 1.50 0.59 0.59 0.07 2.16 2.16 XXX 99321 ......... ............ A Rest home visit, new patient ....................... 0.71 0.34 NA 0.04 1.09 NA XXX 99322 ......... ............ A Rest home visit, new patient ....................... 1.01 0.46 NA 0.06 1.53 NA XXX 99323 ......... ............ A Rest home visit, new patient ....................... 1.28 0.55 NA 0.06 1.89 NA XXX 99331 ......... ............ A Rest home visit, est pat ............................... 0.60 0.32 NA 0.03 0.95 NA XXX 99332 ......... ............ A Rest home visit, est pat ............................... 0.80 0.39 NA 0.04 1.23 NA XXX 99333 ......... ............ A Rest home visit, est pat ............................... 1.00 0.46 NA 0.05 1.51 NA XXX 99341 ......... ............ A Home visit, new patient ............................... 1.01 0.48 NA 0.06 1.55 NA XXX 99342 ......... ............ A Home visit, new patient ............................... 1.52 0.68 NA 0.09 2.29 NA XXX 99343 ......... ............ A Home visit, new patient ............................... 2.27 0.94 NA 0.12 3.33 NA XXX 99344 ......... ............ A Home visit, new patient ............................... 3.03 1.18 NA 0.15 4.36 NA XXX 99345 ......... ............ A Home visit, new patient ............................... 3.78 1.43 NA 0.18 5.39 NA XXX 99347 ......... ............ A Home visit, est patient ................................. 0.76 0.40 NA 0.04 1.20 NA XXX 99348 ......... ............ A Home visit, est patient ................................. 1.26 0.58 NA 0.06 1.90 NA XXX 99349 ......... ............ A Home visit, est patient ................................. 2.02 0.84 NA 0.10 2.96 NA XXX 99350 ......... ............ A Home visit, est patient ................................. 3.03 1.18 NA 0.15 4.36 NA XXX 99354 ......... ............ A Prolonged service, office ............................. 1.77 0.77 0.65 0.08 2.62 2.50 ZZZ 99355 ......... ............ A Prolonged service, office ............................. 1.77 0.75 0.62 0.08 2.60 2.47 ZZZ 99356 ......... ............ A Prolonged service, inpatient ........................ 1.71 NA 0.62 0.08 NA 2.41 ZZZ 99357 ......... ............ A Prolonged service, inpatient ........................ 1.71 NA 0.63 0.08 NA 2.42 ZZZ 99374 ......... ............ B Home health care supervision ..................... 1.10 0.70 0.42 0.05 1.85 1.57 XXX 99377 ......... ............ B Hospice care supervision ............................ 1.10 0.70 0.42 0.05 1.85 1.57 XXX 99379 ......... ............ B Nursing fac care supervision ....................... 1.10 0.70 0.42 0.04 1.84 1.56 XXX 99380 ......... ............ B Nursing fac care supervision ....................... 1.73 1.00 0.65 0.06 2.79 2.44 XXX 99431 ......... ............ A Initial care, normal newborn ........................ 1.17 NA 0.38 0.04 NA 1.59 XXX 99432 ......... ............ A Newborn care, not in hosp .......................... 1.26 0.93 0.40 0.05 2.24 1.71 XXX 99433 ......... ............ A Normal newborn care/hospital ..................... 0.62 NA 0.20 0.03 NA 0.85 XXX 99435 ......... ............ A Newborn discharge day hosp ...................... 1.50 NA 0.59 0.06 NA 2.15 XXX 99436 ......... ............ A Attendance, birth .......................................... 1.50 NA 0.47 0.11 NA 2.08 XXX 99440 ......... ............ A Newborn resuscitation ................................. 2.93 NA 0.93 0.13 NA 3.99 XXX G0030 ........ 26 ....... A PET imaging prev PET single ..................... 1.50 0.58 0.58 0.05 2.13 2.13 XXX G0031 ........ 26 ....... A PET imaging prev PET multple ................... 1.87 0.72 0.72 0.07 2.66 2.66 XXX G0032 ........ 26 ....... A PET follow SPECT 78464 singl ................... 1.50 0.54 0.54 0.07 2.11 2.11 XXX G0033 ........ 26 ....... A PET follow SPECT 78464 mult ................... 1.87 0.73 0.73 0.07 2.67 2.67 XXX G0034 ........ 26 ....... A PET follow SPECT 76865 singl ................... 1.50 0.57 0.57 0.05 2.12 2.12 XXX G0035 ........ 26 ....... A PET follow SPECT 78465 mult ................... 1.87 0.72 0.72 0.07 2.66 2.66 XXX G0036 ........ 26 ....... A PET follow cornry angio sing ....................... 1.50 0.56 0.56 0.05 2.11 2.11 XXX G0037 ........ 26 ....... A PET follow cornry angio mult ...................... 1.87 0.71 0.71 0.06 2.64 2.64 XXX G0038 ........ 26 ....... A PET follow myocard perf sing ..................... 1.50 0.52 0.52 0.06 2.08 2.08 XXX G0039 ........ 26 ....... A PET follow myocard perf mult ..................... 1.87 0.71 0.71 0.07 2.65 2.65 XXX G0040 ........ 26 ....... A PET follow stress echo singl ....................... 1.50 0.59 0.59 0.07 2.16 2.16 XXX G0041 ........ 26 ....... A PET follow stress echo mult ........................ 1.87 0.73 0.73 0.07 2.67 2.67 XXX G0042 ........ 26 ....... A PET follow ventriculogm sing ...................... 1.50 0.61 0.61 0.05 2.16 2.16 XXX G0043 ........ 26 ....... A PET follow ventriculogm mult ...................... 1.87 0.75 0.75 0.06 2.68 2.68 XXX G0044 ........ 26 ....... A PET following rest ECG singl ...................... 1.50 0.59 0.59 0.05 2.14 2.14 XXX G0045 ........ 26 ....... A PET following rest ECG mult ....................... 1.87 0.72 0.72 0.06 2.65 2.65 XXX G0046 ........ 26 ....... A PET follow stress ECG singl ....................... 1.50 0.59 0.59 0.05 2.14 2.14 XXX G0047 ........ 26 ....... A PET follow stress ECG mult ........................ 1.87 0.73 0.73 0.06 2.66 2.66 XXX G0101 ........ ............ A CA screen;pelvic/breast exam ..................... 0.45 0.52 0.17 0.02 0.99 0.64 XXX G0102 ........ ............ A Prostate ca screening; dre .......................... 0.17 0.40 0.06 0.01 0.58 0.24 XXX G0104 ........ ............ A CA screen;flexi sigmoidscope ..................... 0.96 2.30 0.50 0.08 3.34 1.54 000 G0105 ........ ............ A Colorectal scrn; hi risk ind ........................... 3.69 6.20 1.47 0.24 10.13 5.40 000


## 47692

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare Payments. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

G0105 ........ 53 ....... A Colorectal scrn; hi risk ind ........................... 0.96 2.30 0.50 0.08 3.34 1.54 000 G0106 ........ ............ A Colon CA screen;barium enema ................. 0.99 2.55 NA 0.17 3.71 NA XXX G0106 ........ 26 ....... A Colon CA screen;barium enema ................. 0.99 0.32 0.32 0.04 1.35 1.35 XXX G0106 ........ TC ...... A Colon CA screen;barium enema ................. 0.00 2.23 NA 0.13 2.36 NA XXX G0108 ........ ............ A Diab manage trn per indiv ........................... 0.00 0.83 NA 0.01 0.84 NA XXX G0109 ........ ............ A Diab manage trn ind/group .......................... 0.00 0.48 NA 0.01 0.49 NA XXX G0110 ........ ............ R Nett pulm-rehab educ; ind ........................... 0.90 0.68 0.29 0.04 1.62 1.23 XXX G0111 ........ ............ R Nett pulm-rehab educ; group ....................... 0.27 0.29 0.13 0.01 0.57 0.41 XXX G0112 ........ ............ R Nett;nutrition guid, initial .............................. 1.72 1.21 0.65 0.07 3.00 2.44 XXX G0113 ........ ............ R Nett;nutrition guid,subseqnt ......................... 1.29 0.82 0.41 0.05 2.16 1.75 XXX G0114 ........ ............ R Nett; psychosocial consult ........................... 1.20 0.48 0.37 0.04 1.72 1.61 XXX G0115 ........ ............ R Nett; psychological testing ........................... 1.20 0.84 0.37 0.03 2.07 1.60 XXX G0116 ........ ............ R Nett; psychosocial counsel .......................... 1.11 0.98 0.33 0.03 2.12 1.47 XXX G0117 ........ ............ T Glaucoma scrn hgh risk direc ...................... 0.45 0.72 0.19 0.01 1.18 0.65 XXX G0118 ........ ............ T Glaucoma scrn hgh risk direc ...................... 0.17 0.53 0.06 0.00 0.70 0.23 XXX G0120 ........ ............ A Colon ca scrn; barium enema ..................... 0.99 2.55 NA 0.17 3.71 NA XXX G0120 ........ 26 ....... A Colon ca scrn; barium enema ..................... 0.99 0.32 0.32 0.04 1.35 1.35 XXX G0120 ........ TC ...... A Colon ca scrn; barium enema ..................... 0.00 2.23 NA 0.13 2.36 NA XXX G0121 ........ ............ A Colon ca scrn not hi rsk ind ........................ 3.69 6.20 1.47 0.24 10.13 5.40 000 G0121 ........ 53 ....... A Colon ca scrn not hi rsk ind ........................ 0.96 2.30 0.50 0.08 3.34 1.54 000 G0124 ........ ............ A Screen c/v thin layer by MD ........................ 0.42 0.15 0.15 0.02 0.59 0.59 XXX G0125 ........ 26 ....... A PET image pulmonary nodule ..................... 1.50 0.52 0.52 0.07 2.09 2.09 XXX G0127 ........ ............ R Trim nail(s) ................................................... 0.17 0.25 0.07 0.01 0.43 0.25 000 G0128 ........ ............ R CORF skilled nursing service ...................... 0.08 0.03 0.03 0.01 0.12 0.12 XXX G0130 ........ ............ A Single energy x-ray study ............................ 0.22 0.87 NA 0.06 1.15 NA XXX G0130 ........ 26 ....... A Single energy x-ray study ............................ 0.22 0.07 0.07 0.01 0.30 0.30 XXX G0130 ........ TC ...... A Single energy x-ray study ............................ 0.00 0.80 NA 0.05 0.85 NA XXX G0141 ........ ............ A Scr c/v cyto,autosys and md ....................... 0.42 0.15 0.15 0.02 0.59 0.59 XXX G0166 ........ ............ A Extrnl counterpulse, per tx ........................... 0.07 3.22 0.03 0.00 3.29 0.10 XXX G0168 ........ ............ A Wound closure by adhesive ........................ 0.45 1.94 0.22 0.03 2.42 0.70 000 G0179 ........ ............ A MD recertification HHA PT .......................... 0.45 1.06 NA 0.02 1.53 NA XXX G0180 ........ ............ A MD certification HHA patient ....................... 0.67 1.29 NA 0.04 2.00 NA XXX G0181 ........ ............ A Home health care supervision ..................... 1.73 1.51 NA 0.08 3.32 NA XXX G0182 ........ ............ A Hospice care supervision ............................ 1.73 1.71 NA 0.07 3.51 NA XXX G0202 ........ ............ A Screeningmammographydigital ................... 0.70 2.77 NA 0.10 3.57 NA XXX G0202 ........ 26 ....... A Screeningmammographydigital ................... 0.70 0.23 0.23 0.03 0.96 0.96 XXX G0202 ........ TC ...... A Screeningmammographydigital ................... 0.00 2.54 NA 0.07 2.61 NA XXX G0204 ........ ............ A Diagnosticmammographydigital ................... 0.87 2.78 NA 0.11 3.76 NA XXX G0204 ........ 26 ....... A Diagnosticmammographydigital ................... 0.87 0.28 0.28 0.04 1.19 1.19 XXX G0204 ........ TC ...... A Diagnosticmammographydigital ................... 0.00 2.50 NA 0.07 2.57 NA XXX G0206 ........ ............ A Diagnosticmammographydigital ................... 0.70 2.25 NA 0.09 3.04 NA XXX G0206 ........ 26 ....... A Diagnosticmammographydigital ................... 0.70 0.23 0.23 0.03 0.96 0.96 XXX G0206 ........ TC ...... A Diagnosticmammographydigital ................... 0.00 2.02 NA 0.06 2.08 NA XXX G0210 ........ 26 ....... A PET img wholebody dxlung ......................... 1.50 0.51 0.51 0.07 2.08 2.08 XXX G0211 ........ 26 ....... A PET img wholbody init lung ......................... 1.50 0.51 0.51 0.07 2.08 2.08 XXX G0212 ........ 26 ....... A PET img wholebod restag lung ................... 1.50 0.51 0.51 0.06 2.07 2.07 XXX G0213 ........ 26 ....... A PET img wholbody dx .................................. 1.50 0.51 0.51 0.07 2.08 2.08 XXX G0214 ........ 26 ....... A PET img wholebod init ................................. 1.50 0.51 0.51 0.07 2.08 2.08 XXX G0215 ........ 26 ....... A PETimg wholebod restag ............................ 1.50 0.51 0.51 0.06 2.07 2.07 XXX G0216 ........ 26 ....... A PET img wholebod dx melanoma ............... 1.50 0.51 0.51 0.06 2.07 2.07 XXX G0217 ........ 26 ....... A PET img wholebod init melan ...................... 1.50 0.51 0.51 0.06 2.07 2.07 XXX G0218 ........ 26 ....... A PET img wholebod restag mela .................. 1.50 0.52 0.52 0.06 2.08 2.08 XXX G0220 ........ 26 ....... A PET img wholebod dx lymphoma ................ 1.50 0.51 0.51 0.06 2.07 2.07 XXX G0221 ........ 26 ....... A PET imag wholbod init lympho .................... 1.50 0.51 0.51 0.07 2.08 2.08 XXX G0222 ........ 26 ....... A PET imag wholbod resta lymph .................. 1.50 0.52 0.52 0.06 2.08 2.08 XXX G0223 ........ 26 ....... A PET imag wholbod reg dx head .................. 1.50 0.51 0.51 0.06 2.07 2.07 XXX G0224 ........ 26 ....... A PET imag wholbod reg ini hea .................... 1.50 0.51 0.51 0.06 2.07 2.07 XXX G0225 ........ 26 ....... A PET whol restag headneckonly ................... 1.50 0.52 0.52 0.06 2.08 2.08 XXX G0226 ........ 26 ....... A PET img wholbody dx esophagl .................. 1.50 0.53 0.53 0.06 2.09 2.09 XXX G0227 ........ 26 ....... A PET img wholbod ini esophage ................... 1.50 0.52 0.52 0.06 2.08 2.08 XXX G0228 ........ 26 ....... A PET img wholbod restg esopha .................. 1.50 0.51 0.51 0.06 2.07 2.07 XXX G0229 ........ 26 ....... A PET img metaboloc brain pres .................... 1.50 0.52 0.52 0.07 2.09 2.09 XXX G0230 ........ 26 ....... A PET myocard viability post .......................... 1.50 0.53 0.53 0.06 2.09 2.09 XXX G0231 ........ 26 ....... A PET WhBD colorec; gamma cam ............... 1.50 0.51 0.51 0.06 2.07 2.07 XXX G0232 ........ 26 ....... A PET whbd lymphoma; gamma cam ............ 1.50 0.52 0.52 0.06 2.08 2.08 XXX G0233 ........ 26 ....... A PET whbd melanoma; gamma cam ............ 1.50 0.52 0.52 0.06 2.08 2.08 XXX G0234 ........ 26 ....... A PET WhBD pulm nod; gamma cam ............ 1.50 0.52 0.52 0.06 2.08 2.08 XXX G0237 ........ ............ A Therapeutic procd strg endur ...................... 0.00 0.47 NA 0.02 0.49 NA XXX G0238 ........ ............ A Oth resp proc, indiv ..................................... 0.00 0.47 NA 0.02 0.49 NA XXX G0239 ........ ............ A Oth resp proc, group ................................... 0.00 0.32 NA 0.02 0.34 NA XXX G0245 ........ ............ R Initial foot exam pt lops ............................... 0.88 0.79 0.31 0.05 1.72 1.24 XXX G0246 ........ ............ R Followup eval of foot pt lop ......................... 0.45 0.54 0.16 0.03 1.02 0.64 XXX G0247 ........ ............ R Routine footcare pt w lops ........................... 0.50 0.52 0.21 0.03 1.05 0.74 ZZZ G0248 ........ ............ R Demonstrate use home inr mon .................. 0.00 6.61 NA 0.01 6.62 NA XXX G0249 ........ ............ R Provide test material,equipm ....................... 0.00 3.97 NA 0.01 3.98 NA XXX


## 47693

A DDENDUM 

### B.

— R ELATIVE 

### V ALUE 

### U NITS 

### (RVUS) AND 

### R ELATED 

### I NFORMATION



### — Continued

CPT 1 / HCPCS 2 MOD Status Description Physician work RVUs 3 Nonfacility PE RVUs Facility PE RVUs Malpractice RVUs Nonfacility Total Facility total Global

G0250 ........ ............ R MD review interpret of test .......................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX G0253 ........ 26 ....... A PET image brst dection recur ...................... 1.87 0.63 0.63 0.06 2.56 2.56 XXX G0254 ........ 26 ....... A PET image brst eval to tx ............................ 1.87 0.65 0.65 0.06 2.58 2.58 XXX G0268 ........ ............ A Removal of impacted wax md ..................... 0.61 0.63 0.24 0.02 1.26 0.87 000 G0270 ........ ............ A MNT subs tx for change dx ......................... 0.00 0.47 NA 0.01 0.48 NA XXX G0271 ........ ............ A Group MNT 2 or more 30 mins ................... 0.00 0.18 NA 0.01 0.19 NA XXX G0275 ........ ............ A Renal angio, cardiac cath ............................ 0.25 NA 0.10 0.01 NA 0.36 ZZZ G0278 ........ ............ A Iliac art angio,cardiac cath ........................... 0.25 NA 0.10 0.01 NA 0.36 ZZZ G0281 ........ ............ A Elec stim unattend for press ........................ 0.18 0.11 NA 0.01 0.30 NA XXX G0283 ........ ............ A Elec stim other than wound ......................... 0.18 0.11 NA 0.01 0.30 NA XXX G0288 ........ ............ A Recon, CTA for surg plan ............................ 0.00 10.60 NA 0.18 10.78 NA XXX G0289 ........ ............ A Arthro, loose body + chondro ...................... 1.48 NA 0.80 0.33 NA 2.61 ZZZ G0296 ........ 26 ....... A PET imge restag thyrod cance .................... 1.87 0.71 0.71 0.08 2.66 2.66 XXX G0308 ........ ............ A ESRD related svc 4+mo<2yrs ..................... 12.74 8.54 8.54 0.42 21.70 21.70 XXX G0309 ........ ............ A ESRD related svc 2-3mo<2yrs .................... 10.61 7.10 7.10 0.36 18.07 18.07 XXX G0310 ........ ............ A ESRD related svc 1 visit<2yr ...................... 8.49 5.68 5.68 0.28 14.45 14.45 XXX G0311 ........ ............ A ESRD related svs 4+mo 2-11yr .................. 9.73 4.72 4.72 0.34 14.79 14.79 XXX G0312 ........ ............ A ESRD relate svs 2-3 mo 2-11y ................... 8.11 3.92 3.92 0.29 12.32 12.32 XXX G0313 ........ ............ A ESRD related svs 1 mon 2-11y ................... 6.49 3.14 3.14 0.22 9.85 9.85 XXX G0314 ........ ............ A ESRD related svs 4+ mo 12-19 .................. 8.28 4.42 4.42 0.27 12.97 12.97 XXX G0315 ........ ............ A ESRD related svs 2-3mo 12-19 .................. 6.90 3.67 3.67 0.23 10.80 10.80 XXX G0316 ........ ............ A ESRD relate svs 1 vist 12-19 ...................... 5.52 2.94 2.94 0.17 8.63 8.63 XXX G0317 ........ ............ A ESRD related svs 4+mo 20+yrs .................. 5.09 2.86 2.86 0.17 8.12 8.12 XXX G0318 ........ ............ A ESRD related svs 2-3 mo 20+y .................. 4.24 2.38 2.38 0.14 6.76 6.76 XXX G0319 ........ ............ A ESRD related svs 1 visit 20+ ...................... 3.39 1.90 1.90 0.11 5.40 5.40 XXX G0320 ........ ............ A ESRD related svs home under2 .................. 10.61 7.10 7.10 0.36 18.07 18.07 XXX G0321 ........ ............ A ESRDrelatedsvs home mo 2-11y ................ 8.11 3.92 3.92 0.23 12.26 12.26 XXX G0322 ........ ............ A ESRD relate svs home mo12-19 ................. 6.90 3.67 3.67 0.29 10.86 10.86 XXX G0323 ........ ............ A ESRD related svs home mo 20+ ................ 4.24 2.38 2.38 0.14 6.76 6.76 XXX G0324 ........ ............ A ESRD related svs home/dy<2y ................... 0.35 0.24 0.24 0.01 0.60 0.60 XXX G0325 ........ ............ A ESRD relate home/dy 2-11 yr ..................... 0.23 0.12 0.12 0.01 0.36 0.36 XXX G0326 ........ ............ A ESRD relate home/dy 12-19y ...................... 0.27 0.13 0.13 0.01 0.41 0.41 XXX G0327 ........ ............ A ESRD relate home/dy 20+yrs ...................... 0.14 0.08 0.08 0.01 0.23 0.23 XXX G0329 ........ ............ A Electromagntic tx for ulcers ......................... 0.06 0.12 0.02 0.01 0.19 0.09 XXX G0XX1 ........ ............ A Bone marrow aspir ...................................... 0.16 0.21 0.08 0.04 0.41 0.28 ZZZ G0XX2 ........ ............ A Preventative exam ....................................... 1.51 1.65 0.54 0.13 3.29 2.18 XXX G0XX3 ........ ............ A Venous mapping .......................................... 0.45 3.28 NA 0.30 4.03 NA XXX G0XX3 ........ 26 ....... A Venous mapping .......................................... 0.45 0.15 0.15 0.03 0.63 0.63 XXX G0XX3 ........ TC ...... A Venous mapping .......................................... 0.00 3.13 NA 0.27 3.40 NA XXX G0XX4 ........ ............ X Hospice, pre-elect ........................................ 1.34 0.00 0.00 0.10 1.44 1.44 XXX M0064 ........ ............ A Visit for drug monitoring .............................. 0.37 0.34 0.12 0.01 0.72 0.50 XXX P3001 ......... ............ A Screening pap smear by phys ..................... 0.42 0.15 0.15 0.02 0.59 0.59 XXX Q0035 ........ ............ A Cardiokymography ....................................... 0.17 0.45 NA 0.03 0.65 NA XXX Q0035 ........ 26 ....... A Cardiokymography ....................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX Q0035 ........ TC ...... A Cardiokymography ....................................... 0.00 0.39 NA 0.02 0.41 NA XXX Q0091 ........ ............ A Obtaining screen pap smear ....................... 0.37 0.67 0.14 0.02 1.06 0.53 XXX Q0092 ........ ............ A Set up port xray equipment ......................... 0.00 0.32 NA 0.01 0.33 NA XXX

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS App ly.

2 Copyright 2004 American Dental Association. All rights reserved.

3 + Indicates RVUs are not used for Medicare payment.

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### C.

— C ODES FOR 

### W HICH 

### W E 

### R ECEIVED 

### PEAC R ECOMMENDA



### TIONS ON 

### P RACTICE 

### E XPENSE 

### D I



### RECT 

### C OST 

### I NPUTS

CPT code Short descriptors

00100 Disability examination 00102 Anesth, salivary gland 00103 Anesth, repair of cleft lip 00120 Anesth, blepharoplasty 00126 Anesth, ear surgery 00140 Anesth, tympanotomy 00142 Anesth, procedures on eye 00144 Anesth, lens surgery 00145 Anesth, corneal transplant 00147 Anesth, vitreoretinal surg 00148 Anesth, iridectomy 

### A DDENDUM 

### C.

— C ODES FOR 

### W HICH 

### W E 

### R ECEIVED 

### PEAC R ECOMMENDA



### TIONS ON 

### P RACTICE 

### E XPENSE 

### D I



### RECT 

### C OST 

### I NPUTS



### — Continued

CPT code Short descriptors

00160 Anesth, eye exam 00162 Anesth, nose/sinus surgery 00164 Anesth, nose/sinus surgery 00170 Anesth, biopsy of nose 00172 Anesth, procedure on mouth 00174 Anesth, cleft palate repair 00176 Anesth, pharyngeal surgery 00190 Anesth, pharyngeal surgery 00192 Anesth, face/skull bone surg 00210 Anesth, facial bone surgery 00212 Anesth, open head surgery 

### A DDENDUM 

### C.

— C ODES FOR 

### W HICH 

### W E 

### R ECEIVED 

### PEAC R ECOMMENDA



### TIONS ON 

### P RACTICE 

### E XPENSE 

### D I



### RECT 

### C OST 

### I NPUTS



### — Continued

CPT code Short descriptors

00214 Anesth, skull drainage 00215 Anesth, skull drainage 00216 Anesth, skull repair/fract 00218 Anesth, head vessel surgery 00220 Anesth, special head surgery 00222 Anesth, intrcrn nerve 00300 Anesth, head nerve surgery 00320 Anesth, head/neck/ptrunk 00322 Anesth, neck organ, 1 & over 00326 Anesth, biopsy of thyroid 00350 Anesth, larynx/trach, < 1 yr


## 47694

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### C.

— C ODES FOR 

### W HICH 

### W E 

### R ECEIVED 

### PEAC R ECOMMENDA



### TIONS ON 

### P RACTICE 

### E XPENSE 

### D I



### RECT 

### C OST 

### I NPUTS



### — Continued

CPT code Short descriptors

00352 Anesth, neck vessel surgery 00400 Anesth, neck vessel surgery 00402 Anesth, skin, ext/per/atrunk 00404 Anesth, surgery of breast 00406 Anesth, surgery of breast 00410 Anesth, surgery of breast 00450 Anesth, correct heart rhythm 00452 Anesth, surgery of shoulder 00454 Anesth, surgery of shoulder 00470 Anesth, collar bone biopsy 00472 Anesth, removal of rib 00474 Anesth, chest wall repair 00500 Anesth, surgery of rib(s) 00520 Anesth, esophageal surgery 00522 Anesth, chest procedure 00524 Anesth, chest lining biopsy 00528 Anesth, chest drainage 00529 Anesth, chest partition view 00530 Anesth, chest partition view 00532 Anesth, pacemaker insertion 00534 Anesth, vascular access 00537 Anesth, cardioverter/defib 00539 Anesth, cardiac electrophys 00540 Anesth, trach-bronch reconst 00541 Anesth, chest surgery 00542 Anesth, one lung ventilation 00546 Anesth, release of lung 00548 Anesth, lung,chest wall surg 00550 Anesth, trachea,bronchi surg 00560 Anesth, sternal debridement 00562 Anesth, open heart surgery 00563 Anesth, open heart surgery 00566 Anesth, heart proc w/pump 00580 Anesth, cabg w/o pump 00600 Anesth, heart/lung transplnt 00604 Anesth, spine, cord surgery 00620 Anesth, sitting procedure 00622 Anesth, spine, cord surgery 00630 Anesth, removal of nerves 00632 Anesth, spine, cord surgery 00634 Anesth, removal of nerves 00635 Anesth for chemonucleolysis 00640 Anesth, lumbar puncture 00670 Anesth, spine manipulation 00700 Anesth, spine, cord surgery 00702 Anesth, abdominal wall surg 00730 Anesth, for liver biopsy 00740 Anesth, abdominal wall surg 00750 Anesth, upper gi visualize 00752 Anesth, repair of hernia 00754 Anesth, repair of hernia 00756 Anesth, repair of hernia 00770 Anesth, repair of hernia 00790 Anesth, blood vessel repair 00792 Anesth, surg upper abdomen 00794 Anesth, hemorr/excise liver 00796 Anesth, pancreas removal 00797 Anesth, for liver transplant 00800 Anesth, surgery for obesity 00802 Anesth, abdominal wall surg 00810 Anesth, fat layer removal 00820 Anesth, low intestine scope 00830 Anesth, abdominal wall surg 

### A DDENDUM 

### C.

— C ODES FOR 

### W HICH 

### W E 

### R ECEIVED 

### PEAC R ECOMMENDA



### TIONS ON 

### P RACTICE 

### E XPENSE 

### D I



### RECT 

### C OST 

### I NPUTS



### — Continued

CPT code Short descriptors

00832 Anesth, repair of hernia 00834 Anesth, repair of hernia 00836 Anesth, hernia repair< 1 yr 00840 Anesth hernia repair preemie 00842 Anesth, surg lower abdomen 00844 Anesth, amniocentesis 00846 Anesth, pelvis surgery 00848 Anesth, hysterectomy 00851 Anesth, pelvic organ surg 00860 Anesth, tubal ligation 00862 Anesth, surgery of abdomen 00864 Anesth, kidney/ureter surg 00865 Anesth, removal of bladder 00866 Anesth, removal of prostate 00868 Anesth, removal of adrenal 00870 Anesth, kidney transplant 00872 Anesth, bladder stone surg 00873 Anesth kidney stone destruct 00880 Anesth kidney stone destruct 00882 Anesth, abdomen vessel surg 00902 Anesth, major vein ligation 00904 Anesth, anorectal surgery 00906 Anesth, perineal surgery 00908 Anesth, removal of vulva 00910 Anesth, removal of prostate 00912 Anesth, bladder surgery 00914 Anesth, bladder tumor surg 00916 Anesth, removal of prostate 00918 Anesth, bleeding control 00920 Anesth, stone removal 00921 Anesth, genitalia surgery 00922 Anesth, vasectomy 00924 Anesth, sperm duct surgery 00926 Anesth, testis exploration 00928 Anesth, removal of testis 00930 Anesth, removal of testis 00932 Anesth, testis suspension 00934 Anesth, amputation of penis 00936 Anesth, penis, nodes removal 00938 Anesth, penis, nodes removal 00940 Anesth, insert penis device 00942 Anesth, vaginal procedures 00944 Anesth, surg on vag/urethral 00948 Anesth, vaginal hysterectomy 00950 Anesth, repair of cervix 00952 Anesth, vaginal endoscopy 01112 Anesth, hysteroscope/graph 01120 Anesth, bone aspirate/bx 01130 Anesth, pelvis surgery 01140 Anesth, body cast procedure 01150 Anesth, amputation at pelvis 01160 Anesth, pelvic tumor surgery 01170 Anesth, pelvis procedure 01173 Anesth, pelvis surgery 01180 Anesth, fx repair, pelvis 01190 Anesth, pelvis nerve removal 01200 Anesth, pelvis nerve removal 01202 Anesth, hip joint procedure 01210 Anesth, arthroscopy of hip 01212 Anesth, hip joint surgery 01214 Anesth, hip disarticulation 01215 Anesth, hip arthroplasty 01220 Anesth, revise hip repair 

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CPT code Short descriptors

01230 Anesth, procedure on femur 01232 Anesth, surgery of femur 01234 Anesth, amputation of femur 01250 Anesth, radical femur surg 01260 Anesth, upper leg surgery 01270 Anesth, upper leg veins surg 01272 Anesth, thigh arteries surg 01274 Anesth, femoral artery surg 01320 Anesth, femoral embolectomy 01340 Anesth, knee area surgery 01360 Anesth, knee area procedure 01380 Anesth, knee area surgery 01382 Anesth, knee joint procedure 01390 Anesth, dx knee arthroscopy 01392 Anesth, knee area procedure 01400 Anesth, knee area surgery 01402 Anesth, knee joint surgery 01404 Anesth, knee arthroplasty 01420 Anesth, amputation at knee 01430 Anesth, knee joint casting 01432 Anesth, knee veins surgery 01440 Anesth, knee vessel surg 01442 Anesth, knee arteries surg 01444 Anesth, knee artery surg 01462 Anesth, knee artery repair 01464 Anesth, lower leg procedure 01470 Anesth, ankle/ft arthroscopy 01472 Anesth, lower leg surgery 01474 Anesth, achilles tendon surg 01480 Anesth, lower leg surgery 01482 Anesth, lower leg bone surg 01484 Anesth, radical leg surgery 01486 Anesth, lower leg revision 01490 Anesth, ankle replacement 01500 Anesth, lower leg casting 01502 Anesth, leg arteries surg 01520 Anesth, lwr leg embolectomy 01522 Anesth, lower leg vein surg 01610 Anesth, lower leg vein surg 01620 Anesth, surgery of shoulder 01622 Anesth, shoulder procedure 01630 Anes dx shoulder arthroscopy 01632 Anesth, surgery of shoulder 01634 Anesth, surgery of shoulder 01636 Anesth, shoulder joint amput 01638 Anesth, forequarter amput 01650 Anesth, shoulder replacement 01652 Anesth, shoulder artery surg 01654 Anesth, shoulder vessel surg 01656 Anesth, shoulder vessel surg 01670 Anesth, arm-leg vessel surg 01680 Anesth, shoulder vein surg 01682 Anesth, shoulder casting 01710 Anesth, airplane cast 01712 Anesth, elbow area surgery 01714 Anesth, uppr arm tendon surg 01716 Anesth, uppr arm tendon surg 01730 Anesth, biceps tendon repair 01732 Anesth, uppr arm procedure 01740 Anesth, dx elbow arthroscopy 01742 Anesth, upper arm surgery 01744 Anesth, humerus surgery 01756 Anesth, humerus repair


## 47695

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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CPT code Short descriptors

01758 Anesth, radical humerus surg 01760 Anesth, humeral lesion surg 01770 Anesth, elbow replacement 01772 Anesth, uppr arm artery surg 01780 Anesth, uppr arm embolectomy 01782 Anesth, upper arm vein surg 01810 Anesth, uppr arm vein repair 01820 Anesth, lower arm surgery 01829 Anesth, lower arm procedure 01830 Anesth, dx wrist arthroscopy 01832 Anesth, lower arm surgery 01840 Anesth, wrist replacement 01842 Anesth, lwr arm artery surg 01844 Anesth, lwr arm embolectomy 01850 Anesth, vascular shunt surg 01852 Anesth, lower arm vein surg 01860 Anesth, lwr arm vein repair 01905 Anesth, lower arm casting 01916 Anes, spine inject, x-ray/re 01920 Anesth, dx arteriography 01922 Anesth, catheterize heart 01924 Anesth, cat or MRI scan 01925 Anes, ther interven rad, art 01926 Anes, ther interven rad, car 01930 Anes, tx interv rad hrt/cran 01931 Anes, ther interven rad, vei 01932 Anes, ther interven rad, tip 01933 Anes, tx interv rad, th vein 01951 Anes, tx interv rad, cran v 01952 Anesth, burn, less 4 percent 01953 Anesth, burn, 4-9 percent 01958 Anesth, burn, each 9 percent 01960 Anesth, antepartum manipul 01961 Anesth, vaginal delivery 01962 Anesth, cs delivery 01963 Anesth, emer hysterectomy 01964 Anesth, cs hysterectomy 01967 Anesth, abortion procedures 01968 Anesth/analg, vag delivery 01969 Anes/analg cs deliver add-on 01990 Anesth/analg cs hyst add-on 01991 Support for organ donor 01992 Anesth, nerve block/inj 01995 Anesth, n block/inj, prone 01996 Regional anesthesia limb 01999 Hosp manage cont drug admin 10120 Remove foreign body 10121 Remove foreign body 10140 Drainage of hematoma/fluid 10160 Puncture drainage of lesion 10180 Complex drainage, wound 11010 Debride skin, fx 11011 Debride skin/muscle, fx 11012 Debride skin/muscle/bone, fx 11740 Drain blood from under nail 11755 Biopsy, nail unit 11760 Repair of nail bed 11762 Reconstruction of nail bed 11765 Excision of nail fold, toe 11772 Removal of pilonidal lesion 11920 Correct skin color defects 11921 Correct skin color defects 11922 Correct skin color defects 

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CPT code Short descriptors

11971 Remove tissue expander(s) 12020 Closure of split wound 12021 Closure of split wound 12036 Layer closure of wound(s) 12037 Layer closure of wound(s) 12045 Layer closure of wound(s) 13100 Repair of wound or lesion 13101 Repair of wound or lesion 13102 Repair wound/lesion add-on 13120 Repair of wound or lesion 13121 Repair of wound or lesion 13122 Repair wound/lesion add-on 13131 Repair of wound or lesion 13132 Repair of wound or lesion 13133 Repair wound/lesion add-on 13150 Repair of wound or lesion 13151 Repair of wound or lesion 13152 Repair of wound or lesion 13153 Repair wound/lesion add-on 14000 Skin tissue rearrangement 14001 Skin tissue rearrangement 14020 Skin tissue rearrangement 14021 Skin tissue rearrangement 14040 Skin tissue rearrangement 14060 Skin tissue rearrangement 15050 Skin pinch graft 15200 Skin full graft 15201 Skin full graft add-on 15220 Skin full graft 15221 Skin full graft add-on 15240 Skin full graft 15241 Skin full graft add-on 15260 Skin full graft 15350 Skin homograft 15351 Skin homograft add-on 15400 Skin heterograft 15401 Skin heterograft add-on 15570 Form skin pedicle flap 15572 Form skin pedicle flap 15574 Form skin pedicle flap 15576 Form skin pedicle flap 15600 Skin graft 15610 Skin graft 15620 Skin graft 15630 Skin graft 15650 Transfer skin pedicle flap 15740 Island pedicle flap graft 15760 Composite skin graft 15780 Abrasion treatment of skin 15781 Abrasion treatment of skin 15782 Abrasion treatment of skin 15783 Abrasion treatment of skin 15786 Abrasion, lesion, single 15787 Abrasion, lesions, add-on 15788 Chemical peel, face, epiderm 15789 Chemical peel, face, dermal 15792 Chemical peel, nonfacial 15793 Chemical peel, nonfacial 15810 Salabrasion 15811 Salabrasion
15835 Excise excessive skin tissue 15837 Excise excessive skin tissue 15839 Excise excessive skin tissue 

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CPT code Short descriptors

15860 Test for blood flow in graft 19000 Drainage of breast lesion 19001 Drain breast lesion add-on 19020 Incision of breast lesion 19030 Injection for breast x-ray 19110 Nipple exploration 19112 Excise breast duct fistula 19291 Place needle wire, breast 19295 Place breast clip, percut 19350 Breast reconstruction 19355 Correct inverted nipple(s) 20000 Incision of abscess 20005 Incision of deep abscess 20100 Explore wound, neck 20101 Explore wound, chest 20102 Explore wound, abdomen 20103 Explore wound, extremity 20150 Excise epiphyseal bar 20206 Needle biopsy, muscle 20220 Bone biopsy, trocar/needle 20225 Bone biopsy, trocar/needle 20240 Bone biopsy, excisional 20245 Bone biopsy, excisional 20250 Open bone biopsy 20251 Open bone biopsy 20520 Removal of foreign body 20525 Removal of foreign body 20615 Treatment of bone cyst 20650 Insert and remove bone pin 20670 Removal of support implant 20680 Removal of support implant 20690 Apply bone fixation device 20694 Remove bone fixation device 20900 Removal of bone for graft 20910 Remove cartilage for graft 20922 Removal of fascia for graft 20950 Fluid pressure, muscle 20972 Bone/skin graft, metatarsal
20974 Electrical bone stimulation 20975 Electrical bone stimulation 21025 Excision of bone, lower jaw 21026 Excision of facial bone(s) 21029 Contour of face bone lesion 21030 Excise max/zygoma b9 tumor 21031 Remove exostosis, mandible 21032 Remove exostosis, maxilla 21034 Excise max/zygoma mlg tumor
21040 Excise mandible lesion 21044 Removal of jaw bone lesion 21045 Extensive jaw surgery 21050 Removal of jaw joint 21060 Remove jaw joint cartilage 21070 Remove coronoid process 21100 Maxillofacial fixation 21110 Interdental fixation 21116 Injection, jaw joint x-ray 21120 Reconstruction of chin 21121 Reconstruction of chin 21122 Reconstruction of chin 21123 Reconstruction of chin 21125 Augmentation, lower jaw bone 21127 Augmentation, lower jaw bone 21137 Reduction of forehead


## 47696

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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CPT code Short descriptors

21138 Reduction of forehead 21139 Reduction of forehead 21143 Reconstruct midface, lefort 21150 Reconstruct midface, lefort 21151 Reconstruct midface, lefort 21154 Reconstruct midface, lefort 21155 Reconstruct midface, lefort 21159 Reconstruct midface, lefort 21160 Reconstruct midface, lefort 21188 Reconstruction of midface 21195 Reconst lwr jaw w/o fixation 21196 Reconst lwr jaw w/fixation 21198 Reconstr lwr jaw segment 21206 Reconstruct upper jaw bone 21208 Augmentation of facial bones 21209 Reduction of facial bones 21210 Face bone graft 21215 Lower jaw bone graft 21235 Ear cartilage graft 21244 Reconstruction of lower jaw 21245 Reconstruction of jaw 21246 Reconstruction of jaw 21248 Reconstruction of jaw 21249 Reconstruction of jaw 21255 Reconstruct lower jaw bone 21260 Revise eye sockets 21261 Revise eye sockets 21263 Revise eye sockets 21267 Revise eye sockets 21268 Revise eye sockets 21270 Augmentation, cheek bone 21295 Revision of jaw muscle/bone 21296 Revision of jaw muscle/bone 21315 Treatment of nose fracture 21320 Treatment of nose fracture 21325 Treatment of nose fracture 21330 Treatment of nose fracture 21335 Treatment of nose fracture 21336 Treat nasal septal fracture 21337 Treat nasal septal fracture 21338 Treat nasoethmoid fracture 21339 Treat nasoethmoid fracture 21343 Treatment of sinus fracture 21344 Treatment of sinus fracture 21345 Treat nose/jaw fracture 21346 Treat nose/jaw fracture 21347 Treat nose/jaw fracture 21355 Treat cheek bone fracture 21356 Treat cheek bone fracture 21360 Treat cheek bone fracture 21365 Treat cheek bone fracture 21385 Treat eye socket fracture 21386 Treat eye socket fracture 21387 Treat eye socket fracture 21400 Treat eye socket fracture 21401 Treat eye socket fracture 21421 Treat mouth roof fracture 21422 Treat mouth roof fracture 21423 Treat mouth roof fracture 21431 Treat craniofacial fracture 21432 Treat craniofacial fracture 21440 Treat dental ridge fracture 21445 Treat dental ridge fracture 

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CPT code Short descriptors

21450 Treat lower jaw fracture 21451 Treat lower jaw fracture 21452 Treat lower jaw fracture 21453 Treat lower jaw fracture 21461 Treat lower jaw fracture 21462 Treat lower jaw fracture 21485 Reset dislocated jaw 21493 Treat hyoid bone fracture 21494 Treat hyoid bone fracture 21495 Treat hyoid bone fracture 21497 Interdental wiring 21501 Drain neck/chest lesion 21555 Remove lesion, neck/chest 21700 Revision of neck muscle 21720 Revision of neck muscle 21800 Treatment of rib fracture 21820 Treat sternum fracture 21925 Biopsy soft tissue of back 21930 Remove lesion, back or flank 22305 Treat spine process fracture 22310 Treat spine fracture 22315 Treat spine fracture 23000 Removal of calcium deposits 23030 Drain shoulder lesion 23031 Drain shoulder bursa 23065 Biopsy shoulder tissues 23066 Biopsy shoulder tissues 23075 Removal of shoulder lesion 23330 Remove shoulder foreign body 23350 Injection for shoulder x-ray 23500 Treat clavicle fracture 23505 Treat clavicle fracture 23520 Treat clavicle dislocation 23525 Treat clavicle dislocation 23540 Treat clavicle dislocation 23545 Treat clavicle dislocation 23570 Treat shoulder blade fx 23575 Treat shoulder blade fx 23600 Treat humerus fracture 23605 Treat humerus fracture 23620 Treat humerus fracture 23625 Treat humerus fracture 23650 Treat shoulder dislocation 23665 Treat dislocation/fracture 23675 Treat dislocation/fracture 23700 Fixation of shoulder 23921 Amputation follow-up surgery 23930 Drainage of arm lesion 23931 Drainage of arm bursa 24065 Biopsy arm/elbow soft tissue 24066 Biopsy arm/elbow soft tissue 24075 Remove arm/elbow lesion 24200 Removal of arm foreign body 24201 Removal of arm foreign body 24220 Injection for elbow x-ray 24500 Treat humerus fracture 24505 Treat humerus fracture 24530 Treat humerus fracture 24535 Treat humerus fracture 24560 Treat humerus fracture 24565 Treat humerus fracture 24576 Treat humerus fracture 24577 Treat humerus fracture 

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CPT code Short descriptors

24600 Treat elbow dislocation 24640 Treat elbow dislocation 24650 Treat radius fracture 24655 Treat radius fracture 24670 Treat ulnar fracture 24675 Treat ulnar fracture 25065 Biopsy forearm soft tissues 25246 Injection for wrist x-ray 25500 Treat fracture of radius 25505 Treat fracture of radius 25520 Treat fracture of radius 25530 Treat fracture of ulna 25535 Treat fracture of ulna 25560 Treat fracture radius & ulna 25565 Treat fracture radius & ulna 25600 Treat fracture radius/ulna 25605 Treat fracture radius/ulna 25622 Treat wrist bone fracture 25624 Treat wrist bone fracture 25630 Treat wrist bone fracture 25635 Treat wrist bone fracture 25650 Treat wrist bone fracture 25675 Treat wrist dislocation 26600 Treat metacarpal fracture 26605 Treat metacarpal fracture 26641 Treat thumb dislocation 26645 Treat thumb fracture 26670 Treat hand dislocation 26675 Treat hand dislocation 26700 Treat knuckle dislocation 26705 Treat knuckle dislocation 26720 Treat finger fracture, each 26725 Treat finger fracture, each 26740 Treat finger fracture, each 26742 Treat finger fracture, each 26750 Treat finger fracture, each 26755 Treat finger fracture, each 26770 Treat finger dislocation 26775 Treat finger dislocation 26863 Fuse/graft added joint 26991 Drainage of pelvis bursa 27040 Biopsy of soft tissues 27047 Remove hip/pelvis lesion 27086 Remove hip foreign body 27093 Injection for hip x-ray 27095 Injection for hip x-ray 27193 Treat pelvic ring fracture 27194 Treat pelvic ring fracture 27200 Treat tail bone fracture 27220 Treat hip socket fracture 27230 Treat thigh fracture 27246 Treat thigh fracture 27256 Treat hip dislocation 27257 Treat hip dislocation 27275 Manipulation of hip joint 27301 Drain thigh/knee lesion 27323 Biopsy, thigh soft tissues 27327 Removal of thigh lesion 27370 Injection for knee x-ray 27372 Removal of foreign body 27500 Treatment of thigh fracture 27501 Treatment of thigh fracture 27508 Treatment of thigh fracture


## 47697

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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CPT code Short descriptors

27516 Treat thigh fx growth plate 27517 Treat thigh fx growth plate 27520 Treat kneecap fracture 27530 Treat knee fracture 27532 Treat knee fracture 27538 Treat knee fracture(s) 27550 Treat knee dislocation 27560 Treat kneecap dislocation 27570 Fixation of knee joint 27603 Drain lower leg lesion 27604 Drain lower leg bursa 27605 Incision of achilles tendon 27606 Incision of achilles tendon 27613 Biopsy lower leg soft tissue 27614 Biopsy lower leg soft tissue 27618 Remove lower leg lesion 27619 Remove lower leg lesion 27630 Removal of tendon lesion 27648 Injection for ankle x-ray 27656 Repair leg fascia defect 27658 Repair of leg tendon, each 27659 Repair of leg tendon, each 27664 Repair of leg tendon, each 27665 Repair of leg tendon, each 27685 Revision of lower leg tendon 27686 Revise lower leg tendons 27692 Revise additional leg tendon 27730 Repair of tibia epiphysis 27732 Repair of fibula epiphysis 27740 Repair of leg epiphyses 27742 Repair of leg epiphyses 27750 Treatment of tibia fracture 27752 Treatment of tibia fracture 27760 Treatment of ankle fracture 27762 Treatment of ankle fracture 27780 Treatment of fibula fracture 27781 Treatment of fibula fracture 27786 Treatment of ankle fracture 27788 Treatment of ankle fracture 27808 Treatment of ankle fracture 27810 Treatment of ankle fracture 27816 Treatment of ankle fracture 27818 Treatment of ankle fracture 27824 Treat lower leg fracture 27825 Treat lower leg fracture 27830 Treat lower leg dislocation 27860 Fixation of ankle joint 28001 Drainage of bursa of foot 28002 Treatment of foot infection 28003 Treatment of foot infection 28008 Incision of foot fascia 28010 Incision of toe tendon 28011 Incision of toe tendons 28020 Exploration of foot joint 28022 Exploration of foot joint 28024 Exploration of toe joint 28035 Decompression of tibia nerve 28043 Excision of foot lesion 28045 Excision of foot lesion 28046 Resection of tumor, foot 28050 Biopsy of foot joint lining 28052 Biopsy of foot joint lining 28054 Biopsy of toe joint lining 

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CPT code Short descriptors

28060 Partial removal, foot fascia 28062 Removal of foot fascia 28070 Removal of foot joint lining 28072 Removal of foot joint lining 28080 Removal of foot lesion 28086 Excise foot tendon sheath 28088 Excise foot tendon sheath 28090 Removal of foot lesion 28092 Removal of toe lesions 28100 Removal of ankle/heel lesion 28103 Remove/graft foot lesion 28104 Removal of foot lesion 28107 Remove/graft foot lesion 28108 Removal of toe lesions 28110 Part removal of metatarsal 28111 Part removal of metatarsal 28112 Part removal of metatarsal 28113 Part removal of metatarsal 28114 Removal of metatarsal heads 28116 Revision of foot 28118 Removal of heel bone 28119 Removal of heel spur 28120 Part removal of ankle/heel 28122 Partial removal of foot bone 28124 Partial removal of toe 28126 Partial removal of toe 28140 Removal of metatarsal 28150 Removal of toe 28153 Partial removal of toe 28160 Partial removal of toe 28173 Extensive foot surgery 28175 Extensive foot surgery 28190 Removal of foot foreign body 28192 Removal of foot foreign body 28193 Removal of foot foreign body 28200 Repair of foot tendon 28202 Repair/graft of foot tendon 28208 Repair of foot tendon 28210 Repair/graft of foot tendon 28220 Release of foot tendon 28222 Release of foot tendons 28225 Release of foot tendon 28226 Release of foot tendons 28230 Incision of foot tendon(s) 28232 Incision of toe tendon 28234 Incision of foot tendon 28238 Revision of foot tendon 28288 Partial removal of foot bone 28289 Repair hallux rigidus 28290 Correction of bunion 28292 Correction of bunion 28294 Correction of bunion 28296 Correction of bunion 28297 Correction of bunion 28298 Correction of bunion 28299 Correction of bunion 28300 Incision of heel bone 28302 Incision of ankle bone 28305 Incise/graft midfoot bones 28400 Treatment of heel fracture 28405 Treatment of heel fracture 28430 Treatment of ankle fracture 28435 Treatment of ankle fracture 

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CPT code Short descriptors

28450 Treat midfoot fracture, each 28455 Treat midfoot fracture, each 28470 Treat metatarsal fracture 28475 Treat metatarsal fracture 28490 Treat big toe fracture 28495 Treat big toe fracture 28510 Treatment of toe fracture 28515 Treatment of toe fracture 28530 Treat sesamoid bone fracture 28540 Treat foot dislocation 28545 Treat foot dislocation 28570 Treat foot dislocation 28575 Treat foot dislocation 28600 Treat foot dislocation 28605 Treat foot dislocation 28630 Treat toe dislocation 28635 Treat toe dislocation 28636 Treat toe dislocation 28660 Treat toe dislocation 28665 Treat toe dislocation 30115 Removal of nose polyp(s) 30117 Removal of intranasal lesion 30118 Removal of intranasal lesion 30120 Revision of nose 30124 Removal of nose lesion 30125 Removal of nose lesion 30130 Removal of turbinate bones 30140 Removal of turbinate bones 30150 Partial removal of nose 30160 Removal of nose 30320 Remove nasal foreign body 30400 Reconstruction of nose 30410 Reconstruction of nose 30420 Reconstruction of nose 30430 Revision of nose 30435 Revision of nose 30450 Revision of nose 30460 Revision of nose 30462 Revision of nose 30465 Repair nasal stenosis 30520 Repair of nasal septum 30540 Repair nasal defect 30545 Repair nasal defect 30580 Repair upper jaw fistula 30600 Repair mouth/nose fistula
30620 Intranasal reconstruction 30630 Repair nasal septum defect 30801 Cauterization, inner nose 30802 Cauterization, inner nose 30915 Ligation, nasal sinus artery 30920 Ligation, upper jaw artery 31020 Exploration, maxillary sinus 31030 Exploration, maxillary sinus 31032 Explore sinus, remove polyps 31040 Exploration behind upper jaw 31050 Exploration, sphenoid sinus 31051 Sphenoid sinus surgery 31070 Exploration of frontal sinus 31075 Exploration of frontal sinus 31080 Removal of frontal sinus 31081 Removal of frontal sinus 31084 Removal of frontal sinus 31085 Removal of frontal sinus


## 47698

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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CPT code Short descriptors

31086 Removal of frontal sinus 31087 Removal of frontal sinus 31090 Exploration of sinuses 31200 Removal of ethmoid sinus 31201 Removal of ethmoid sinus 31205 Removal of ethmoid sinus 31225 Removal of upper jaw 31230 Removal of upper jaw 31300 Removal of larynx lesion 31320 Diagnostic incision, larynx 31360 Removal of larynx 31365 Removal of larynx 31367 Partial removal of larynx 31368 Partial removal of larynx 31370 Partial removal of larynx 31375 Partial removal of larynx 31380 Partial removal of larynx 31382 Partial removal of larynx 31390 Removal of larynx & pharynx 31395 Reconstruct larynx & pharynx 31400 Revision of larynx 31420 Removal of epiglottis 31502 Change of windpipe airway 31580 Revision of larynx 31582 Revision of larynx 31584 Treat larynx fracture 31585 Treat larynx fracture 31586 Treat larynx fracture 31587 Revision of larynx 31588 Revision of larynx 31590 Reinnervate larynx 31595 Larynx nerve surgery 31610 Incision of windpipe 31611 Surgery/speech prosthesis 31613 Repair windpipe opening 31614 Repair windpipe opening 31622 Dx bronchoscope/wash 31623 Dx bronchoscope/brush 31624 Dx bronchoscope/lavage 31625 Bronchoscopy w/biopsy(s) 31628 Bronchoscopy/lung bx, each 31629 Bronchoscopy/needle bx, each 31630 Bronchoscopy dilate/fx repr 31631 Bronchoscopy, dilate w/stent 31635 Bronchoscopy w/fb removal 31640 Bronchoscopy w/tumor excise 31641 Bronchoscopy, treat blockage 31643 Diag bronchoscope/catheter 31645 Bronchoscopy, clear airways 31646 Bronchoscopy, reclear airway 31656 Bronchoscopy, inj for x-ray 31708 Instill airway contrast dye 31710 Insertion of airway catheter 31715 Injection for bronchus x-ray 31717 Bronchial brush biopsy 31720 Clearance of airways 31725 Clearance of airways 31750 Repair of windpipe 31755 Repair of windpipe 31800 Repair of windpipe injury 31820 Closure of windpipe lesion 31825 Repair of windpipe defect 31830 Revise windpipe scar 

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CPT code Short descriptors

32002 Treatment of collapsed lung 32020 Insertion of chest tube 32201 Drain, percut, lung lesion 32400 Needle biopsy chest lining 32405 Biopsy, lung or mediastinum 32420 Puncture/clear lung 32851 Lung transplant, single 32852 Lung transplant with bypass 32853 Lung transplant, double 32854 Lung transplant with bypass 33010 Drainage of heart sac 33011 Repeat drainage of heart sac 33210 Insertion of heart electrode 33211 Insertion of heart electrode 33225 L ventric pacing lead add-on 33508 Endoscopic vein harvest 33935 Transplantation, heart/lung 33945 Transplantation of heart 33960 External circulation assist 33967 Insert ia percut device 33968 Remove aortic assist device 33970 Aortic circulation assist 33973 Insert balloon device 33975 Implant ventricular device 33976 Implant ventricular device 33979 Insert intracorporeal device 35450 Repair arterial blockage 35452 Repair arterial blockage 35454 Repair arterial blockage 35456 Repair arterial blockage 35458 Repair arterial blockage 35459 Repair arterial blockage 35460 Repair venous blockage 35470 Repair arterial blockage 35471 Repair arterial blockage 35472 Repair arterial blockage 35473 Repair arterial blockage 35474 Repair arterial blockage 35475 Repair arterial blockage 35476 Repair venous blockage 35480 Atherectomy, open 35481 Atherectomy, open 35482 Atherectomy, open 35483 Atherectomy, open 35484 Atherectomy, open 35485 Atherectomy, open 35572 Harvest femoropopliteal vein 35697 Reimplant artery each 36010 Place catheter in vein 36011 Place catheter in vein 36012 Place catheter in vein 36013 Place catheter in artery 36014 Place catheter in artery 36015 Place catheter in artery 36100 Establish access to artery 36120 Establish access to artery 36140 Establish access to artery 36145 Artery to vein shunt 36160 Establish access to aorta 36200 Place catheter in aorta 36215 Place catheter in artery 36216 Place catheter in artery 36217 Place catheter in artery 

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### — Continued

CPT code Short descriptors

36218 Place catheter in artery 36245 Place catheter in artery 36246 Place catheter in artery 36247 Place catheter in artery 36248 Place catheter in artery 36420 Vein access cutdown < 1 yr 36430 Blood transfusion service 36481 Insertion of catheter, vein 36500 Insertion of catheter, vein 36514 Apheresis plasma 36515 Apheresis, adsorp/reinfuse 36516 Apheresis, selective 36625 Insertion catheter, artery 36680 Insert needle, bone cavity 37195 Thrombolytic therapy, stroke 37200 Transcatheter biopsy 37203 Transcatheter retrieval 37204 Transcatheter occlusion 37209 Exchange arterial catheter 37785 Ligate/divide/excise vein 38200 Injection for spleen x-ray 38204 Bl donor search management 38205 Harvest allogenic stem cells 38206 Harvest auto stem cells 38207 Cryopreserve stem cells 38208 Thaw preserved stem cells 38209 Wash harvest stem cells 38210 T-cell depletion of harvest 38211 Tumor cell deplete of harvst 38212 Rbc depletion of harvest 38213 Platelet deplete of harvest 38214 Volume deplete of harvest 38215 Harvest stem cell concentrte 38240 Bone marrow/stem transplant 38241 Bone marrow/stem transplant 38242 Lymphocyte infuse transplant 38305 Drainage, lymph node lesion 38308 Incision of lymph channels 38380 Thoracic duct procedure 38520 Biopsy/removal, lymph nodes 38542 Explore deep node(s), neck 38700 Removal of lymph nodes, neck 38720 Removal of lymph nodes, neck 38724 Removal of lymph nodes, neck 40500 Partial excision of lip 40510 Partial excision of lip 40520 Partial excision of lip 40525 Reconstruct lip with flap 40527 Reconstruct lip with flap 40530 Partial removal of lip 40650 Repair lip 40652 Repair lip 40654 Repair lip 40700 Repair cleft lip/nasal 40701 Repair cleft lip/nasal 40702 Repair cleft lip/nasal 40720 Repair cleft lip/nasal 40761 Repair cleft lip/nasal 40800 Drainage of mouth lesion 40801 Drainage of mouth lesion 40804 Removal, foreign body, mouth 40805 Removal, foreign body, mouth 40806 Incision of lip fold


## 47699

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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CPT code Short descriptors

40808 Biopsy of mouth lesion 40810 Excision of mouth lesion 40812 Excise/repair mouth lesion 40814 Excise/repair mouth lesion 40816 Excision of mouth lesion 40818 Excise oral mucosa for graft 40819 Excise lip or cheek fold 40820 Treatment of mouth lesion 40830 Repair mouth laceration 40831 Repair mouth laceration 40840 Reconstruction of mouth 40842 Reconstruction of mouth 40843 Reconstruction of mouth 40844 Reconstruction of mouth 40845 Reconstruction of mouth 41005 Drainage of mouth lesion 41006 Drainage of mouth lesion 41007 Drainage of mouth lesion 41008 Drainage of mouth lesion 41009 Drainage of mouth lesion 41010 Incision of tongue fold 41015 Drainage of mouth lesion 41016 Drainage of mouth lesion 41017 Drainage of mouth lesion 41018 Drainage of mouth lesion 41110 Excision of tongue lesion 41112 Excision of tongue lesion 41113 Excision of tongue lesion 41114 Excision of tongue lesion 41115 Excision of tongue fold 41116 Excision of mouth lesion 41120 Partial removal of tongue 41130 Partial removal of tongue 41135 Tongue and neck surgery 41140 Removal of tongue 41145 Tongue removal, neck surgery 41150 Tongue, mouth, jaw surgery 41153 Tongue, mouth, neck surgery 41155 Tongue, jaw, & neck surgery 41500 Fixation of tongue 41510 Tongue to lip surgery 41520 Reconstruction, tongue fold 41823 Excision of gum lesion 41827 Excision of gum lesion 41872 Repair gum 41874 Repair tooth socket 42107 Excision lesion, mouth roof 42120 Remove palate/lesion 42140 Excision of uvula 42145 Repair palate, pharynx/uvula 42200 Reconstruct cleft palate 42205 Reconstruct cleft palate 42210 Reconstruct cleft palate 42215 Reconstruct cleft palate 42220 Reconstruct cleft palate 42225 Reconstruct cleft palate 42226 Lengthening of palate 42227 Lengthening of palate 42235 Repair palate 42260 Repair nose to lip fistula 42305 Drainage of salivary gland 42325 Create salivary cyst drain 42326 Create salivary cyst drain 

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CPT code Short descriptors

42335 Removal of salivary stone 42340 Removal of salivary stone 42408 Excision of salivary cyst 42409 Drainage of salivary cyst 42410 Excise parotid gland/lesion 42415 Excise parotid gland/lesion 42420 Excise parotid gland/lesion 42425 Excise parotid gland/lesion 42426 Excise parotid gland/lesion 42440 Excise submaxillary gland 42450 Excise sublingual gland 42500 Repair salivary duct 42505 Repair salivary duct 42507 Parotid duct diversion 42508 Parotid duct diversion 42509 Parotid duct diversion 42510 Parotid duct diversion 42550 Injection for salivary x-ray 42600 Closure of salivary fistula 42665 Ligation of salivary duct 42725 Drainage of throat abscess 42810 Excision of neck cyst 42815 Excision of neck cyst 42820 Remove tonsils and adenoids 42821 Remove tonsils and adenoids 42825 Removal of tonsils 42826 Removal of tonsils 42830 Removal of adenoids 42831 Removal of adenoids 42835 Removal of adenoids 42836 Removal of adenoids 42842 Extensive surgery of throat 42844 Extensive surgery of throat 42845 Extensive surgery of throat 42860 Excision of tonsil tags 42870 Excision of lingual tonsil 42890 Partial removal of pharynx 42892 Revision of pharyngeal walls 42894 Revision of pharyngeal walls 42950 Reconstruction of throat 42953 Repair throat, esophagus 42955 Surgical opening of throat 42961 Control throat bleeding 42962 Control throat bleeding 42970 Control nose/throat bleeding 42971 Control nose/throat bleeding 42972 Control nose/throat bleeding 43020 Incision of esophagus 43030 Throat muscle surgery 43600 Biopsy of stomach 43761 Reposition gastrostomy tube 44100 Biopsy of bowel 44385 Endoscopy of bowel pouch 44386 Endoscopy, bowel pouch/biop 44500 Intro, gastrointestinal tube 44701 Intraop colon lavage add-on 44901 Drain app abscess, percut 45005 Drainage of rectal abscess 45520 Treatment of rectal prolapse 45915 Remove rectal obstruction 46040 Incision of rectal abscess 46200 Removal of anal fissure 46210 Removal of anal crypt 

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CPT code Short descriptors

46211 Removal of anal crypts 46221 Ligation of hemorrhoid(s) 46250 Hemorrhoidectomy 46255 Hemorrhoidectomy 46270 Removal of anal fistula 46275 Removal of anal fistula 46285 Removal of anal fistula 46500 Injection into hemorrhoid(s) 46900 Destruction, anal lesion(s) 46910 Destruction, anal lesion(s) 46934 Destruction of hemorrhoids 46936 Destruction of hemorrhoids 46938 Cryotherapy of rectal lesion 46945 Ligation of hemorrhoids 46946 Ligation of hemorrhoids 47135 Transplantation of liver 47136 Transplantation of liver 47140 Partial removal, donor liver 47141 Partial removal, donor liver 47142 Partial removal, donor liver 47500 Injection for liver x-rays 47525 Change bile duct catheter 47530 Revise/reinsert bile tube 47553 Biliary endoscopy thru skin 47556 Biliary endoscopy thru skin 47561 Laparo w/cholangio/biopsy 48511 Drain pancreatic pseudocyst 48554 Transpl allograft pancreas 48556 Removal, allograft pancreas 49021 Drain abdominal abscess 49041 Drain, percut, abdom abscess 49061 Drain, percut, retroper absc 49400 Air injection into abdomen 49423 Exchange drainage catheter 49424 Assess cyst, contrast inject 49427 Injection, abdominal shunt 49505 Prp i/hern init reduc>5 yr 50010 Exploration of kidney 50020 Renal abscess, open drain 50021 Renal abscess, percut drain 50040 Drainage of kidney 50045 Exploration of kidney 50060 Removal of kidney stone 50065 Incision of kidney 50070 Incision of kidney 50075 Removal of kidney stone 50080 Removal of kidney stone 50081 Removal of kidney stone 50100 Revise kidney blood vessels 50120 Exploration of kidney 50125 Explore and drain kidney 50130 Removal of kidney stone 50135 Exploration of kidney 50200 Biopsy of kidney 50205 Biopsy of kidney 50220 Remove kidney, open 50225 Removal kidney open, complex 50230 Removal kidney open, radical 50234 Removal of kidney & ureter 50236 Removal of kidney & ureter 50240 Partial removal of kidney 50280 Removal of kidney lesion 50290 Removal of kidney lesion


## 47700

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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CPT code Short descriptors

50300 Removal of donor kidney 50320 Removal of donor kidney 50340 Removal of kidney 50360 Transplantation of kidney 50365 Transplantation of kidney 50370 Remove transplanted kidney 50380 Reimplantation of kidney 50390 Drainage of kidney lesion 50392 Insert kidney drain 50393 Insert ureteral tube 50394 Injection for kidney x-ray 50395 Create passage to kidney 50396 Measure kidney pressure 50398 Change kidney tube 50400 Revision of kidney/ureter 50405 Revision of kidney/ureter 50500 Repair of kidney wound 50520 Close kidney-skin fistula 50525 Repair renal-abdomen fistula 50526 Repair renal-abdomen fistula 50540 Revision of horseshoe kidney 50541 Laparo ablate renal cyst 50542 Laparo ablate renal mass 50544 Laparoscopy, pyeloplasty 50545 Laparo radical nephrectomy 50546 Laparoscopic nephrectomy 50547 Laparo removal donor kidney 50548 Laparo remove w/ ureter 50551 Kidney endoscopy 50553 Kidney endoscopy 50555 Kidney endoscopy & biopsy 50555 Kidney endoscopy & biopsy 50557 Kidney endoscopy & treatment 50559 Renal endoscopy/radiotracer 50561 Kidney endoscopy & treatment 50562 Renal scope w/tumor resect 50570 Kidney endoscopy 50572 Kidney endoscopy 50574 Kidney endoscopy & biopsy 50575 Kidney endoscopy 50576 Kidney endoscopy & treatment 50578 Renal endoscopy/radiotracer 50580 Kidney endoscopy & treatment 50590 Fragmenting of kidney stone 50600 Exploration of ureter 50605 Insert ureteral support 50610 Removal of ureter stone 50620 Removal of ureter stone 50630 Removal of ureter stone 50650 Removal of ureter 50660 Removal of ureter 50684 Injection for ureter x-ray 50686 Measure ureter pressure 50688 Change of ureter tube 50690 Injection for ureter x-ray 50700 Revision of ureter 50715 Release of ureter 50722 Release of ureter 50725 Release/revise ureter
50727 Revise ureter 50728 Revise ureter 50740 Fusion of ureter & kidney 50750 Fusion of ureter & kidney 

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CPT code Short descriptors

50760 Fusion of ureters 50770 Splicing of ureters 50780 Reimplant ureter in bladder 50782 Reimplant ureter in bladder 50783 Reimplant ureter in bladder 50785 Reimplant ureter in bladder 50800 Implant ureter in bowel 50810 Fusion of ureter & bowel 50815 Urine shunt to intestine 50820 Construct bowel bladder 50825 Construct bowel bladder 50830 Revise urine flow 50840 Replace ureter by bowel 50845 Appendico-vesicostomy 50860 Transplant ureter to skin 50900 Repair of ureter 50920 Closure ureter/skin fistula 50930 Closure ureter/bowel fistula 50940 Release of ureter 50945 Laparoscopy ureterolithotomy 50947 Laparo new ureter/bladder 50948 Laparo new ureter/bladder 50949 Laparoscope proc, ureter 50951 Endoscopy of ureter 50953 Endoscopy of ureter 50955 Ureter endoscopy & biopsy 50957 Ureter endoscopy & treatment 50959 Ureter endoscopy & tracer 50961 Ureter endoscopy & treatment 50970 Ureter endoscopy 50972 Ureter endoscopy & catheter 50974 Ureter endoscopy & biopsy 50976 Ureter endoscopy & treatment 50978 Ureter endoscopy & tracer 50980 Ureter endoscopy & treatment 52007 Cystoscopy and biopsy 52010 Cystoscopy & duct catheter 52204 Cystoscopy 52214 Cystoscopy and treatment 52224 Cystoscopy and treatment 52234 Cystoscopy and treatment 52235 Cystoscopy and treatment 52240 Cystoscopy and treatment 52265 Cystoscopy and treatment 52270 Cystoscopy & revise urethra 52275 Cystoscopy & revise urethra 52310 Cystoscopy and treatment 52315 Cystoscopy and treatment
52317 Remove bladder stone 52327 Cystoscopy, inject material 52330 Cystoscopy and treatment 52332 Cystoscopy and treatment 53040 Drainage of urethra abscess 53060 Drainage of urethra abscess 53200 Biopsy of urethra 53260 Treatment of urethra lesion 53265 Treatment of urethra lesion 53270 Removal of urethra gland 53605 Dilate urethra stricture 53665 Dilation of urethra 53850 Prostatic microwave thermotx 53852 Prostatic rf thermotx 53853 Prostatic water thermother 

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CPT code Short descriptors

54000 Slitting of prepuce 54001 Slitting of prepuce 54056 Cryosurgery, penis lesion(s) 54057 Laser surg, penis lesion(s) 54060 Excision of penis lesion(s) 54065 Destruction, penis lesion(s) 54105 Biopsy of penis 54110 Treatment of penis lesion 54111 Treat penis lesion, graft 54112 Treat penis lesion, graft 54115 Treatment of penis lesion 54120 Partial removal of penis 54125 Removal of penis 54130 Remove penis & nodes 54135 Remove penis & nodes 54150 Circumcision 54160 Circumcision 54162 Lysis penil circumic lesion 55110 Explore scrotum 55120 Removal of scrotum lesion 55150 Removal of scrotum 55175 Revision of scrotum 55180 Revision of scrotum 55200 Incision of sperm duct 55250 Removal of sperm duct(s) 55400 Repair of sperm duct 56605 Biopsy of vulva/perineum 56700 Partial removal of hymen 56720 Incision of hymen 56740 Remove vagina gland lesion 57100 Biopsy of vagina 57105 Biopsy of vagina 57160 Insert pessary/other device 57400 Dilation of vagina 57452 Exam of cervix w/scope 57454 Bx/curett of cervix w/scope 57460 Bx of cervix w/scope, leep 57500 Biopsy of cervix 57520 Conization of cervix 57522 Conization of cervix 58555 Hysteroscopy, dx, sep proc 58558 Hysteroscopy, biopsy 58559 Hysteroscopy, lysis 58560 Hysteroscopy, resect septum 58561 Hysteroscopy, remove myoma 58562 Hysteroscopy, remove fb 58800 Drainage of ovarian cyst(s) 58823 Drain pelvic abscess, percut 59030 Fetal scalp blood sample 59140 Treat ectopic pregnancy 59320 Revision of cervix 59325 Revision of cervix 59350 Repair of uterus 59820 Care of miscarriage 59821 Treatment of miscarriage 61107 Drill skull for implantation 61210 Pierce skull, implant device 61316 Implt cran bone flap to abdo 61517 Implt brain chemotx add-on 61576 Skull base/brainstem surgery 61864 Implant neuroelectrde, add ’ l 61868 Implant neuroelectrde, add ’ l 62120 Repair skull cavity lesion


## 47701

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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CPT code Short descriptors

62121 Incise skull repair 62148 Retr bone flap to fix skull 62160 Neuroendoscopy add-on 62270 Spinal fluid tap, diagnostic 62272 Drain cerebro spinal fluid 62273 Treat epidural spine lesion 62280 Treat spinal cord lesion 62281 Treat spinal cord lesion 62282 Treat spinal canal lesion 62284 Injection for myelogram 62290 Inject for spine disk x-ray 62291 Inject for spine disk x-ray 62310 Inject spine c/t 62311 Inject spine l/s (cd) 62318 Inject spine w/cath, c/t 62319 Inject spine w/cath l/s (cd) 62367 Analyze spine infusion pump 62368 Analyze spine infusion pump 63048 Remove spinal lamina add-on 63057 Decompress spine cord add-on 63066 Decompress spine cord add-on 63076 Neck spine disk surgery 63078 Spine disk surgery, thorax 63082 Remove vertebral body add-on 63086 Remove vertebral body add-on 63088 Remove vertebral body add-on 63091 Remove vertebral body add-on 63103 Remove vertebral body add-on 63308 Remove vertebral body add-on 64400 N block inj, trigeminal 64402 N block inj, facial 64405 N block inj, occipital 64408 N block inj, vagus 64410 N block inj, phrenic 64412 N block inj, spinal accessor 64413 N block inj, cervical plexus 64415 N block inj, brachial plexus 64417 N block inj, axillary 64418 N block inj, suprascapular 64420 N block inj, intercost, sng 64421 N block inj, intercost, mlt 64425 N block inj ilio-ing/hypogi 64430 N block inj, pudendal 64435 N block inj, paracervical 64445 N block inj, sciatic, sng 64450 N block, other peripheral 64470 Inj paravertebral c/t 64472 Inj paravertebral c/t add-on 64475 Inj paravertebral l/s 64476 Inj paravertebral l/s add-on 64479 Inj foramen epidural c/t 64480 Inj foramen epidural add-on 64483 Inj foramen epidural l/s 64484 Inj foramen epidural add-on 64505 N block, spenopalatine gangl 64508 N block, carotid sinus s/p 64510 N block, stellate ganglion 64520 N block, lumbar/thoracic 64530 N block inj, celiac pelus 64561 Implant neuroelectrodes 64600 Injection treatment of nerve 64605 Injection treatment of nerve 64610 Injection treatment of nerve 

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CPT code Short descriptors

64612 Destroy nerve, face muscle 64613 Destroy nerve, spine muscle 64614 Destroy nerve, extrem musc 64620 Injection treatment of nerve 64622 Destr paravertebrl nerve l/s 64623 Destr paravertebral n add-on 64626 Destr paravertebrl nerve c/t 64627 Destr paravertebral n add-on 64630 Injection treatment of nerve 64640 Injection treatment of nerve 64680 Injection treatment of nerve 64716 Revision of cranial nerve 64740 Incision of tongue nerve 64778 Digit nerve surgery add-on 64864 Repair of facial nerve 64865 Repair of facial nerve 64866 Fusion of facial/other nerve 64868 Fusion of facial/other nerve 64885 Nerve graft, head or neck 64886 Nerve graft, head or neck 65125 Revise ocular implant 65205 Remove foreign body from eye 65210 Remove foreign body from eye 65220 Remove foreign body from eye 65222 Remove foreign body from eye 65270 Repair of eye wound 65272 Repair of eye wound 65273 Repair of eye wound 65275 Repair of eye wound 65280 Repair of eye wound 65285 Repair of eye wound 65286 Repair of eye wound 65290 Repair of eye socket wound 65400 Removal of eye lesion 65410 Biopsy of cornea 65420 Removal of eye lesion 65426 Removal of eye lesion 65430 Corneal smear 65435 Curette/treat cornea 65436 Curette/treat cornea 65450 Treatment of corneal lesion 65600 Revision of cornea 65771 Radial keratotomy 65772 Correction of astigmatism 65800 Drainage of eye 65805 Drainage of eye 65810 Drainage of eye 65815 Drainage of eye 65855 Laser surgery of eye 65860 Incise inner eye adhesions 66020 Injection treatment of eye 66030 Injection treatment of eye 66130 Remove eye lesion 66250 Follow-up surgery of eye 66625 Removal of iris 66630 Removal of iris 66635 Removal of iris 66990 Ophthalmic endoscope add-on 67025 Replace eye fluid 67027 Implant eye drug system 67028 Injection eye drug 67031 Laser surgery, eye strands 67101 Repair detached retina 

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CPT code Short descriptors

67105 Repair detached retina 67107 Repair detached retina 67108 Repair detached retina 67110 Repair detached retina 67112 Rerepair detached retina 67115 Release encircling material 67120 Remove eye implant material 67121 Remove eye implant material 67141 Treatment of retina 67145 Treatment of retina 67345 Destroy nerve of eye muscle 67500 Inject/treat eye socket 67505 Inject/treat eye socket 67515 Inject/treat eye socket 67700 Drainage of eyelid abscess 67710 Incision of eyelid 67715 Incision of eyelid fold 67800 Remove eyelid lesion 67801 Remove eyelid lesions 67805 Remove eyelid lesions 67808 Remove eyelid lesion(s) 67820 Revise eyelashes 67825 Revise eyelashes 67830 Revise eyelashes 67840 Remove eyelid lesion 67850 Treat eyelid lesion 67875 Closure of eyelid by suture 67880 Revision of eyelid 67882 Revision of eyelid 67900 Repair brow defect 67901 Repair eyelid defect 67902 Repair eyelid defect 67903 Repair eyelid defect 67904 Repair eyelid defect 67906 Repair eyelid defect 67908 Repair eyelid defect 67909 Repair eyelid defect 67911 Repair eyelid defect 67914 Repair eyelid defect 67915 Repair eyelid defect 67916 Repair eyelid defect 67917 Repair eyelid defect 67921 Repair eyelid defect 67922 Repair eyelid defect 67923 Repair eyelid defect 67924 Repair eyelid defect 67930 Repair eyelid wound 67935 Repair eyelid wound 67938 Remove eyelid foreign body 67950 Revision of eyelid 67961 Revision of eyelid 67966 Revision of eyelid 67971 Reconstruction of eyelid 67973 Reconstruction of eyelid 67974 Reconstruction of eyelid 67975 Reconstruction of eyelid 68020 Incise/drain eyelid lining 68040 Treatment of eyelid lesions 68100 Biopsy of eyelid lining 68110 Remove eyelid lining lesion 68115 Remove eyelid lining lesion 68130 Remove eyelid lining lesion 68135 Remove eyelid lining lesion


## 47702

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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CPT code Short descriptors

68200 Treat eyelid by injection 68320 Revise/graft eyelid lining 68325 Revise/graft eyelid lining 68326 Revise/graft eyelid lining 68328 Revise/graft eyelid lining 68330 Revise eyelid lining 68335 Revise/graft eyelid lining 68340 Separate eyelid adhesions 68360 Revise eyelid lining 68362 Revise eyelid lining 68440 Incise tear duct opening 68700 Repair tear ducts 68705 Revise tear duct opening 68760 Close tear duct opening 68761 Close tear duct opening 68770 Close tear duct opening 68801 Dilate tear duct opening 68810 Probe nasolacrimal duct 68811 Probe nasolacrimal duct 68815 Probe nasolacrimal duct 68840 Explore/irrigate tear ducts 68850 Injection for tear sac x-ray 69110 Remove external ear, partial 69120 Removal of external ear 69140 Remove ear canal lesion(s) 69145 Remove ear canal lesion(s) 69150 Extensive ear canal surgery 69155 Extensive ear/neck surgery 69310 Rebuild outer ear canal 69320 Rebuild outer ear canal 69440 Exploration of middle ear 69450 Eardrum revision 69501 Mastoidectomy 69502 Mastoidectomy 69505 Remove mastoid structures 69511 Extensive mastoid surgery 69530 Extensive mastoid surgery 69535 Remove part of temporal bone 69550 Remove ear lesion 69552 Remove ear lesion 69554 Remove ear lesion 69601 Mastoid surgery revision 69602 Mastoid surgery revision 69603 Mastoid surgery revision 69604 Mastoid surgery revision 69605 Mastoid surgery revision 69620 Repair of eardrum 69631 Repair eardrum structures 69632 Rebuild eardrum structures 69633 Rebuild eardrum structures 69635 Repair eardrum structures 69636 Rebuild eardrum structures 69637 Rebuild eardrum structures 69641 Revise middle ear & mastoid 69642 Revise middle ear & mastoid 69643 Revise middle ear & mastoid 69644 Revise middle ear & mastoid 69645 Revise middle ear & mastoid 69646 Revise middle ear & mastoid 69650 Release middle ear bone 69660 Revise middle ear bone 69661 Revise middle ear bone 69662 Revise middle ear bone 

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CPT code Short descriptors

69666 Repair middle ear structures 69667 Repair middle ear structures 69670 Remove mastoid air cells 69676 Remove middle ear nerve 69700 Close mastoid fistula 69711 Remove/repair hearing aid 69714 Implant temple bone w/stimul 69715 Temple bne implnt w/stimulat 69717 Temple bone implant revision 69718 Revise temple bone implant 69720 Release facial nerve 69725 Release facial nerve 69740 Repair facial nerve 69745 Repair facial nerve 69801 Incise inner ear 69802 Incise inner ear 69805 Explore inner ear 69806 Explore inner ear 69820 Establish inner ear window 69840 Revise inner ear window 69905 Remove inner ear 69910 Remove inner ear & mastoid 69915 Incise inner ear nerve 69930 Implant cochlear device 69950 Incise inner ear nerve 69955 Release facial nerve 69960 Release inner ear canal 69970 Remove inner ear lesion 69990 Microsurgery add-on 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 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 

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### — Continued

CPT code Short descriptors

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 70542 Mri orbit/face/neck w/dye 70543 Mri orbt/fac/nck w/o & w dye 70552 Mri brain w/ dye 70553 Mri brain w/o & w/ dye 70557 Mri brain w/o dye 70558 Mri brain w/ dye 70559 Mri brain w/o & w/ dye 71010 Chest x-ray 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 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


## 47703

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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CPT code Short descriptors

72131 Ct lumbar spine w/o dye 72132 Ct lumbar spine w/dye 72133 Ct lumbar spine w/o & w/dye 72142 Mri neck spine w/dye 72147 Mri chest spine w/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 72192 Ct pelvis w/o dye 72193 Ct pelvis w/dye 72194 Ct pelvis w/o & w/dye 72196 Mri pelvis w/dye 72197 Mri pelvis w/o & w/dye 72198 Mr angio pelvis w/o & w/dye 72200 X-ray exam sacroiliac joints 72202 X-ray exam sacroiliac joints 72220 X-ray exam of tailbone 72240 Contrast x-ray of neck spine 72255 Contrast x-ray, thorax spine 72270 Contrast x-ray, spine 72275 Epidurography 72285 X-ray c/t spine disk 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 73219 Mri upper extremity w/dye 73220 Mri uppr extremity w/o&w/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 

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CPT code Short descriptors

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 73719 Mri lower extremity w/dye 73720 Mri lwr extremity w/o&w/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 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 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 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 74420 Contrst x-ray, urinary tract 74425 Contrst x-ray, urinary tract 74440 X-ray, male genital tract 

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### — Continued

CPT code Short descriptors

74445 X-ray exam of penis 74450 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 74742 X-ray, fallopian tube 74775 X-ray exam of perineum 75553 Heart mri for morph w/dye 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 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 74250 X-ray exam of small bowel 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


## 47704

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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### — Continued

CPT code Short descriptors

75894 X-rays, transcath therapy 75896 X-rays, transcath therapy 75898 Follow-up angiography 75900 Arterial catheter exchange 75940 X-ray placement, vein filter 75952 Endovasc repair abdom aorta 75953 Abdom aneurysm endovas rpr 75954 Iliac aneurysm endovas rpr 75960 Transcatheter intro, stent 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 75993 Atherectomy, x-ray exam 75994 Atherectomy, x-ray exam 75995 Atherectomy, x-ray exam 75996 Atherectomy, x-ray exam 76001 Fluoroscope exam, extensive 76003 Needle localization by x-ray 76005 Fluoroguide for spine inject 76006 X-ray stress view 76010 X-ray, nose to rectum 76012 Percut vertebroplasty fluor 76013 Percut vertebroplasty, ct 76020 X-rays for bone age 76040 X-rays, bone evaluation 76061 X-rays, bone survey 76062 X-rays, bone survey 76065 X-rays, bone evaluation 76066 Joint survey, single view 76070 Ct bone density, axial 76075 Dexa, axial skeleton study 76076 Dexa, peripheral study 76078 Radiographic absorptiometry 76080 X-ray exam of fistula 76086 X-ray of mammary duct 76088 X-ray of mammary ducts 76090 Mammogram, one breast 76091 Mammogram, both breasts 76092 Mammogram, screening 76093 Magnetic image, breast 76094 Magnetic image, both breasts 76095 Stereotactic breast biopsy 76096 X-ray of needle wire, breast 76096 X-ray of needle wire, breast 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 76350 Special x-ray contrast study 76355 Ct scan for localization 76360 Ct scan for needle biopsy 76362 Ct guide for tissue ablation 76362 Ct guide for tissue ablation 76370 Ct scan for therapy guide 

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### — Continued

CPT code Short descriptors

76375 3d/holograph reconstr add-on 76380 CAT scan follow-up study 76390 Mr spectroscopy 76394 Mri for tissue ablation 76394 Mri for tissue ablation 76604 Us exam, chest, b-scan 76645 Us exam, breast(s) 76700 Us exam, abdom, complete 76705 Echo exam of abdomen 76775 Us exam abdo back wall, lim 76800 Us exam, spinal canal 76886 Us exam infant hips, static 76932 Echo guide for heart biopsy 76936 Echo guide for artery repair 76941 Us guide, tissue ablation 76941 Echo guide for transfusion 76945 Echo guide for transfusion 76946 Echo guide, villus sampling 76948 Echo guide for amniocentesis 76950 Echo guide, ova aspiration 76965 Echo guidance radiotherapy 76970 Echo guidance radiotherapy 76977 Ultrasound exam follow-up 76986 Us bone density measure 77295 Ultrasound guide intraoper 77326 Set radiation therapy field 77327 Brachytx isodose calc simp 77328 Brachytx isodose calc interm 77427 Brachytx isodose plan compl 77431 Radiation tx management, x5 77470 Stereotactic radiation trmt 77600 Special radiation treatment 77605 Hyperthermia treatment 77610 Hyperthermia treatment 77615 Hyperthermia treatment 77620 Hyperthermia treatment 77750 Hyperthermia treatment 77761 Infuse radioactive materials 77762 Apply intrcav radiat simple 77763 Apply intrcav radiat interm 77776 Apply intrcav radiat compl 77777 Apply interstit radiat simpl 77778 Apply interstit radiat inter 77790 Apply surface radiation 78000 Radiation handling 78001 Thyroid, single uptake 78003 Thyroid, multiple uptakes 78006 Thyroid suppress/stimul 78007 Thyroid imaging with uptake 78010 Thyroid image, mult uptakes 78011 Thyroid imaging 78015 Thyroid imaging with flow 78016 Thyroid met imaging 78018 Thyroid met imaging/studies 78020 Thyroid met imaging, body 78070 Thyroid met uptake 78075 Parathyroid nuclear imaging 78102 Adrenal nuclear imaging 78103 Bone marrow imaging, ltd 78104 Bone marrow imaging, mult 78110 Bone marrow imaging, body 78111 Plasma volume, single 78120 Plasma volume, multiple 

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### — Continued

CPT code Short descriptors

78121 Red cell mass, single 78122 Red cell mass, multiple 78130 Blood volume 78135 Red cell survival study 78140 Red cell survival kinetics 78185 Total body iron estimation 78190 Spleen imaging 78191 Platelet survival, kinetics 78195 Platelet survival 78201 Lymph system imaging 78202 Liver imaging 78205 Liver imaging with flow 78215 Liver image (3d) with flow 78216 Liver and spleen imaging 78220 Liver & spleen image/flow 78223 Liver function study 78230 Hepatobiliary imaging 78231 Salivary gland imaging 78232 Serial salivary imaging 78258 Salivary gland function exam 78261 Esophageal motility study 78262 Gastric mucosa imaging 78264 Gastroesophageal reflux exam 78270 Gastric emptying study 78271 Vit B-12 absorption exam 78272 Vit b-12 absrp exam, int fac 78278 Vit B-12 absorp, combined 78290 GI protein loss exam 78291 Meckel ’ s divert exam 78300 Leveen/shunt patency exam 78305 Bone imaging, limited area 78306 Bone imaging, multiple areas 78315 Bone imaging, whole body 78320 Bone imaging, 3 phase 78428 Bone mineral, dual photon 78445 Cardiac shunt imaging 78456 Venous thrombosis study 78457 Acute venous thrombus image 78458 Venous thrombosis imaging 78460 Ven thrombosis images, bilat 78461 Heart muscle blood, single 78464 Heart muscle blood, multiple 78466 Heart image (3d), single 78468 Heart infarct image 78469 Heart infarct image (ef) 78472 Heart infarct image (3D) 78473 Gated heart, planar, single 78478 Gated heart, multiple
78480 Heart wall motion add-on 78481 Heart function add-on 78483 Heart first pass, single 78494 Heart first pass, multiple 78496 Heart image, spect 78580 Heart first pass add-on 78584 Lung perfusion imaging 78585 Lung V/Q image single breath 78586 Lung V/Q imaging 78587 Aerosol lung image, single 78588 Aerosol lung image, multiple 78591 Perfusion lung image 78593 Vent image, 1 breath, 1 proj 78594 Vent image, 1 proj, gas 78596 Vent image, mult proj, gas


## 47705

—————————— Some of these codes have previously been refined and additional refinements were made by the PEAC. All anesthesia codes were reviewed with the exception of 00104 abd 00124. CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

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### — Continued

CPT code Short descriptors

78601 Brain imaging, ltd static 78605 Brain imaging, ltd w/flow 78606 Brain imaging, complete 78610 Brain imaging (3D) 78615 Brain flow imaging only 78630 Cerebral vascular flow image 78635 Cerebrospinal fluid scan 78645 CSF ventriculography 78650 Cerebrospinal fluid scan 78660 CSF leakage imaging 78700 Nuclear exam of tear flow 78701 Kidney imaging, static 78704 Kidney imaging with flow 78707 Imaging renogram 78708 Kidney flow/function image 78709 Kidney flow/function image 78710 Kidney flow/function image 78715 Kidney imaging (3D) 78725 Renal vascular flow exam 78730 Kidney function study 78740 Urinary bladder retention 78760 Ureteral reflux study 78761 Testicular imaging 78800 Testicular imaging/flow 78801 Tumor imaging, limited area 78802 Tumor imaging, mult areas 78804 Tumor imaging (3D) 78805 Tumor imaging, whole body 78806 Abscess imaging, ltd area 78890 Nuclear localization/abscess 78891 Nuclear medicine data proc 85396 Nuclear joint therapy 88125 TB tine test 88141 Forensic cytopathology 88348 Cytopath, c/v, interpret 88349 Electron microscopy 90865 Sample stomach contents 90870 Narcosynthesis 90875 Electroconvulsive therapy 90876 Psychophysiological therapy 90885 Hypnotherapy 91000 Psy evaluation of records 91010 Esophageal intubation 91011 Esophagus motility study 91012 Esophagus motility study 91020 Esophagus motility study 91030 Gastric motility 91052 Prolonged acid reflux test 91055 Gastric analysis test 91060 Gastric intubation for smear 91065 Gastric saline load test 91100 Breath hydrogen test 91105 Pass intestine bleeding tube 91122 Gastric intubation treatment 91123 Anal pressure record 91132 Irrigate fecal impaction 91133 Electrogastrography 92325 Prescription of contact lens 92326 Modification of contact lens 92354 Fitting of artificial eye 92355 Special spectacles fitting 92358 Special spectacles fitting 92371 Eye prosthesis service 

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### — Continued

CPT code Short descriptors

92392 Repair & adjust spectacles 92393 Supply of low vision aids 92395 Supply of artificial eye 92512 Supply of contact lenses 92516 Nasal function studies 92547 Facial nerve function test 92548 Supplemental electrical test 92565 Posturography 92571 Stenger test, pure tone 92572 Filtered speech hearing test 92573 Staggered spondaic word test 92575 Lombard test 92576 Sensorineural acuity test 92577 Synthetic sentence test 92579 Stenger test, speech 92582 Visual audiometry (vra) 92583 Conditioning play audiometry 92584 Select picture audiometry 92585 Electrocochleography 92586 Auditor evoke potent, compre 92587 Auditor evoke potent, limit 92588 Evoked auditory test 92596 Evoked auditory test 92950 Oral speech device eval 92975 Cardioassist, external 93012 Dissolve clot, heart vessel 93014 Transmission of ecg 93224 Cardiac drug stress test 93225 ECG monitor/report, 24 hrs 93226 ECG monitor/record, 24 hrs 93227 ECG monitor/report, 24 hrs 93230 ECG monitor/review, 24 hrs 93231 ECG monitor/report, 24 hrs 93232 Ecg monitor/record, 24 hrs 93235 ECG monitor/report, 24 hrs 93236 ECG monitor/report, 24 hrs 93237 ECG monitor/report, 24 hrs 93268 ECG monitor/review, 24 hrs 93270 ECG record/review 93271 ECG recording 93272 Ecg/monitoring and analysis 93278 Ecg/review, interpret only 93318 Echo transesophageal 93501 Echo transesophageal intraop 93505 Right heart catheterization 93508 Biopsy of heart lining 93510 Cath placement, angiography 93526 Left heart catheterization 93555 R & l heart cath, congenital 93556 Imaging, cardiac cath 93609 Heart flow reserve measure 93613 Map tachycardia, add-on 93660 Electrophys map 3d, add-on 93721 Tilt table evaluation 93724 Plethysmography tracing 93727 Analyze pacemaker system 93731 Analyze ilr system 93732 Analyze pacemaker system 93734 Analyze pacemaker system 93735 Analyze pacemaker system 93741 Analyze pacemaker system 93742 Analyze ht pace device sngl 93743 Analyze ht pace device sngl 

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### — Continued

CPT code Short descriptors

93744 Analyze ht pace device dual 93798 Cardiac rehab 93980 Cardiac rehab/monitor 93981 Penile vascular study 94070 Review patient spirometry 94450 CO2 breathing response curve 94770 Pulmonary compliance study 95044 Breath recording, infant 95052 Allergy patch tests 95056 Photo patch test 95070 Photosensitivity tests 95180 Ingestion challenge test 95250 Rapid desensitization 95806 Multiple sleep latency test 95819 Sleep study, attended 95824 Eeg, awake and asleep 95824 Eeg, cerebral death only 95827 Eeg, cerebral death only 95858 Tensilon test 95869 Tensilon test & myogram 95872 Muscle test, thor paraspinal 95920 Limb exercise test 95925 Intraop nerve test add-on 95926 Somatosensory testing 95927 Somatosensory testing 95930 Somatosensory testing 95936 Visual evoked potential test 95957 Eeg monitoring, cable/radio 95958 EEG digital analysis 95961 EEG monitoring/function test 95962 Electrode stimulation, brain 95970 Meg, evoked, each add ’ l 95971 Analyze neurostim, no prog 95972 Analyze neurostim, simple 95973 Analyze neurostim, complex 95974 Analyze neurostim, complex 95975 Cranial neurostim, complex 96902 Ultraviolet light therapy 99026 Wound(s) care, selective 99027 In-hospital on call service 99170 Out-of-hosp on call service 99175 Anogenital exam, child 99183 Induction of vomiting 99217 Total body hypothermia 99218 Observation care discharge 99219 Observation care 99220 Observation care 99221 Observation care 99222 Initial hospital care 99223 Initial hospital care 99231 Initial hospital care 99232 Subsequent hospital care 99233 Subsequent hospital care 99234 Subsequent hospital care 99235 Observ/hosp same date 99236 Observ/hosp same date 99238 Observ/hosp same date 99239 Hospital discharge day 99251 Office consultation 99252 Initial inpatient consult 99253 Initial inpatient consult 99254 Initial inpatient consult 99255 Initial inpatient consult


## 47706

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### — Continued

CPT code Short descriptors

99261 Initial inpatient consult 99262 Follow-up inpatient consult 99263 Follow-up inpatient consult 99271 Follow-up inpatient consult 99272 Confirmatory consultation 99273 Confirmatory consultation 99274 Confirmatory consultation 99275 Confirmatory consultation 99281 Confirmatory consultation 99282 Emergency dept visit 99283 Emergency dept visit 99284 Emergency dept visit 99285 Emergency dept visit 99288 Emergency dept visit 99289 Direct advanced life support 99290 Ped crit care transport 99291 Ped crit care transport addl 99292 Critical care, first hour 99293 Critical care, add ’ l 30 min 99294 Ped critical care, initial 99295 Ped critical care, subseq 99296 Neonate crit care, initial 99298 Neonate critical care subseq 99299 Ic for lbw infant < 1500 gm 99301 Ic, lbw infant 1500-2500 gm 99302 Nursing facility care 99303 Nursing facility care 99311 Nursing facility care 99312 Nursing fac care, subseq 99313 Nursing fac care, subseq 99315 Nursing fac care, subseq 99316 Nursing fac discharge day 99321 Nursing fac discharge day 99322 Rest home visit, new patient 

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### — Continued

CPT code Short descriptors

99323 Rest home visit, new patient 99331 Rest home visit, new patient 99332 Rest home visit, est pat 99333 Rest home visit, est pat 99341 Rest home visit, est pat 99342 Home visit, new patient 99343 Home visit, new patient 99344 Home visit, new patient 99345 Home visit, new patient 99347 Home visit, new patient 99348 Home visit, est patient 99349 Home visit, est patient 99350 Home visit, est patient 99354 Home visit, est patient 99355 Prolonged service, office 99356 Prolonged service, office 99357 Prolonged service, inpatient 99358 Prolonged service, inpatient 99359 Prolonged serv, w/o contact 99360 Prolonged serv, w/o contact 99361 Physician standby services 99362 Physician/team conference 99371 Physician/team conference 99372 Physician phone consultation 99373 Physician phone consultation 99374 Physician phone consultation 99375 Home health care supervision 99377 Home health care supervision 99378 Hospice care supervision 99379 Hospice care supervision 99380 Nursing fac care supervision 99381 Nursing fac care supervision 99382 Prev visit, new, infant 99383 Prev visit, new, age 1-4 

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### — Continued

CPT code Short descriptors

99384 Prev visit, new, age 5-11 99385 Prev visit, new, age 12-17 99386 Prev visit, new, age 18-39 99387 Prev visit, new, age 40-64 99391 Prev visit, new, 65 & over 99392 Prev visit, est, infant 99393 Prev visit, est, age 1-4 99394 Prev visit, est, age 5-11 99395 Prev visit, est, age 12-17 99396 Prev visit, est, age 18-39 99397 Prev visit, est, age 40-64 99401 Prev visit, est, 65 & over 99402 Preventive counseling, indiv 99403 Preventive counseling, indiv 99404 Preventive counseling, indiv 99411 Preventive counseling, indiv 99412 Preventive counseling, group 99420 Preventive counseling, group
99431 Health risk assessment test 99432 Initial care, normal newborn 99433 Newborn care, not in hosp 99435 Normal newborn care/hospital 99436 Newborn discharge day hosp 99440 Attendance, birth
99450 Newborn resuscitation 99455 Life/disability evaluation 99456 Disability examination

Some of these codes have previously been refined and additional refinements were made by the PEAC.

All anesthesia codes were reviewed with the exception of 00104 abd 00124.

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

### Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules


## 47707 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed RulesADDENDUMD.—PROPOSEDCHANGES TOPRACTICEEXPENSEEQUIPMENTDESCRIPTION, LIFE,ANDPRICINGEquip code2004 practice expense equipment details 2005 practice expense supply details (proposed)Description Life Price Description Life Price Equipment categoryE54006 ..... 22 channel EEG (split to separate systems) 7.0 $44,310.00 EEG, digital, prolonged testing system (computer w-remote camera).7 $46,750.00 Other EquipmentE54006 ..... 22 channel EEG (split to separate systems) 7.0 $44,310.00 EEG, digital, standard testing system (computer hardware & software).7 $21,000.00 Other EquipmentE54004 + .. 22 channel EMG-EP machine ....................... 7.0 $66,650.00 EMG-NCV-EP system, 8 channel .................. 10 $59,500.00 Other EquipmentE51028 ..... 2-D Scanning Densitometer ........................... 5.0 $6,000.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE55002 ..... 3 Channel ECG machine ............................... 5.0 $4,800.00 ECG, 3-channel .............................................. 7 $1,845.42 Other EquipmentE55005 ..... 3 channel ECG/BP monitor ............................ 5.0 $3,895.00 ECG, 3-channel (with SpO2, NIBP, temp,resp).7 $4,322.50 Other EquipmentE51034 ..... 30 cm Water Phantom w/ Manual positioner 5.0 $2,850.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE50002 ..... 35mm camera ................................................ 5.0 $1,150.00 camera, 35mm system (medical grade) ........5 $1,106.50 DocumentationE13623 ..... 37*, 60*, 90* degree oven ............................. 10.0 $682.00 oven, convection (lab) .................................... 10 $640.73 Laboratory3-D Phantom .................................................. 5.0 $1,084.00 phantom, 3-D ................................................. 10 $1,084.00 RadiologyE51032 ..... 3-D Water Scanning Phantom ....................... 5.0 $56,000.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE71025 ..... ABR machine, (Mikolay or Biologic) .............. 7.0 $23,000.00 ABR-auditory brainstem response system .... 7 $27,000.00Other EquipmentAccelerator, 4 MV .......................................... 5.0 $1,600,000.00 accelerator, 4-6 MV ........................................ 7 $1,408,491.00 RadiologyAccelerator, 6 MV .......................................... 5.0 $1,770,708.00 accelerator, 4-6 MV ........................................ 7 $1,408,491.00 RadiologyAccelerator, 18 MV ........................................ 5.0 $1,741,018.00 accelerator, 6-18 MV ...................................... 7 $1,832,941.00 RadiologyAccelerator, 20 MV ........................................ 5.0accelerator, 6-18 MV ...................................... 7 $1,832,941.00 Radiology.E52020 ..... Acusonic Sequoia C0256 ............................... 5.0 $250,000.00 ultrasound, echocardiography w-4 transducers (Sequoia C256).5 $248,000.00 Other EquipmentAdjustable computer table ............................. 7.0 $895.00 table, motorized (for instruments-equipment) 15 $895.00 FurnitureADL kit ............................................................ 7.0 $587.00 kit, ADL ........................................................... 10 $586.50 Other EquipmentADL kit ............................................................ 10.0 $586.00 kit, ADL ........................................................... 10 $586.50 Other Equipmentaerosol machine ............................................. 5.0 .............................. Deleted (less than $500) ................................ .......... .............................. No Detailsair compressor, safety .................................... 10.0 $575.00 air compressor, safety .................................... 12 $575.00 Other EquipmentE30026 ..... Albarran bridge ............................................... 7.5 $975.00 Albarran deflecting bridge, single channel..... 3 $988.00 Scopealternans system, CH2000 ............................. 8.0 $29,400.00 cardiac monitor w-treadmill (microvolt,CH2000).10 $32,600.00 Other Equipmentambulation kit (canes, walker, mirror, balance board, crutches, safety belt).10.0 $750.00 kit, ambulation ................................................ 10 $763.70 Other EquipmentE52015 ..... a-mode ultrasonic biometry unit ..................... 5.0 $6,950.00 ultrasonic biometry, A-scan ............................ 5 $5,247.50 Other Equipmentaneroid barometer .......................................... 5.0 $550.00 barometer, aneroid ......................................... 7 $587.50 RadiologyE30025 ..... anesthesia machine ....................................... 7.0 $49,035.00 anesthesia machine (w-vaporizers) ............... 7 $60,000.00 Other EquipmentE51084 ..... angiographic room ......................................... 5.0 $1,580,000.00 room, angiography ......................................... 5 $1,386,816.00 Room - LaneE71010 ..... anomaloscopes - diagnostic .......................... 5.0 $10,500.00 anomaloscope, diagnostic (HMC) .................. 10 $6,146.00 Other EquipmentE13116 ..... anoscope & light source ................................ 3.0 $550.00 anoscope with light source ............................ 3 $657.62 ScopeE51038 ..... Anthropomorphic Phantom ............................ 5.0 $8,250.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE51066 ..... Applicator sets for HDR ................................. 5.0 $3,333.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE51068 ..... Applicator sets for LDR .................................. 5.0 $2,723.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE72001 ..... argon laser ..................................................... 5.0 $45,000.00 laser, argon (w-slit lamp adapter) .................. 5 $32,900.00 Other EquipmentE72002 ..... argon-krypton laser ........................................ 5.0 $65,000.00 laser, argon-kripton ........................................ 5 $85,000.00 Other EquipmentE55035 ..... ART signal averaging machine ...................... 7.5 $8,250.00 ECG signal averaging system ....................... 5 $8,250.00 Other Equipmentaudio system, MRI ......................................... 10.0 $16,000.00 intercom (incl. master, pt substation, power,wiring).10 $1,630.00 Other EquipmentE71029 ..... audiometer ..................................................... 7.0 $5,495.00 audiometer, clinical-diagnostic ....................... 10 $6,250.00 Other EquipmentE71011 ..... auto lensometer ............................................. 5.0 $2,095.00 lensometer, auto ............................................ 7 $2,995.00 Other EquipmentE71026 ..... Autoacustic Emission Equipment ................... 7.0 $7,995.00 OAE-otoacoustic emission system ................ 7 $7,780.00 Other EquipmentE55024 ..... Autobox V6200 ............................................... 8.0 $22,985.00 Vmax 62j (body plethysmograph autobox) .... 8 $21,055.00 Other Equipmentautomated radio frequency generator ............ 5.0 $30,000.00 radiofrequency generator, TUNA procedure .. 5 $16,500.00 Other EquipmentE52016 ..... b scan ultrasonography .................................. 5.0 $24,975.00 ultrasonic biometry, B-scan ............................ 5 $12,500.00 Other EquipmentE13604 ..... balance ........................................................... 7.0 $2,400.00 balance, analytic ............................................ 10 $4,001.67 Laboratory


## 47708 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed RulesADDENDUMD.—PROPOSEDCHANGES TOPRACTICEEXPENSEEQUIPMENTDESCRIPTION, LIFE,ANDPRICING—ContinuedEquip code2004 practice expense equipment details 2005 practice expense supply details (proposed)Description Life Price Description Life Price Equipment categorybalance board ................................................ 10.0 $600.00 balance board ................................................ 15 $509.66 Other Equipmentbalance master ............................................... 10.0 $12,500.00 balance assessment-retraining system (Balance Master).5 $13,500.00 Other Equipmentbalance scales ............................................... 10.0 $995.00 balance, scale ................................................ 7 $768.50 Laboratorybalance, analytic ............................................ 7.0 $5,570.00 balance, analytic ............................................ 10 $4,001.67 LaboratoryE51004 ..... basic radiology room ...................................... 5.0 $150,000.00 room, basic radiology ..................................... 5 $150,000.00 Room - LaneE92002 ..... bath tub .......................................................... 10.0 $1,224.00 bath tub .......................................................... 10 $1,150.00 Furniturebath, paraffin, institutional .............................. 10.0 $3,349.00 paraffin bath, hand-foot (institutional) ............ 7$2,406.50 Other Equipmentbeat-to-beat bp unit ........................................ 7.0 $14,900.00 arterial tonometry monitor (Colin Pilot) .......... 7 $14,900.00 Other EquipmentE50005 ..... Bio Impedance Body Weight Analysis Machine.7.0 $4,490.00 body analysis machine, bioimpedence .......... 10 $2,151.32 Other Equipmentbiohazard hood .............................................. 10.0 $7,612.00 hood, biohazard ............................................. 10 $6,884.25 Laboratorybladder scanner with cart ............................... 5.0 $11,445.00 ultrasound, noninvasive bladder scanner wcart.5 $11,450.00 Other EquipmentE72005 ..... Blepharoplasty Tray ....................................... 4.0 $1,949.53 instrument pack, medium ($1500 and up) ..... 4$1,500.00 Other Equipmentbody analysis machine, bioimpedence .......... 7.0 $2,700.00 body analysis machine, bioimpedence .......... 10 $2,151.32 Other EquipmentBody Plethysmography Unit ........................... 8.0 $45,000.00 Vmax 22d and 62j (PFT equip, autobox,computer system).8 $47,930.00 Other Equipmentbone drill system, surgical, small bone(Stryker).4.0 $8,979.00 drill system, surgical, small-micro (Stryker) ... 3 $8,979.00 Other Equipmentbone saw, electric (Stryker) ........................... 7.5 $6,080.00 saw, surgical, electric (Stryker) ...................... 10$6,080.00 Other EquipmentBTE primus .................................................... 10.0 $45,820.00 rehab and testing system (BTE primus) ........ 5 $45,820.00 Other EquipmentCAD processor unit ........................................ 8.0 $210,000.00 CAD processor unit (mammography) ............ 5 $210,000.00 DocumentationCalibrated Chamber ....................................... 5.0 $500.00 calibration (AAPM ADCL), ion chamber ........ 5 $500.00 RadiologyCalibration Computer with Software .............. 5.0 $5,500.00 electrometer, PC-based, dual channel .......... 5 $5,675.00 Radiologycalibration equipment ..................................... 5.0 $5,000.00 electrometer, PC-based, dual channel .......... 5 $5,675.00 Radiologycaloric irrigator ................................................ 7.0 $4,875.00 caloric stimulator, air or water ........................ 7 $5,950.00 Other EquipmentE55017 ..... camera (autoswitching) with 16X zoom lens 5.0 $6,300.00 camera, remote-autoswitching ....................... 5 $5,250.00Documentationcamera, retinal topcon ................................... 5.0 $78,000.00 camera, retinal (TRC 50IX, w-ICG, filters,motor drives).5 $37,000.00 DocumentationE13611 ..... carbon coater ................................................. 7.5 $6,200.00 Deleted (part of new system) ......................... .......... .............................. No Detailscardiac gating device ..................................... 5.0 $40,000.00 ECG R-wave trigger (gating) device .............. 7 $5,671.00 Other EquipmentE55016 ..... cardiac monitor - 12 lead- stress test monitorand treadmill.5.0 $18,726.00 cardiac monitor w-treadmill (12-lead PCbased ECG).10 $14,271.03 Other EquipmentE53005 ..... Cardiac Nuclear Camera System .................. 7.5 $675,000.00 camera system, cardiac, nuclear ................... 5 $675,000.00 DocumentationE55018 ..... cardiac output monitor ................................... 7.5 $22,790.00 ICG monitoring system (impedance cardiography).5 $28,625.00 Other EquipmentE53003 ..... Cardiac Phantom ........................................... 7.5 $3,990.00 phantom, SPECT with cardiac insert ............. 10 $3,042.00 RadiologyE53026 ..... Cardiofocal Collimators (1Set) ....................... 5.0 $29,990.00 collimator, cardiofocal set .............................. 7 $29,990.00 Radiologycardio-pulmonary stress testing system ........ 8.0 $58,751.00 Vmax 29c (cardio-pulm stress test equip,treadmill, computer system).8 $58,751.00 Other Equipmentcardio-respiratory monitor .............................. 5.0 $12,000.00 ECG, 3-channel (with SpO2, NIBP, temp,resp).7 $4,322.50 Other Equipmentcart heating pan, Splint-Form 2000 ............... 10.0 $790.00 water bath, thermoplastic softener (20in x12in).7 $722.36 Radiologycart, laboratory ............................................... 10.0 $585.00 cart, laboratory ............................................... 10 $677.83 Furniturecast cart .......................................................... 10.0 $5,000.00 cast cart .......................................................... 10 $3,808.00 Other EquipmentE30022 ..... cast cutter ....................................................... 7.0 $1,295.00 cast cutter ....................................................... 10 $1,160.62 Other Equipmentcast table ........................................................ 10.0 $25,000.00 casting table attachment, hip-spica cast ........ 10 $4,099.00 Furniturecast vacuum ................................................... 7.0 $1,476.00 cast vacuum ................................................... 8 $1,475.50 Other Equipmentcasting frame .................................................. 10.0 $12,500.00 casting table attachment, Risser .................... 10 $2,538.00 FurnitureE72007 ..... Cataract Tray ................................................. 4.0 $11,261.33 Deleted through PEAC refinement. ............... .......... .............................. No Details


## 47709 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed RulesE71112 ..... Central (Pod) Equipment Lane ...................... 7.0 $30,442.01 lane, central pod (oph) ................................... 7 $23,029.00 Room - LaneE13656 ..... centrifuge ........................................................ 7.0 $3,250.00 centrifuge (with rotor) ..................................... 7 $4,291.65 LaboratoryCerrobend melting pots .................................. 7.0 $1,500.00 alloy melter, digital, 3 gallon ..........................7 $1,393.00 RadiologyE53046 ..... Cesium 137 sources (6-10mg, 6-15mg, 6-20mg, 2-25mg, 2-5mg) 3m.7.0 $43,580.00 Deleted through PEAC refinement. ............... .......... .............................. No Detailschair, medical recliner (chemo, phlebotomy) 10.0 $829.03 chair, medical recliner .................................... 10 $829.03 Furniturechair, phlebotomy-injection ............................ 10 1200 chair, medical recliner .................................... 10 $829.03 FurnitureE91004 ..... Chemo couch ................................................. 10.0 $895.00 chair, medical recliner .................................... 10 $829.03 FurnitureE51086 ..... chest room ..................................................... 5.0 $200,000.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE30007 ..... CO2 laser ....................................................... 5.0 $42,500.00 laser, CO2 (Star X) ........................................ 5 $7,795.00 Other EquipmentE55025 ..... CO2 monitor ................................................... 7.0 $7,495.00 CO2 respiratory profile monitor ...................... 7 $7,995.00 Other EquipmentE53002 ..... Colbalt-57 sheet flood source ........................ 0.5 $2,790.00 Cobalt-57 Flood Source (47cm dia) (10 mCi) 5 $2,243.00 RadiologyE53002 ..... Colbalt-57 sheet flood source ........................ 7.5 $2,790.00 Cobalt-57 Flood Source (47cm dia) (10 mCi) 5 $2,243.00 RadiologyE53002 ..... Colbalt-57 sheet flood source ........................ 8.0 $2,790.00 Cobalt-57 Flood Source (47cm dia) (10 mCi) 5 $2,243.00 RadiologyE13110 ..... colonoscope, video (SPLIT: scope and videosystem).3.0 $54,590.00 videoscope, colonoscopy ............................... 3 $23,650.00 ScopeE13401 ..... colposcope ..................................................... 3.0 $4,550.00 colposcope ..................................................... 8 $3,946.67 ScopeE71013 ..... computer and VDT and software ................... 5.0 $9,000.00 computer and VDT and software ................... 5 $9,000.00 DocumentationE92013 ..... computerized spinal range of motion device 10.0 $9,995.00 range of motion (spinal) device and software(Myo-Logic).5 $7,995.00 Other EquipmentE71014 ..... corneal topography unit ................................. 5.0 $17,950.00 topography unit, corneal (Magellan) .............. 7 $13,495.00 Other EquipmentCPAP/BiPAP remote clinical unit ................... 7.0 .............................. CPAP/BiPAP remote clinical unit ................... 7 .............................. Other EquipmentE13609 ..... critical point dryer ........................................... 10.0 $8,000.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE30015 ..... cryostat ........................................................... 7.0 $13,950.00 cryostat ........................................................... 7 $17,197.50 Other EquipmentE30014 ..... cryostat knife sharpener ................................. 7.0 $6,234.00 microtome sharpener ..................................... 10 $6,400.00 Radiologycryosurgery equipment package .................... 7.5 $2,750.00 cryosurgery equipment (for liquid nitrogen) ... 10 $2,394.30 OtherEquipmentcryosurgery system, non-ophthalmic ............. 7.5 $1,608.00 cryosurgery system, non-ophthalmic ............. 10 $1,607.50 OtherEquipmentcryosurgery system, ophthalmic .................... 7.5 $5,245.00 cryosurgery system, ophthalmic .................... 7 $5,245.00 Other Equipmentcryo-thermal unit ............................................ 7.5 .............................. cryo-thermal unit ............................................ 10 .............................. Other Equipmentcsf shunt reprogramming device (hand-held) 5.0 $1,500.00 CSF shunt programmer unit .......................... 7 $2,392.00 Other EquipmentE51082 ..... CT Room ........................................................ 5.0 $1,000,000.00 room, CT ........................................................ 5 $981,045.00 Room - LaneE51018 ..... CT-Based Virtual Simulator ........................... 5.0 $900,000.00 IMRT CT-based simulator .............................. 5 $975,000.00 RadiologyE13657 ..... cytology thin prep processor .......................... 7.5 $35,000.00 cytology thinlayer processor (ThinPrep) ........7 $54,000.00 LaboratoryE51054 ..... Daily Output QA Device, RMI (RBA-5) .......... 5.0 $5,795.00 Deleted through PEAC refinement. ............... ........................................ No DetailsE13658 ..... dark field microscope ..................................... 7.0 $4,500.00 microscope, polarized (dark field) .................. 7 $5,374.50 Laboratorydata acquisition beat-to-beat analysis system 7.0 $14,496.00 arterial tonometry acquisition system (WRTestworks).7 $14,500.00 Other Equipmentdata acquisition/q-sart recording system ....... 7.0 $22,228.00 QSART acquisition system (Q-Sweat) ........... 5 $28,000.00 Other Equipmentdecloaking chamber ....................................... 7.5 $875.00 decloaking chamber (DC2002) ...................... 7 $1,249.00 Laboratorydecloaking chamber (DC2002) ...................... 7.5 $1,249.00 decloaking chamber (DC2002) ...................... 7 $1,249.00 LaboratoryE71001 ..... dedicated slit lamp for argon laser ................ 10.0 $6,561.00 slit lamp (Haag-Streit), dedicated to laseruse.10 $7,435.00 Other Equipmentdefibrillator ...................................................... 5.0 .............................. defibrillator ...................................................... 5 $2,853.33 Other EquipmentDELETED ....................................................... .......... .............................. Deleted through PEAC refinement. ............... .......... .............................. No DetailsE51078 ..... Dental X-ray ................................................... 5.0 $80,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Detailsdermatome ..................................................... 5.0 $4,030.00 dermatome, electric ........................................ 10 $4,399.00 Other EquipmentE71102 ..... Designed for Vision loupes ............................ 7.0 $600.00 loupes, standard, up to 3.5x .......................... 7 $836.67 Other EquipmentE53036 ..... Detector (Probe) ............................................. 5.0 $14,000.00 Detector (Probe) ............................................. 5 $14,000.00 RadiologyE51010 ..... DEXA Unit Dual Energy X-rayAbsorptiometry.5.0 $49,500.00 densitometry unit, whole body, DXA .............. 5 $41,000.00 Radiologydialysis access flow monitor .......................... 5.0 $10,000.00 dialysis access flow monitor .......................... 5 $10,000.00 Other EquipmentE13659 ..... diamond knife ................................................. 10.0 $3,100.00 diamond knife (4.0-4.4mm) (electron microscopy).7 $3,400.00 LaboratoryE13660 ..... diamond knife resharpener ............................ 7.0 $1,795.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE52002 ..... diasonic software ........................................... 5.0 $35,000.00 fetal monitor software ..................................... 5 $35,000.00 Other EquipmentE71015 ..... diathermy machine ......................................... 5.0 $3,120.00 diathermy, short wave (AutoTherm 395) .......10 $8,185.00 Other EquipmentE71015 ..... diathermy machine ......................................... 5.0 $10,000.00 diathermy, short wave (AutoTherm 395) ....... 10 $8,185.00 Other Equipmentdifferential analyzer ........................................ 7.0 $38,500.00 differential analyzer, hematology ................... 7 $37,216.67 Laboratorydifferential counter, hematology ..................... 7.0 $1,238.00 differential tally counter, 12-channel .............. 5 $672.73Laboratory


## 47710 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed RulesADDENDUMD.—PROPOSEDCHANGES TOPRACTICEEXPENSEEQUIPMENTDESCRIPTION, LIFE,ANDPRICING—ContinuedEquip code2004 practice expense equipment details 2005 practice expense supply details (proposed)Description Life Price Description Life Price Equipment categoryE52007 ..... Digital Aquisition Unit (Nova MicrosonicsImage Vue DCR or TomTec FreelandP90).5.0 $29,900.00 ultrasound, echocardiography digital acquisition (Novo Microsonics, TomTec).5 $29,900.00 Other Equipmentdigital camera ................................................. 5.0 $800.00 camera, digital (6 mexapixel) ......................... 5 $946.16 DocumentationE51020 ..... Digital Camera ............................................... 5.0 $300,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Detailsdigital camera package .................................. 5.0 $3,060.00 camera, digital system, 12 megapixel (medical grade).5 $3,570.98 DocumentationE13113 ..... digitrapper (24-hr ambulatory pH monitor byCynectics).10.0 $9,685.00 pH recorder, 24-hr ambulatory (Digitrapper) 5 $6,900.00 Other Equipmentdiscogram pressure monitor .......................... 7.0 .............................. discogram pressure monitor .......................... 7 $600.00 Other Equipmentdissecting instrument kit ................................. 5.0 $596.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other EquipmentDNA image analyzer (ACIS) .......................... 7.0 $200,000.00 DNA image analyzer (ACIS) .......................... 7 $200,000.00 LaboratoryDNA image analyzer (ACIS) .......................... 7.5 $200,000.00 DNA image analyzer (ACIS) .......................... 7 $200,000.00 LaboratoryE30016 ..... doppler ........................................................... 5.0 $1,350.00 doppler (fetal or vascular) .............................. 5 $708.22 Other Equipmentdose calibration source vial set (Cs137,Co57, and Ba137).5.0 $1,159.00 dose calibration source vial set (Cs137,Co57, and Ba137).5 $1,159.00 RadiologyE51064 ..... Dose Callibrator w/ Lead Glass Sheild & Ce137 Standard.5.0 $6,000.00 dose calibrator (Atomlab) ............................... 5 $5,496.67 RadiologyDosimetry software ........................................ 5.0 $21,000.00 radiation therapy dosimetry software (ArgusQC).5 $21,000.00 RadiologyE53034 ..... Dual Photon Densitometer/Computer ............ 5.0 $65,000.00 densitometry unit, whole body, DPA .............. 5 $65,000.00 Radiologydust extractor ................................................. 10.0 $1,982.00 dust extractor ................................................. 8 $500.00 Other EquipmentDynavox/Dynamyte Wireless Backup andcomputer backup.7.0 $549.00 augmentative communication - DynaBeamaccess w-memory backup.7 $604.00 Other EquipmentDynovox 3100 ................................................ 7.0 $6,995.00 augmentative communication - DynaVox3100.7 $7,295.00 Other EquipmentE55009 ..... ECG Burdick EK-10 ....................................... 7.0 $1,985.50 ECG, 1-channel (Burdick) .............................. 7 $1,506.00 Other EquipmentEECP system ................................................. 5.0 $180,000.00 EECP, external counterpulsation system ...... 7 $150,000.00 Other EquipmentE11015 ..... electric bed ..................................................... 12.0 $2,024.00 bed, hospital, electric ..................................... 12 $1,746.52 FurnitureE11010 ..... electric table ................................................... 15.0 $935.71 table, motorized (for instruments-equipment).doc.15 $895.00 FurnitureE30005 ..... electrocautery ................................................. 7.0 $995.00 electrocautery-hyfrecator, up to 45 watts...... 10 $975.08 Other Equipmentelectrogastrography machine system ............ 10.0 $20,750.00 EGG monitoring system ................................. 7 $32,900.00Other Equipmentelectro-oculography machine ......................... 10.0 $50,000.00 EOG, ERG, VEP electrodiagnostic unit ......... 7 $33,500.00 Other Equipmentelectro-retinography machine ......................... 10.0 $50,000.00 EOG, ERG, VEP electrodiagnostic unit ......... 7 $33,500.00 Other EquipmentE30008 ..... electro-surgical device ................................... 7.0 $1,225.00 electrosurgical generator, up to 120 watts .... 7 $1,838.42 Other EquipmentE13641 ..... embedding station .......................................... 8.0 $8,200.00 tissue embedding center ................................ 8 $9,096.67 LaboratoryEMG biofeedback continence training system(Pathway CTS2000).5.0 $11,750.00 EMG biofeedback continence training system(Pathway CTS2000).8 $11,750.00 Other EquipmentE54012 ..... EMG botox ..................................................... 7.0 $1,500.00 EMG botox ..................................................... 7 $1,500.00 Other EquipmentE54007 ..... EMG Machine ................................................ 7.0 $21,157.50 EMG-NCV-EP system, 2-4 channel ............... 10 $18,288.63 Other EquipmentEMG, surface system (OT, PT, clinician)(Therapist System).7.0 $10,995.00 EMG, surface system (OT, PT, clinician)(Therapist System).8 $9,995.00 Other EquipmentE13118 ..... endoscope, rigid, cystoscopy ......................... 3.0 $3,365.00 endoscope, rigid, cystoscopy ......................... 3 $3,394.00 ScopeE13402 ..... endoscope, rigid, hysteroscopy ..................... 3.0 $8,878.00 endoscope, rigid, hysteroscopy .....................3 $4,990.50 Scopeendoscope, rigid, laryngoscopy ..................... 3.0 $5,080.00 endoscope, rigid, laryngoscopy ..................... 3 $3,095.67Scopeendoscope, rigid, otology ............................... 3.0 $2,456.88 endoscope, rigid, otology ............................... 7$2,456.88 Scopeendoscope, rigid, sigmoidoscopy ................... 3.0 $841.00 endoscope, rigid, sigmoidoscopy ................... 3 $841.38 ScopeE13126 ..... endoscope, rigid, sinoscopy ........................... 3.0 $5,080.00 endoscope, rigid, sinoscopy ........................... 7 $2,414.17 Scopeendoscope, rigid, sinoscopy ........................... 3.0 $5,080.00 endoscope, rigid, sinoscopy ........................... 7 $2,414.17 ScopeE11005 ..... endoscopy stretcher ....................................... 10.0 $1,010.00 stretcher, endoscopy ...................................... 10 $2,414.00 FurnitureE71027 ..... ENG Recorder ................................................ 7.0 $19,900.00 ENG recording system ................................... 5 $19,900.00 Other Equipment


## 47711 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rulesenvironmental module - car ........................... 10.0 $30,000.00 environmental module - car ........................... 15 $33,750.00 Room - Laneenvironmental module - kitchen ..................... 10.0 $50,000.00 environmental module - kitchen ..................... 15 $56,250.00 Room - Laneenvironmental module - the workshop ........... 10.0 $20,000.00 environmental module - the workshop ........... 15 $22,500.00 Room- Laneergonomic kit .................................................. 10.0 $2,285.00 kit, ergonomic (office) ..................................... 10 $2,285.48 Other EquipmentE13114 ..... esophogeal motility monitor (physiograph ) ... 10.0 $22,865.00 Deleted through PEAC refinement. ............... .......... .............................. No Detailsevaluation system for upper extremity/hand .. 10.0 $16,500.00 evaluation system for upper extremity-hand(Greenleaf).5 $17,495.00 Other Equipmentexam chair, reclining ...................................... 15.0 $1,000.00 chair, medical recliner .................................... 10 $829.03 FurnitureE30006 ..... exam lamp ...................................................... 10.0 $1,850.00 light, exam ...................................................... 10 $1,630.12 Other EquipmentE71109 ..... Exam Lane ..................................................... 7.0 $31,046.15 lane, exam (oph) ............................................ 7 $30,453.33 Room - LaneE11001 ..... exam table ...................................................... 15.0 $1,360.00 table, exam ..................................................... 15 $1,338.17 Furnitureexercise kit aquatic (boots, fins,gloves,weights, cuffs, spine safety board).5.0 $500.00 kit, aquatic exercise ....................................... 10 $500.00 Other Equipmentexercise staircase .......................................... 10.0 $870.00 stairs, ambulation training .............................. 15 $793.67 Other Equipmentexercise staircase .......................................... 15.0 $870.00 stairs, ambulation training .............................. 15 $793.67 Other EquipmentE71016 ..... external 35 mm camera with medical lenses 5.0 $10,795.00 camera, 35mm system (medical grade) ........ 5 $1,106.50 DocumentationE51062 ..... External Microwave Applicators (set of 5),BSD.10.0 $7,250.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsFarmer Chamber ............................................ 5.0 $1,500.00 chamber, Farmer-type .................................... 7 $1,169.38 RadiologyE71002 ..... Farnsworth-Munsell 100-Hue Test or Nagelanomoscoope, McBeth light.7.5 $556.00 Farnsworth-Munsell 100-Hue color vision testw/software.7 $626.50 Other EquipmentE13404 ..... fetal monitor ................................................... 5.0 $9,435.00 fetal monitor ................................................... 5 $5,415.95 Other EquipmentE11006 ..... fiberoptic exam light (combine with source) .. 10.0 $608.75 light, fiberoptic headlight w-source ................ 5 $1,992.92 Other EquipmentE13123 ..... fiberscope, flexible, bronchoscopy ................. 3.0 $9,700.00 fiberscope, flexible, bronchoscopy .................3 $14,175.00 Scopefiberscope, flexible, bronchoscopy ................. 3.0 $14,175.00 fiberscope, flexible, bronchoscopy ................. 3 $14,175.00 Scopefiberscope, flexible, bronchoscopy w-forceps(SPLIT: Scope/Forceps).3.0 $10,943.33 fiberscope, flexible, bronchoscopy ................. 3 $14,175.00 Scopefiberscope, flexible, cystoscopy ..................... 3.0 $7,410.00 fiberscope, flexible, cystoscopy ..................... 3 $7,408.33 ScopeE13117 ..... fiberscope, flexible, cystoscopy, with lightsource.3.0 $7,760.00 fiberscope, flexible, cystoscopy, with lightsource.3 $9,082.50 ScopeE13124 ..... fiberscope, flexible, rhinolaryngoscopy .......... 3.0 $5,080.00 fiberscope, flexible, rhinolaryngoscopy .......... 3 $6,301.93 Scopefiberscope, flexible, rhinolaryngoscopy .......... 3.0 $5,080.00 fiberscope, flexible, rhinolaryngoscopy .......... 3 $6,301.93 ScopeE13101 ..... fiberscope, flexible, sigmoidoscopy ............... 3.0 $5,803.00 fiberscope, flexible, sigmoidoscopy ............... 3 $5,803.33 Scopefiberscope, flexible, sigmoidoscopy ............... 3.0 $5,803.00 fiberscope, flexible, sigmoidoscopy ............... 3 $5,803.33 ScopeE13121 ..... fiberscope, flexible, ureteroscopy .................. 3.0 $12,920.00 fiberscope, flexible, ureteroscopy .................. 3 $12,595.00 Scopefilm alternator ................................................. 10.0 $30,000.00 film alternator (motorized film viewbox) ......... 10 $27,500.00 RadiologyFilm Densitometer .......................................... 5.0 $1,580.00 densitometer, film ........................................... 5 $1,435.00 Radiologyfilm dosimetry equipment for IMRT ................ 5.0 $28,500.00 film dosimetry equipment-software (RIT) ....... 5 $30,840.00 Radiologyfilm printer, laser ............................................ 5.0 $45,000.00 film processor, dry, laser ................................ 8 $69,950.00 Documentationfilm processor, precision calibrated ............... 8.0 $25,000.00 film processor, wet ......................................... 8$26,325.00 Documentationfistula probes, set of 4 ................................... 5.0 $560.00 Deleted (less than $500) .......................................... .............................. No DetailsE13616 ..... flow cytometer ................................................ 5.0 $11,000.00 flow cytometer ................................................ 5 $119,850.00 LaboratoryE13639 ..... fluorescence microscope ............................... 7.0 $12,000.00 microscope, fluorescence .............................. 7 $9,468.48 LaboratoryE51070 ..... Fluroscopic unit, Mobile C-Arm ...................... 5.0 $205,000.00 fluoroscopic system, mobile C-Arm ...............8 $73,000.00 Radiologyfood models .................................................... 5.0 $700.00 food models .................................................... 4 $700.00 Other EquipmentE30021 ..... foot & ankle surgery instrument pack ............ 4.0 $1,530.40 instrument pack, medium ($1500 and up) ..... 4 $1,500.00Other Equipmentforceps, biopsy ............................................... 4.0 $1,310.00 endoscope forceps, biopsy ............................ 3 $1,243.33 Scopeforceps, grasping ............................................ 4.0 $735.00 endoscope forceps, grasping ......................... 3 $745.67 ScopeE71103 ..... full diameter trial lens set ............................... 7.5 $1,180.00 lens set, trial, full diameter, w-frame .............. 10 $904.93 Other EquipmentE13613 ..... fume hood ...................................................... 10.0 $6,500.00 hood, fume ..................................................... 15 $4,778.46 Laboratorygamma counter, automatic ............................ 7.5 $17,900.00 gamma counter, automatic ............................ 7 $17,665.00 RadiologyE71003 ..... Ganzfeld stimulator ........................................ 10.0 $45,000.00 Ganzfeld stimulator ........................................ 7 $8,750.00 Other Equipmentgas cylinders .................................................. 5.0 $8,000.00 laser gas cylinder (for excimer) ..................... 5 $1,140.00 Other EquipmentE13104 ..... gastro cautery unit ......................................... 7.0 $5,450.00 electrosurgical generator, gastrocautery ........ 7 $11,375.00 Other EquipmentE13106 ..... gastroscope video (SPLIT: scope and videosystem).3.0 $52,990.00 videoscope, gastroscopy ................................ 3 $21,598.33 ScopeE55022 ..... Gating Device ................................................. 5.0 $3,625.00 ECG R-wave trigger (gating) device .............. 7 $5,671.00 Other Equipmentgenerator, constant current ............................ 3.0 $950.00 generator, constant current ............................ 20 $950.00 Other Equipment


## 47712 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed RulesADDENDUMD.—PROPOSEDCHANGES TOPRACTICEEXPENSEEQUIPMENTDESCRIPTION, LIFE,ANDPRICING—ContinuedEquip code2004 practice expense equipment details 2005 practice expense supply details (proposed)Description Life Price Description Life Price Equipment categoryglucose monitor continuous(incl.accessories).5.0 $2,613.00 glucose continuous monitoring system .......... 5 $2,465.00 Other EquipmentE13666 ..... GLX linear stainer .......................................... 7.5 $6,995.00 slide stainer, automated, standard throughput.7 $8,265.64 LaboratoryE13637 ..... grossing station .............................................. 10.0 $23,391.00 grossing station w-heavy duty disposal......... 20 $20,175.50 Laboratoryhalogen light (Edit light type) ......................... 5.0 $5,080.00 light source, xenon ......................................... 5 $6,723.33 Other Equipmenthalogen light cable ......................................... 5.0 .............................. Deleted (part of new system) ......................... .......... .............................. No Detailshand dexterity/sensory/strength kit ................ 7.0 $1,407.00 kit, hand dexterity, sensory, strength ............. 10 $1,561.40 Other EquipmentHand Held Voice ............................................ 7.0 $645.00 augmentative communication - Hand HeldVoice.7 $695.00 Other EquipmentHand Measurement Kit (dynamometers,goniometers, etc).7.0 $600.00 kit, hand evaluation ........................................ 10 $617.65 Other Equipmenthand-case instrument set ............................... 4.0 $2,000.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other EquipmentE51072 ..... HDR Afterload System, Nucletron - Oldelft ... 5.0 $375,000.00 HDR Afterload System, Nucletron - Oldelft ... 7 $375,000.00Radiologyheadmaster adapters (Accessibility) .............. 5.0 $1,675.00 augmentative communication - HeadMasterw-adapters.7 $1,695.00 Other EquipmentE53006 ..... Heavy Duty Imaging Table ............................ 7.5 $4,550.00 table, imaging ................................................. 15 $5,188.33 Furnitureheavy-duty disposer ....................................... 5.0 $1,506.00 Deleted (part of new system) ......................... .......... .............................. No DetailsE71037 ..... hilger nerve stimulator .................................... 7.5 $1,805.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE55008 ..... Holter Monitor ................................................. 7.0 $2,590.00 holter monitor ................................................. 7 $1,413.43 Other EquipmentE55015 ..... Holter monitor reader ..................................... 7.0 $14,995.00 holter analysys system ................................... 7 $8,815.58 Other EquipmentE55015 ..... Holter monitor reader ..................................... 7.0 $14,995.00 holter system with one recorder .................... 7 $11,303.90 Other Equipmenthood, biohazard ............................................. 10.0 $7,612.00 hood, biohazard ............................................. 10 $6,884.25 Laboratoryhot wire cutter, Heustis .................................. 7.0 $28,600.00 Huestis block cutting machine w-attachments 15 $22,030.00 RadiologyE92016 ..... Hubbard tank .................................................. 15.0 $17,000.00 whirlpool (Hubbard tank) ................................ 10 $15,195.00 FurnitureE71005 ..... Humphrey field analyzer (or octopus) ............ 7.5 $27,950.00 Humphrey field analyzer ................................ 7 $27,000.00 Other EquipmentE92006 ..... hydroculator, cold ........................................... 10.0 $1,675.00 hydrocollator, cold .......................................... 10 $1,910.50 Other EquipmentE92007 ..... hydroculator, hot ............................................ 10.0 $1,265.00 hydrocollator, hot ............................................ 10 $1,090.17 Other EquipmentE55033 ..... Hydrogen gas analyzer .................................. 7.5 $6,117.00 breath hydrogen analyzer (MicroLyzer) ......... 8$4,895.00 Other Equipmenthyperbaric chamber ....................................... 10.0 $125,000.00 hyperbaric chamber ....................................... 15 $125,000.00 Other EquipmentE13652 ..... image analyzer (CAS system) ....................... 5.0 $92,000.00 image analyzer (CAS system) ....................... 5$92,000.00 LaboratoryImmittance bridge ........................................... 7.0 $6,900.00 immittance, middle-ear analyzer .................... 10$4,995.00 Other Equipmentimpedance meter ........................................... 7.0 $1,312.00 impedance meter, 32-channel ....................... 7 $1,120.00 Other EquipmentIMRT physics tools ......................................... 5.0 $55,485.00 IMRT physics tools ......................................... 5 $55,485.00 RadiologyE92012 ..... inclinometer .................................................... 10.0 $520.00 Deleted (less than $500) ................................ .......... .............................. No Detailsincubator ......................................................... 10.0 $795.00 incubator ......................................................... 10 $837.30 LaboratoryE13631 ..... incubator (CO2) .............................................. 10.0 $6,000.00 incubator, CO2 (dry-wall) ............................... 10 $5,842.99 Laboratoryinfrared ceiling lamps/temperature control ..... 3.0 $2,000.00 light, infra-red, ceiling mount .......................... 10 $555.00 Other EquipmentE30023 ..... infrared coagulator ......................................... 7.0 $3,550.00 infrared coagulator (with hand applicator)..... 10 $3,087.50 Other Equipmentinfrared illuminator .......................................... 7.0 $1,050.00 Deleted (part of new system) ......................... .......... .............................. No DetailsE91001 ..... infusion pump ................................................. 10.0 $4,150.00 IV infusion pump ............................................ 10 $2,384.45 Other EquipmentINR monitor, home ......................................... 4.0 $2,000.00 INR monitor, home ......................................... 5 $2,000.00 Other Equipmentinstrument pack, basic (auricle) ..................... 4.0 $500.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 OtherEquipmentinstrument pack, basic (EPF) ......................... 4.0 $1,200.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 OtherEquipmentinstrument pack, basic (surgery) .................... 4.0 $500.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other Equipmentinstrument pack, medium (ear) ...................... 4.0 $1,500.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipmentinstrument pack, medium (intraoral biopsy) ... 4.0 $1,500.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipmentinstrument pack, medium (nasal endoscopy) 4.0 $1,500.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipmentinstrument pack, medium (nasal) ................... 4.0 $1,500.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipmentinstrument pack, medium (otology POV) ....... 4.0 $1,500.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipmentinstrument pack, medium (surgery) ............... 4.0 $1,500.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other EquipmentE92009 ..... Intellect High Voltage electrical stimulator ..... 10.0 $1,395.00 electrotherapy stimulator, high volt, 2 channel.7 $1,923.00 Other Equipment


## 47713 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed RulesIntellikeys ........................................................ 7.0 $525.00 augmentative communication - IntelliKeys,Overlay, ClickIt.7 $560.00 Other EquipmentE92020 ..... Intercom ......................................................... 10.0 $10,000.00 intercom (incl. master, pt substation, power,wiring).10 $1,630.00 Other Equipmentintestinal imaging workstation ........................ 7.0 $25,400.00 intestinal imaging workstation ........................ 5Other Equipment.E51042 ..... Ion Chamber Array ......................................... 5.0 $6,445.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE71030 ..... iontophoresis machine ................................... 7.5 $1,500.00 iontophoresis machine ................................... 8 $995.00 Other Equipmentisoalign device ................................................ 5.0 $950.00 isocentric beam alignment device .................. 5 $995.00 RadiologyE92014 ..... isokinetic strenghthening equipment .............. 10.0 $29,823.00 exercise equipment (treadmill, bike, stepper,UBE, pulleys, balance board).15 $12,710.00 Other Equipmentisokinetic testing equipment ........................... 7.0 $45,820.00 rehab and testing system (BTE primus) ........ 5 $45,820.00Other EquipmentE50003 ..... isokinetometer ................................................ 10.0 $11,995.00 isokinetic evaluation system (Cybex NORM) 5 $39,900.00 Other EquipmentE91008 ..... IVAC Injection Automatic Pump ..................... 5.0 $2,500.00 IVAC Injection Automatic Pump ..................... 10$2,500.00 Other EquipmentE55010 ..... King of Hearts-20 (Instromedix) ..................... 7.0 $1,750.00 Deleted through PEAC refinement. ............... .......... .............................. No Detailskit, capsule endoscopy recorder .................... .......... $6,950.00 kit, capsule endoscopy recorder .................... 10 $6,950.00 Other Equipmentlacrimal probes ............................................... 4.0 .............................. Deleted (less than $500) ................................ .......... .............................. No Detailslaryngeal injector ............................................ 4.0 $1,032.00 kit, laryngeal injector ...................................... 3 $1,032.00 Other EquipmentE13405 ..... laser ................................................................ 5.0 $23,500.00 laser (gs, uro, obg, ge) (IndigoOptima) ........ 5 $59,890.00 Other Equipmentlaser generator ............................................... 5.0 $54,890.00 laser (gs, uro, obg, ge) (Indigo Optima) ........ 5 $59,890.00 Other Equipmentlaser printer for CT angiography .................... 5.0 $71,400.00 film processor, dry, laser ................................ 8 $69,950.00 DocumentationLaser Targeting System ................................. 5.0 $11,625.00 laser targeting system (4 diodes) .................. 5 $10,350.00 Radiologylaser, ablation (gs, uro, obg, ge) (Indigo Optima).5.0 $59,890.00 laser (gs, uro, obg, ge) (Indigo Optima) ........ 5 $59,890.00 Other Equipmentlaser, diode, for patient positioning (Probe) ... 5.0 $7,678.00 laser, diode, for patient positioning (Probe) ... 5 $7,678.00 Radiologylaser, excimer ................................................. 5.0 $155,000.00 laser, excimer ................................................. 5 $160,000.00 Other EquipmentE53001 ..... lead safe ......................................................... 20.0 $3,375.00 safe, storage, lead-lined ................................. 15 $3,850.00 RadiologyE13403 ..... LEEP system .................................................. 7.0 $4,670.00 electrosurgical system (w-smoke evac)(LEEP, Quantum).7 $4,283.00 Other EquipmentE55014 ..... life signs receiving center .............................. 7.0 $3,800.00 pacemaker receiving software (GEMS Lite) .. 5 $3,995.00 Other Equipmentlift, chair and sling .......................................... 10.0 $3,000.00 lift, hydraulic, chair ......................................... 10 $4,848.65 Furniturelift, hydraulic ................................................... 10.0 $4,730.00 lift, hydraulic, chair ......................................... 10 $4,848.65 Furniturelight for photodynamic therapy, 400MW(BLU-U).5.0 $15,759.00 light, external PDT, w-probe set (LumaCare) 5 $8,810.00 Other EquipmentE13122 ..... light source (combine with headlight) ............ 3.0 $1,700.00 light, fiberoptic headlight w-source ................ 5$1,992.92 Other Equipmentlight, infrared .................................................. 3.0 $500.00 light, infra-red, pole mount ............................. 10 $512.50 Other Equipmentlight, ultraviolet ............................................... 3.0 $630.00 light, ultra-violet .............................................. 10 $618.22 Other EquipmentE51056 ..... Linear Accelerator - Cliniac-2100 .................. 5.0 $1,600,000.00 accelerator, 6-18 MV ...................................... 7 $1,832,941.00 RadiologyE30010 ..... Liquid Nitro Tank w/ Cryac ............................ 10.0 $1,529.00 cryosurgery system, non-ophthalmic .............10 $1,607.50 Other EquipmentE30024 ..... lithotriptor ........................................................ 5.0 $1,375,000.00 lithotriptor, with C-arm (ESWL) ...................... 5 $440,000.00 Other EquipmentE11001 ..... low mat table .................................................. 10.0 $5,000.00 table, mat, hi-lo, 6 x 8 platform ...................... 15 $4,521.67 Furniturelow mat table .................................................. 10.0 $5,000.00 table, mat, hi-lo, 6 x 8 platform ...................... 15 $4,521.67 Furnituremammatome driver ........................................ 5.0 $27,750.00 breast biopsy device w-system(Mammotome).5 $29,862.00 Other Equipmentmammography cassettes (4) ......................... 5.0 .............................. Deleted (less than $500) ................................ .......... .............................. No DetailsE51016 ..... Mammography Room ..................................... 5.0 $130,000.00 room, mammography ..................................... 5 $130,000.00 Room - Lanemayo stand ..................................................... 7.0 $585.00 mayo stand ..................................................... 15 $530.76 FurnitureE30019 ..... McGrowan ligator/Bander .............................. 7.0 $625.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE92010 ..... mechanical traction ........................................ 10.0 $2,090.00 traction system (hi-low table, digital unit, accessories).10 $5,654.83 Other Equipmentmedium energy collimator (siemens05232868).5.0 $14,000.00 collimator, medium energy (set of 2) ............. 7 $14,000.00 RadiologyE13608 ..... microprobe EDS x-ray analysis ..................... 7.0 $42,500.00 Deleted (part of new system) ......................... .......... .............................. No DetailsE13662 ..... Microscope camera Konan SP 9000 ............. 5.0 $6,995.00 camera system, specular microscope ........... 5 $26,100.00 LaboratoryE13601 ..... microscope, compound .................................. 7.0 $11,600.00 microscope, compound .................................. 7 $11,621.35 LaboratoryE13606 ..... microscope, dissecting ................................... 7.0 $1,700.00 microscope, binocular - dissecting ................. 7 $956.00 LaboratoryE13618 ..... microtome ....................................................... 7.0 $31,500.00 microtome ....................................................... 7 $13,369.00 RadiologyE13619 ..... microtome knife sharpener ............................ 7.0 $7,200.00 microtome sharpener ..................................... 10 $6,400.00 Radiologymicrowave ...................................................... 10.0 .............................. diathermy, microwave .................................... 10 .............................. Other Equipment


## 47714 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed RulesADDENDUMD.—PROPOSEDCHANGES TOPRACTICEEXPENSEEQUIPMENTDESCRIPTION, LIFE,ANDPRICING—ContinuedEquip code2004 practice expense equipment details 2005 practice expense supply details (proposed)Description Life Price Description Life Price Equipment categoryE51060 ..... Microwave Hypothermia System, BSD .......... 10.0 $550,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Detailsmimic/controllers/crane .................................. 5.0 $448,680.00 collimator, multileaf system w-autocrane(MIMiC).7 $355,030.00 RadiologyE72004 ..... Minor Equipment Pack ................................... 4.0 $1,082.95 instrument pack, basic ($500-$1499) ............4 $500.00 Other EquipmentE72006 ..... Minor Surgical Pack ....................................... 4.0 $1,596.88 instrument pack, medium ($1500 and up) ..... 4$1,500.00 Other EquipmentE30020 ..... minor surgical tray .......................................... 4.0 $572.20 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other EquipmentE53008 ..... Mobile Source Storage Safes ........................ 20.0 $3,650.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE92017 ..... mobolization/manipulation table ..................... 10.0 $9,315.00 table, mobolization-manipulation (Lloyd’s) ..... 15 $8,195.00 Furnituremotor coordination kit ..................................... 10.0 $643.00 kit, motor coordination .................................... 10 $643.75 Other EquipmentMount/wheel chair .......................................... 7.0 $830.00 augmentative communication - DynaVoxwheelchair mount.doc.7 $765.00 Other EquipmentE51058 ..... MR Room ....................................................... 5.0 $3,140,000.00 room, MR ....................................................... 5 $1,961,375.00 Room - Lanenasal pressure transducer ............................. 7.0 $525.00 transducer, pressure, airflow sensor .............. 7 $582.50 Other Equipmentnaturally speaking software, dragon (Accessibility).5.0 $696.00 augmentative communication - Dragon Natu-rally-Speaking.7 $699.95 Other EquipmentE91010 ..... Negative Flow Hood ....................................... 10.0 $2,000.00 hood, negative flow ........................................ 15 $2,400.00 LaboratoryE30028 ..... nerve stimulator .............................................. 7.5 $523.80 nerve stimulator (eg, for nerve block) ............ 7 $572.30 Other EquipmentE12002 ..... neurobehavioral status instrument-average ... 7.5 $717.00 neurobehavioral status instrument-average ... 5 $717.00 Other Equipmentnew item ......................................................... .......... .............................. biofeedback equipment .................................. 8 .............................. Other Equipmentnew item ......................................................... .......... .............................. blood warmer ................................................. 7 $3,840.00 Other Equipmentnew item ......................................................... .......... .............................. breast biopsy imagingsystem, stereotactic(imager, table, software).5 $234,000.00 Other Equipmentnew item ......................................................... .......... .............................. camera, digital system, for electron microscopy.5 $41,000.00 Documentationnew item ......................................................... .......... .............................. cell separator system ..................................... 6 $59,320.00 Other Equipmentnew item ......................................................... .......... .............................. chair, thyroid imaging..................................... 10 $2,200.00 Furniturenew item ......................................................... .......... .............................. CO2 infrared analyzer(COSMO) ................... 7 $4,500.00 Other Equipmentnew item ......................................................... .......... .............................. computer workstation,3D hyperthermia treatment planning.5 $98,000.00 Documentationnew item ......................................................... .......... .............................. computer workstation,3D radiation treatmentplanning.5 $130,216.50 Documentationnew item ......................................................... .......... .............................. computer workstation,3D reconstruction CTMR.5 $45,926.00 Documentationnew item ......................................................... .......... .............................. computer workstation,brachytherapy treatment planning.5 $105,403.00 Documentationnew item ......................................................... .......... .............................. computer workstation,cardiac cath monitoring.5 $94,000.00 Documentationnew item ......................................................... .......... .............................. computer workstation,MRA post processing 5 .............................. Documentationnew item ......................................................... .......... .............................. contrast media warmer .................................. 7 $552.00 Other Equipmentnew item ......................................................... .......... .............................. cortical bipolar-biphasic stimulating equipment.7 .............................. Other Equipmentnew item ......................................................... .......... .............................. crash cart (unstocked)................................... 10 $868.50 Furniturenew item ......................................................... .......... .............................. cryosurgical probe, retina ............................... 7 $1,984.00 Other Equipmentnew item ......................................................... .......... .............................. defibrillator w-ECG monitor ............................ 5 $3,150.67 Other Equipmentnew item ......................................................... .......... .............................. densitometry unit, peripheral, SXA ................ 5 $22,096.00 Radiologynew item ......................................................... .......... .............................. densitometry unit, peripheral, ultrasound ....... 5 $13,225.00 Radiologynew item ......................................................... .......... .............................. dermabrader (Osada) ..................................... 10 $1,590.00 Other Equipmentnew item ......................................................... .......... .............................. drill, ophthalmology ........................................ 3 .............................. Other Equipmentnew item ......................................................... .......... .............................. EEG analysis software ................................... 5 $82,000.00 Other Equipmentnew item ......................................................... .......... .............................. EEG monitor, digital,portable ........................ 7 .............................. Other Equipmentnew item ......................................................... .......... .............................. electroconvulsive therapy machine ................ 5 .............................. Other Equipment


## 47715 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rulesnew item ......................................................... .......... .............................. external fixation, craniofacial halo(BlueDevice).4 $5,146.00 Other Equipmentnew item ......................................................... .......... .............................. external fixation, mandible (Joe Hall Morris) 4 $4,508.00 Other Equipmentnew item ......................................................... .......... .............................. gamma camera system, single-dual head ..... 5 $406,816.80 Radiologynew item ......................................................... .......... .............................. hyperthermia system, RF-deep and microwave.5 $790,353.00 Radiologynew item ......................................................... .......... .............................. hyperthermia system, ultrasound, external .... 5 $360,000.00 Radiologynew item ......................................................... .......... .............................. hyperthermia system, ultrasound,intracavitary.5 $250,000.00 Radiologynew item ......................................................... .......... .............................. intracavitary applicator set (tandem andovoids).4 $10,321.50 Radiologynew item ......................................................... .......... .............................. intra-compartmental pressure monitor device 7 $1,737.00 Other Equipmentnew item ......................................................... .......... .............................. lens set, fitting, lowvision .............................. 10 $4,750.00 Other Equipmentnew item ......................................................... .......... .............................. liposorber system ........................................... 7 $7,800.00 Other Equipmentnew item ......................................................... .......... .............................. mammography reportingsoftware ................. 5 .............................. Documentationnew item ......................................................... .......... .............................. manometry system (computer, transducers,catheter).5 $39,400.00 Other Equipmentnew item ......................................................... .......... .............................. micropigmentation (tattoo) system ................. 7 $2,550.00 Other Equipmentnew item ......................................................... .......... .............................. microscope, electron,transmission (TEM) .... 7 $319,290.00 Laboratorynew item ......................................................... .......... .............................. microtome, ultra ............................................. 7 $25,950.00 Radiologynew item ......................................................... .......... .............................. nuclide rod source set.................................... 5 $1,395.00 Radiologynew item ......................................................... .......... .............................. oximeter, whole blood .................................... 5 $6,950.00 Other Equipmentnew item ......................................................... .......... .............................. oxygen system, portable ................................ 8 $569.89 Other Equipmentnew item ......................................................... .......... .............................. phantom, mammography-accreditation .......... 10 $674.00 Radiologynew item ......................................................... .......... .............................. phantom, QCT densitometry .......................... 10 $5,464.00 Radiologynew item ......................................................... .......... .............................. pump, water perfusion(for manometry) ........ 7 $7,307.00 Other Equipmentnew item ......................................................... .......... .............................. radiation L-block tabletop shield .................... 10 $725.00 Radiologynew item ......................................................... .......... .............................. radiusgauge .................................................... 7 $1,234.00 Other Equipmentnew item ......................................................... .......... .............................. resectoscope, continuous flow ....................... 3 $1,200.00 Scopenew item ......................................................... .......... .............................. RGP lens modificationunit ............................ 7 $540.00 Other Equipmentnew item ......................................................... .......... .............................. rhinomanometer system(w-transducers andsoftware).7 $10,800.00 Other Equipmentnew item ......................................................... .......... .............................. sleep screening system, ambulatory (incl.hardware, software).5 $14,877.25 Other Equipmentnew item ......................................................... .......... .............................. stepper, stabilizer, template (forbrachytherapy treatment).7 $18,550.00 Radiologynew item ......................................................... .......... .............................. stirrups (for brachytherapy table) ................... 10 $3,876.00 Radiologynew item ......................................................... .......... .............................. stretcher chair ................................................ 10 $3,133.00 Furniturenew item ......................................................... .......... .............................. table, brachytherapy treatment ...................... 15 $28,900.00 Furniturenew item ......................................................... .......... .............................. table, cystoscopy ............................................ 15 .............................. Furniturenew item ......................................................... .......... .............................. thyroid uptake system .................................... 5 $13,995.00 Radiologynew item ......................................................... .......... .............................. urethrotome, optical ....................................... 3 $1,881.00 Scopenew item ......................................................... .......... .............................. vacuum deposition system (Auto306) ............ 7 $38,070.00 Laboratorynew item ......................................................... .......... .............................. x-ray, dental, intra-oral ................................... 5 $3,869.00 Radiologynew item ......................................................... .......... .............................. x-ray, dental, panoramic ................................ 5 $24,405.00 RadiologyNon-amplified auditory trainer ........................ 7.0 $1,295.00 augmentative communication - auditory trainer.7 $1,096.00 Other EquipmentE13406 ..... NST, Non Stress Test .................................... 5.0 $8,878.00 fetal monitor ................................................... 5 $5,415.95 Other Equipmentnuclear pharmacy management software (wcomputer and printer) (NMIS).5.0 $13,400.00 computer workstation, nuclear pharmacymanagement (hardware and software).5 $13,400.00 DocumentationNucleus Crystal Integrity Testing System ...... 7.0 $9,450.00 cochlear implant testing system ..................... 10 $9,500.00 Other EquipmentNucleus PCI ................................................... 7.0 $8,000.00 cochlear implant programming system .......... 7 $9,000.00 Other Equipmentnutrition therapy software ............................... 5.0 $500.00 nutrition therapy software (Nutritionist Pro) ... 5 $595.00 Other EquipmentE13102 ..... Olympus halogen light ................................... 3.0 $950.00 Deleted (part of new system) ......................... .......... .............................. No DetailsE30013 ..... operating microscope ..................................... 7.0 $5,400.00 microscope, operating .................................... 7 $7,047.50 Other EquipmentE71019 ..... ophthalmic telebinocular ................................ 7.5 $1,025.00 telebinocular, ophthalmic ............................... 7 $1,014.33 Other Equipmentoptical coherence biometer ............................ 5.0 $25,950.00 Deleted through PEAC refinement. ............... .......... .............................. No Detailsoptical disk reader .......................................... 5.0 $4,000.00 optical drive (MO), external ............................ 5 $2,050.00 Documentationoptical fibers ................................................... 5.0 $3,236.00 laser optical delivery system (for excimer) .... 5$1,500.00 Other Equipment


## 47716 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed RulesADDENDUMD.—PROPOSEDCHANGES TOPRACTICEEXPENSEEQUIPMENTDESCRIPTION, LIFE,ANDPRICING—ContinuedEquip code2004 practice expense equipment details 2005 practice expense supply details (proposed)Description Life Price Description Life Price Equipment categoryOrthovoltage Machine .................................... 5.0 $140,000.00 orthovoltage radiotherapy system .................. 5 $140,000.00 RadiologyOSHA ventilated hood ................................... 10.0 $5,000.00 OSHA ventilated hood ................................... 15$5,000.00 RadiologyE13602 ..... osmometer ..................................................... 7.0 $4,595.00 Deleted through PEAC refinement. ............... .......... .............................. No Detailsotoscope-ophthalmoscope ............................. 3.0 $505.00 otoscope-ophthalmoscope (wall unit) ............ 10 $694.00 OtherEquipmentE54008 ..... Oxford PT recorder ........................................ 7.0 $6,940.00 EEG recorder, ambulatory ............................. 7 $6,940.00 Other EquipmentE54009 ..... Oxford review station ..................................... 7.0 $44,950.00 EEG review station, ambulatory .................... 5 $44,950.00 Other EquipmentOximetry Recorder, overnight/software ......... 5.0 $3,660.00 pulse oxymetry recording software (prolonged monitoring).5 $3,660.00 Other Equipmentoxygen concentrator ....................................... 15.0 $3,806.00 oxygen concentrator (5-6 lpm) ....................... 8 $1,035.83 Other Equipmentoxygen tank .................................................... 10.0 .............................. Deleted (less than $500) ................................ .......... .............................. No DetailsE55027 ..... Oxygen uptake expired gas analyzer ............ 7.0 $46,000.00 Vmax 229 (PFT equip, computer system) ..... 8 $44,681.00 Other Equipmentpacemaker follow-up system (e.g. paceart) ... 7.0 $22,000.00 pacemaker follow-up system (incl softwareand hardware) (Paceart).7 $23,507.00 Other EquipmentE71020 ..... pachometer .................................................... 5.0 $3,650.00 ultrasonic biometry, pachymeter .................... 5 $3,945.00 Other EquipmentE13638 ..... paraffin dispenser ........................................... 7.5 $995.00 paraffin dispenser (two-gallon) ....................... 10 $1,520.00 Laboratoryparaffin dispenser, 5 gal. ............................... 7.0 $1,995.00 paraffin dispenser (five-gallon) ....................... 10 $2,222.50 LaboratoryE92011 ..... parallel bars .................................................... 15.0 $1,755.00 parallel bars, platform mounted ..................... 15 $1,670.67 Other EquipmentPC server ....................................................... 5.0 $25,000.00 computer, server ............................................ 5 $25,000.00 DocumentationE52003 ..... Pentium computer .......................................... 5.0 $2,800.00 computer, desktop, w-monitor ........................ 5 $2,501.00 Documentationpercutaneous neuro test stimulator ............... 4.0 $795.00 percutaneous neuro test stimulator ............... 7 $795.00 Other Equipmentperipheral QCT scanner ................................. 5.0 $55,000.00 densitometry unit, peripheral, QCT ................ 5 $79,000.00 Radiologypessary stock kit ............................................ 10.0 $1,824.00 Deleted (less than $500) ................................ .......... .............................. No DetailsE13603 ..... pH meter ........................................................ 7.0 $1,000.00 pH conductivity meter .................................... 10 $1,028.00 Laboratoryphotochemotherapy unit & lamps (200 ea/yr) 5.0 $32,000.00 phototherapy unit, whole body, UVA-UVB ..... 10 $12,975.00 Other Equipmentphotochemotherapy unit, hand/foot combo ... 5.0 $1,525.00 phototherapy unit, hand-foot, UVA-UVB ........ 10 $1,675.00 Other EquipmentE13620 ..... photographic enlarger .................................... 10.0 $15,000.00 photographic enlarger .................................... 5 $3,195.00 DocumentationE13621 ..... photographic film processor ........................... 10.0 $6,000.00 film processor (electron microscopy) ............. 8 $4,400.00 Laboratoryphysician analysis and viewing station .......... 7.5 $35,000.00 computer workstation, nuclear medicineanalysis-viewing.5 $55,097.00 Documentationphysician analysis/viewing station ................. 10.0 $35,000.00 computer workstation, nuclear medicineanalysis-viewing.5 $55,097.00 Documentationphysics support package for intensity modulated radiotherapy.5.0 $12,500.00 Deleted (weekly training cost) ........................ .......... .............................. No DetailsE91011 ..... Plasma pheresis machine w/UV light source 7.5 $37,900.00 plasma pheresis machine w/UV light source 6 $37,900.00 OtherEquipmentE11009 ..... pneumatic chairs ............................................ 15.0 $697.60 Deleted (less than $500) ................................ .......... .............................. No Detailspneumatic tourniquet device .......................... 5.0 .............................. tourniquet system (Zimmer1200) ................... 7 $10,220.00 Other Equipmentpool cleaner .................................................... 10.0 $1,500.00 pool cleaner .................................................... 15 $1,372.15 Other EquipmentE11003 ..... Power Table ................................................... 7.5 $6,939.00 table, power .................................................... 10 $6,153.63 FurnitureE11003 ..... Power Table ................................................... 10.0 $6,939.00 table, power .................................................... 10 $6,153.63 FurnitureE11003 ..... Power Table ................................................... 15.0 $6,939.00 table, power .................................................... 10 $6,153.63 FurnitureE13622 ..... print washer .................................................... 10.0 $670.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsPrinter (HP) .................................................... 5.0 $1,200.00 printer, laser, paper ........................................ 5 $1,199.00 Documentationprinter, dye, sublimated .................................. 5.0 $15,000.00 printer, dye sublimation (photo, color) ........... 5 $2,322.50 Documentationprinter, laser for CT ........................................ 5.0 $75,000.00 film processor, dry, laser ................................ 8 $69,950.00 Documentationprinter, laser for CT angiography ................... 5.0 $71,400.00 film processor, dry, laser ................................ 8 $69,950.00 DocumentationE51080 ..... Processor (wet or dry) ................................... 8.0 $55,000.00 film processor, wet ......................................... 8 $26,325.00 DocumentationE55011 ..... Programmer: Intermedics ............................... 7.0 $10,000.00 Deleted through PEAC refinement. ......................... .............................. No DetailsE55013 ..... Programmers for Pacemakers ....................... 7.0 $10,000.00 programmer, pacemaker ................................ 7 $10,000.00 Other EquipmentE55012 ..... Programmers: Medtronic, CPI, Ventritex ....... 7.0 $11,000.00 programmer, for implanted medication pump(spine).7 $1,975.00 Other EquipmentE55012 ..... Programmers: Medtronic, CPI, Ventritex ....... 7.0 $11,000.00 programmer, neurostimulator (w-printer) ....... 7 $1,975.00Other EquipmentE54011 ..... Pt. Bedroom Furniture .................................... 12.0 $1,824.00 bedroom furniture (hospital bed, table, reclining chair).12 $2,416.99 Furniture


## 47717 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed RulesE30011 ..... pulse dye laser ............................................... 5.0 $125,000.00 laser, pulse dye .............................................. 5 $78,500.00 Other EquipmentE55003 ..... pulse oximeter ................................................ 5.0 $885.00 pulse oximeter w-printer ................................. 7 $1,207.18 Other EquipmentRadiation Source Meter ................................. 7.0 $600.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsRadiation Survey Meter ................................. 7.0 $1,117.00 radiation survey meter ................................... 8$756.25 Radiologyradiofrequency generator (NEURO) .............. 7.0 $32,900.00 radiofrequency generator (NEURO) .............. 5 $32,900.00 Other EquipmentE51005 ..... Radiographic/ fluoroscopic room ................... 5.0 $475,000.00 room, radiographic-fluoroscopic ..................... 5 $475,000.00 Room - LaneE51030 ..... Radiographic/Fluroscopic Evaluation Unit,RMI 4000.5.0 $15,995.00 Deleted through PEAC refinement. ............... .......... .............................. No Detailsradiopharmaceutical receiving area ............... 5.0 $51,545.00 Deleted (split into separate equipment items) .......... .............................. No DetailsE11011 ..... reclining exam chair with headrest ................ 10.0 $4,495.00 chair with headrest, exam, reclining .............. 15 $4,836.33 FurnitureE51022 ..... Record and verify Computer (Varian) ............ 5.0 $60,000.00 computer system, record and verify .............. 5 $60,000.00 Documentationremote monitoring service .............................. 7.0 $9,500.00 remote monitoring service (neurodiagnostics) 5 $9,500.00 Other Equipmentrespiratory plethysmograph ............................ 7.0 .............................. Deleted (part of new system) ......................... .......... .............................. No Detailsretractor, hand ................................................ 4.0 $1,566.20 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other EquipmentE54010 ..... review master ................................................. 7.0 $23,500.00 review master ................................................. 5 $23,500.00 Other Equipmentreview software (e.g. Prosolve) ..................... 5.0 $8,000.00 ultrasound, echocardiography analyzer software (ProSolv).5 $8,000.00 Other EquipmentE52013 ..... Review Station: AG7300 SVHS,17in. ............ 5.0 $899.99 video SVHS VCR (medical grade) ................. 5 $1,250.00 DocumentationE71036 ..... Rhinomenometer ............................................ 7.5 $3,150.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE72010 ..... Rigid Bone fixation system ............................ 7.5 $20,000.00 Deleted through PEAC refinement. ......................... .............................. No DetailsE52014 ..... Rigiscan .......................................................... 7.5 $12,500.00 nocturnal penile tumescence monitor(Rigiscan Plus).7 $9,000.00 Other EquipmentE13642 ..... robotic cover slipper ....................................... 7.5 $32,288.00 slide coverslipper, robotic .............................. 7 $30,143.00 LaboratoryE51087 ..... Roesenthal dosimeter .................................... 5.0 $1,995.00 dosimeter, aerosol provocation ...................... 10 $1,795.00 Other Equipmentrotation chair .................................................. 7.0 $91,059.00 CDP-computerized dynamic posturographysystem.7 $86,957.50 Other EquipmentE13643 ..... routine pap stainer ......................................... 7.0 $20,000.00 slide stainer, automated, high-volumethroughput.7 $14,085.68 LaboratoryRVS System ................................................... 7.0 $54,000.00 radiation virtual simulation system ................. 5 $54,000.00 RadiologyE50006 ..... scale, high capacity ........................................ 10.0 $1,995.00 scale, high capacity (800 lb) .......................... 10 $1,726.33 Furniturescale, new born electronic ............................. 7.0 $1,276.00 scale, new born, digital ..................................15 $1,279.41 FurnitureE13607 ..... scanning electron microscope ....................... 7.0 $120,000.00 microscope, electron, scanning (SEM) (withmicroprobe and x-ray microanalyzer).7 $178,725.00 LaboratoryScanning Laser Device .................................. 5.0 $60,000.00 tomographic device, optical coherence(OCT).7 $49,950.00 Other Equipmentscope washer ................................................. 7.0 .............................. endoscope disinfector, rigid orfiberoptic, wcart.7 $18,802.00 ScopeE71111 ..... Screening Lane .............................................. 7.0 $28,234.95 lane, screening (oph) ..................................... 7 $28,463.33 Room - LaneE54003 ..... Seizure Detection Device ............................... 7.0 $21,000.00 EEG, digital, prolonged testing system (computer w-remote camera).7 $46,750.00 Other Equipmentsensitometer ................................................... 5.0 $2,500.00 sensitometer, film ........................................... 10 $1,050.00 Radiologysensory integration equipment ....................... 8.0 $3,600.00 sensory integration equip (eg, ball pit, glider,trampoline, ramp).15 $3,600.00 Other Equipmentsensory kit ...................................................... 10.0 $677.00 kit, sensory ..................................................... 10 $677.35 Other EquipmentE72008 ..... septoplasty tray .............................................. 4.0 $725.76 Deleted through PEAC refinement. ............... .......... .............................. No Detailsshock wave machine ...................................... 5.0 $450,000.00 shock wave system ........................................ 5 $350,000.00 Other EquipmentE13103 ..... sigmoidoscopic equipment cart ...................... 10.0 $3,340.00 cart, endoscopy imaging equipment .............. 10$2,793.00 Scopesimple ear instrument pack ............................ 4.0 .............................. instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipmentsimple ear instrumentation pack .................... 4.0 .............................. instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other EquipmentSimulator, Varian ............................................ 5.0 $595,000.00 IMRT x-ray-fluoroscopic-based simulator ...... 5 $598,120.00 RadiologyE51024 ..... Simulator, Ximatron CF w/last Image hold .... 5.0 $450,000.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE53018 ..... Single Head Anger Scintillation Camera ....... 5.0 $300,000.00 gamma camera system, single-dual head ..... 5 $406,816.80RadiologyE53020 ..... Single Head or Dual Head Camera ............... 5.0 $575,000.00 gamma camera system, single-dual head ..... 5 $406,816.80RadiologyE53032 ..... Single Photon Densitometer/Computer ......... 5.0 $22,500.00 densitometry unit, whole body, SPA .............. 5 $22,500.00 RadiologyE71028 ..... Sinusoidal Harmonic Acceleration Chair ....... 7.0 $70,080.00 CDP-computerized dynamic posturographysystem.7 $86,957.50 Other Equipmentsleep kit (includes snore sensor & leg kit) ..... 7.0 $630.00 Deleted (less than $500) ................................ .......... .............................. No DetailsE13644 ..... slide dryer oven .............................................. 10.0 $695.00 slide dryer ....................................................... 10 $962.50 LaboratoryE13645 ..... slide etcher ..................................................... 7.5 $9,400.00 slide etcher-labeler ......................................... 7 $15,836.67 Laboratory


## 47718 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed RulesADDENDUMD.—PROPOSEDCHANGES TOPRACTICEEXPENSEEQUIPMENTDESCRIPTION, LIFE,ANDPRICING—ContinuedEquip code2004 practice expense equipment details 2005 practice expense supply details (proposed)Description Life Price Description Life Price Equipment categoryE13617 ..... slide stainer .................................................... 7.0 $13,000.00 slide stainer, automated, high-volumethroughput.7 $14,085.68 Laboratorysmoke evacuation system .............................. 10.0 .............................. Deleted (part of new system) ......................... .......... .............................. No Detailssoft tissue procedure pack ............................. 4.0 $539.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other EquipmentE30003 ..... soft tissue tray ................................................ 4.0 $1,559.40 instrument pack, medium ($1500 and up)..... 4 $1,500.00 Other EquipmentE52009 ..... Software (Paceart) ......................................... 5.0 $6,000.00 pacemaker follow-up system (incl softwareand hardware) (Paceart).7 $23,507.00 Other Equipmentsoftware, MR/PET/CT fusion ......................... 5.0 $60,000.00 computer software, MR/PET/CT fusion ......... 5 $60,000.00 Documentationsoftware-woodcock johnson test/cognitiveabilities.5.0 $728.00 cognitive abilities testing software(Woodcock Johnson).5 $558.00 Other EquipmentE51046 ..... Solid Water Calibration Phantom ................... 5.0 $2,000.00 phantom, solid water calibration check .......... 10 $2,109.50 RadiologyE13646 ..... solvent recycling system ................................ 7.5 $22,000.00 solvent recycling system ................................ 7 $13,995.00 LaboratoryE13614 ..... sonicator ......................................................... 7.5 $600.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE52010 ..... Sony Color Video Printer ............................... 5.0 $10,500.00 Deleted (part of new system) ......................... .......... .............................. No DetailsE52010 ..... Sony Color Video Printer (combine with system).5.0 $10,500.00 video printer, color (Sony medical grade) ...... 4 $2,295.00 DocumentationE71031 ..... sound proof booth- double walled ................. 7.5 $11,900.00 audiometric soundproof booth (exam andcontrol rooms).15 $33,518.00 Other Equipmentsounds and followers set, leforte, 12-24french.4.0 $508.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other Equipmentsounds, female (set) ...................................... 4.0 $1,736.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipmentsounds, male (set) ......................................... 4.0 $1,104.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other Equipmentsounds, VanBurden ........................................ 4.0 $1,104.00 instrument pack, basic ($500-$1499) ............ 4 $500.00Other Equipmentsource, 10 Ci Ir 192 ....................................... 3.0 $22,000.00 source, 10 Ci Ir 192 ....................................... 5 $22,000.00 RadiologyE53028 ..... SPECT Three head Camera .......................... 5.0 $565,000.00 gamma camera system, single-dual head ..... 5 $406,816.80 Radiologyspirometry instrument ..................................... 8.0 $37,974.00 Vmax 29s (spirometry testing equip, computer system).8 $26,875.00 Other EquipmentE13610 ..... sputter coater ................................................. 7.5 $6,000.00 Deleted (part of new system) ......................... .......... .............................. No Detailsstainer, automated hematology ...................... 7.0 $8,253.00 slide stainer, automated, standard throughput.7 $8,265.64 Laboratorystairs, exercise ............................................... 10.0 $870.00 stairs, ambulation training .............................. 15 $793.67 Other Equipmentstereotactic frame /tongs ................................ 5.0 .............................. cranial-skull tongs (Gardner-Wells) ................ 5 $542.00 Other Equipmentstimulator with probe ...................................... 8.0 .............................. Deleted (less than $500) ................................ .......... .............................. No DetailsE11002 ..... stretcher ......................................................... 5.0 $2,664.00 stretcher ......................................................... 10 $1,915.00 FurnitureE11002 ..... stretcher ......................................................... 10.0 $2,664.00 stretcher ......................................................... 10 $1,915.00 Furniturestrontium-90 applicator ................................... 4.0 $8,599.00 strontium-90 applicator ................................... 5 $8,599.00 Other Equipmentsuction and pressure cabinet, ENT (SMR) .... 15.0 $3,195.00 suction and pressure cabinet, ENT (SMR) .... 10 $3,495.00 Other EquipmentE30001 ..... suction machine, Gomco ............................... 10.0 $732.20 suction machine (Gomco) .............................. 10 $743.21 Other EquipmentE72009 ..... surgical drill system ........................................ 7.5 $19,800.00 drill system, surgical, large (Stryker) ............. 10 $15,933.00 Other EquipmentE30009 ..... surgical lamp .................................................. 10.0 $3,650.00 light, surgical .................................................. 10 $4,489.13 FurnitureE30018 ..... surgical loupes ............................................... 10.0 $1,300.00 loupes, surgical, prism, up to 8.0x ................. 7 $1,398.33 Other EquipmentE53004 ..... Survey Meter .................................................. 7.5 $650.00 radiation survey meter ................................... 8 $756.25 Radiologysuspension system for sensory integrationequipment.8.0 $2,500.00 sensory integration equipment, suspensionsystem.10 $2,500.00 Other EquipmentE52012 ..... SVHS video recorder ..................................... 5.0 $599.00 Deleted (part of new system) ......................... .......... .............................. No DetailsE52012 ..... SVHS video recorder ..................................... 5.0 $599.00 video SVHS VCR (medical grade) ................. 5$1,250.00 Documentationswimming pool for aquatic therapy ................ 10.0 $37,500.00 aquatic therapy pool ....................................... 15$36,000.00 Other Equipmentswitch kit ......................................................... 5.0 $1,910.00 augmentative communication - AT switches(eg, arm, tongue, pneumatic).7 $1,910.00 Other Equipmenttable, back, mobile ......................................... 10.0 $709.00 table, instrument, mobile ................................ 15 $634.00 Furnituretable, fluoroscopy (Hydra Vision 64kW) ........ 10.0 $281,600.00 table, fluoroscopy ........................................... 15$281,600.00 Furnituretable, OR, tilt .................................................. 10.0 $1,010.00 table, power .................................................... 10 $6,153.63 Furnituretable, pedestal for OT .................................... 15.0 $795.00 table, for seated OT therapy .......................... 15$718.67 Furniture


## 47719 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rulestable, traction with leg rest ............................. 10.0 $3,770.00 Deleted (part of new system) ......................... .......... .............................. No Detailstable, treatment/work, adjustable height ........ 10.0 $2,905.00 table, treatment, hi-lo ..................................... 15 $2,361.67 FurnitureTech Speak .................................................... 7.0 $645.00 augmentative communication - Tech Speak 7 $645.00 OtherEquipmentTEE transducer .............................................. 5.0 $45,000.00 ultrasound, transducer (TEE Omniplane II) ... 5 $45,000.00 Other Equipmenttest, clerical comprehension (Valpar) ............ 10.0 $2,680.00 work samples, clerical comprehension(Valpar 5).7 $2,680.00 Other Equipmenttest, fine finger dexterity (Valpar) ................... 10.0 $725.00 work samples, fine finger dexterity (Valpar204).7 $725.00 Other Equipmenttest, physical capacity and mobility (Valpar) 10.0 $725.00 work samples, physical capacity (Valpar 201) 7 $725.00 Other EquipmentE92023 ..... Therapeutic exercise equipment set .............. 15.0 $12,260.00 exercise equipment (treadmill, bike, stepper,UBE, pulleys, balance board).15 $12,710.00 Other EquipmentE92001 ..... therapeutic ultrasound unit ............................. 7.0 $1,995.00 ultrasound unit, therapeutic ............................ 7 $1,304.33 Other EquipmentTilt Table ........................................................ 10.0 $6,995.00 table, tilt (w-trendelenberg) ............................ 15 $7,695.00 FurnitureE13649 ..... tissue processing fume hood ......................... 7.5 $6,400.00 hood, fume ..................................................... 15 $4,778.46 LaboratoryE13650 ..... tissue processor ............................................. 7.0 $39,500.00 tissue processor ............................................. 7 $33,593.00 LaboratoryTLD oven/annealing furnace .......................... 5.0 $1,960.00 TLD annealing furnace ................................... 7 $2,536.00 LaboratoryE51048 ..... TLD Reader .................................................... 5.0 $13,000.00 TLD Reader .................................................... 7 $14,390.00 LaboratoryTonography Unit ............................................. 5.0 $10,065.00 tonography unit .............................................. 7 $6,195.00 Other Equipmenttool set, valpar ................................................ 7.0 $1,765.00 work samples, small tools (Valpar 1) .............7 $1,765.00 Other Equipmenttopcon TRC 50 E ........................................... 5.0 $28,790.00 camera, retinal (TRC 50IX, w-ICG, filters,motor drives).5 $37,000.00 Documentationtourniquet device, pneumatic ......................... 7.0 $12,500.00 tourniquet system (Zimmer1200) ................... 7 $10,220.00 Other EquipmentTracher 2000 .................................................. 7.0 $1,895.00 augmentative communication - Tracker 2000 7 $1,795.00Other Equipmenttransthoracic echo probe, pediatric, 8 mHz ... 5.0 $15,000.00 Deleted (part of new system) ......................... .......... .............................. No Detailstreadmill .......................................................... 10.0 $4,700.00 treadmill .......................................................... 8 $4,446.11 Other EquipmentE55020 ..... Treadmill w/ ECG Monitor .............................. 8.0 $16,000.00 cardiac monitor w-treadmill (12-lead PCbased ECG).10 $14,271.03 Other EquipmentE51050 ..... Treatment Planning Computer-3D (Focus) .... 5.0 $221,500.00 computer workstation, 3D teletherapy treatment planning.5 $221,500.00 Documentationtreatment planning system for intensity modulated radiotherapy.5.0 $350,000.00 treatment planning system, IMRT (Corvus w-Peregrine 3D Monte Carlo).5 $350,545.00 DocumentationTreatment Vault .............................................. 7.0 $550,670.00 radiation treatment vault ................................ 15 $550,670.00 RadiologyTUMT device .................................................. 5.0 $60,000.00 TUMT system control unit .............................. 7 $29,995.00 Other EquipmentE71032 ..... tympanometer with printer ............................. 7.0 $2,700.00 tympanometer with printer ............................. 10 $2,648.53 Other Equipmentultrasonic biometry, pachymeter .................... 5.0 $3,945.00 ultrasonic biometry, pachymeter .................... 5 $3,945.00Other EquipmentE13663 ..... ultrasonic instrument cleaner ......................... 7.5 $945.00 Deleted (indirect) ............................................ .......... .............................. No DetailsE52019 ..... Ultrasonic nebulizer ........................................ 10.0 $1,000.00 Deleted (CPT action) ..................................... .......... .............................. No DetailsE52001 ..... ultrasound color doppler, transducers andvaginal probe.5.0 $155,000.00 ultrasound color doppler, transducers andvaginal probe.5 $155,000.00 Other EquipmentE52018 ..... Ultrasound Room ........................................... 5.0 $272,000.00 room, ultrasound, general .............................. 5 $369,945.00 Room - Laneultrasound table .............................................. 10.0 $4,495.00 table, ultrasound ............................................. 15 $5,823.33 FurnitureUltrasound Unit .............................................. 5.0 $30,000.00 ultrasound unit, Shimadzu ............................. 5 $29,999.00 Other EquipmentE52005 ..... ultrasound, shimatsu ...................................... 5.0 $35,000.00 ultrasound unit, Shimadzu ............................. 5 $29,999.00 Other Equipmenturethotome, otis ............................................. 3.0 $1,735.00 urethrotome, Otis ........................................... 4 $1,697.50 ScopeE52006 ..... urodynamics machine, 4-channel video ........ 5.0 $15,175.00 urodynamics system, 4-channel .................... 5 $30,733.00 Other Equipmenturodynamics machine, 6-channel video ........ 5.0 $115,578.00 urodynamics system, 6-channel, w-video ...... 5 $115,578.00 Other Equipmenturoflowmeter, digital, w-chair (Microflo) ......... 5.0 $2,758.00 uroflowmeter, digital, w-chair ......................... 7 $2,758.00 Other Equipmentuterine thermal balloon ablation system(Thermachoice).5.0 $8,500.00 uterine thermal balloon ablation system(Thermachoice).7 $8,500.00 Other EquipmentUV monitor/meter ........................................... 5.0 $690.00 phototherapy UVB measuring device ............ 10 $690.00Other Equipmentvacuum cart .................................................... 10.0 .............................. vacuum cart .................................................... 10Other Equipment.E13615 ..... vacuum dissector ........................................... 10.0 $635.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE13627 ..... vacuum evaporator ........................................ 7.5 $15,000.00 Deleted (part of new system) ......................... .......... .............................. No DetailsE13612 ..... vacuum oven .................................................. 10.0 $3,000.00 Deleted (part of new system) ......................... .......... .............................. No DetailsE13624 ..... vacuum pump ................................................. 10.0 $1,455.00 vacuum pump ................................................. 7 $1,840.00 LaboratoryE92015 ..... Vasopneumatic device ................................... 10.0 $795.00 vasopneumatic compression system ............. 10$632.48 Other EquipmentE91003 ..... ventilator hood & blower ................................ 10.0 $602.55 hood, ventilator with blower ........................... 10 $1,612.50 Laboratory


## 47720 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed RulesADDENDUMD.—PROPOSEDCHANGES TOPRACTICEEXPENSEEQUIPMENTDESCRIPTION, LIFE,ANDPRICING—ContinuedEquip code2004 practice expense equipment details 2005 practice expense supply details (proposed)Description Life Price Description Life Price Equipment categoryvideo add-on camera system w-monitor (endoscopy).5.0 $9,495.00 video add-on camera system w-monitor (en-doscopy).5 $9,495.00 ScopeE13635 ..... video camera .................................................. 5.0 $1,000.00 Deleted (part of new system) ......................... .......... .............................. No DetailsE13635 ..... video camera (combine with system) ............ 5.0 $1,000.00 video add-on camera system w-monitor (endoscopy).5 $9,495.00 ScopeE13635 ..... video camera (combine with system) ............ 5.0 $1,000.00 video camera .................................................. 5 $1,000.00 Documentationvideo system, capsule endoscopy (software,computer, monitor, printer)........... $17,000.00 video system, capsule endoscopy (software,computer, monitor, printer).5 $17,000.00 Scopevideo system, capsule endoscopy, boosterdrive w-accessories........... $2,500.00 video system, capsule endoscopy, boosterdrive w-accessories.5 $2,500.00 Scopevideo system, endoscopy (processor, digitalcapture, monitor, printer, cart).5.0 $33,233.00 video system, endoscopy (processor, digitalcapture, monitor, printer, cart).5 $33,232.50 Scopevideo system, FEES (scope, camera, lightsource, image capture, monitor, printer,cart).5.0 $21,675.00 video system, FEES (scope, camera, lightsource, image capture, monitor, printer,cart).5 $21,675.00 Scopevideo system, FEESST (scope, sensorystimulator, camera, light source, imagecapture, monitor, printer, cart).5.0 $29,550.00 video system, FEESST (scope, sensorystimulator, camera, light source, imagecapture, monitor, printer, cart).5 $29,550.00 Scopevideo system, stroboscopy (strobing platform, camera, digital recorder, monitor,printer, cart).5.0 $25,310.00 video system, stroboscopy (strobing platform, camera, digital recorder, monitor,printer, cart).5 $25,310.00 ScopeE71033 ..... visual response audiometry ........................... 7.0 $700.00 VRA-visual reinforcment audiometry system 5 $1,550.00Other EquipmentE55023 ..... VMax 229 (split/combine systems) ................ 8.0 $56,551.20 Vmax 229 (spirometry testing equip, computer system).8 $44,681.00 Other EquipmentE55023 ..... VMax 229 (split/combine systems) ................ 8.0 $56,551.20 Vmax 29s (spirometry testing equip, computer system).8 $26,875.00 Other EquipmentVoice Pal Max ................................................ 7.0 $555.00 augmentative communication - VoicePal Max 7 $555.00 Other EquipmentE13648 ..... vortex mixer .................................................... 7.5 $500.00 Deleted (less than $500) ................................ .......... .............................. No DetailsE54002 ..... Voyager acquisition station ............................ 7.0 $46,850.00 sleep screening system, attended (w-respplethysmography).5 $22,000.00 Other Equipmentwater bath ...................................................... 10.0 $750.00 water bath, general purpose (lab) .................. 7 $726.45 LaboratoryWater Bath Phantom with Drivers ................. 5.0 $15,000.00 phantom, water, includes remote motor drive 10 $3,070.00 Radiologywater bath, general purpose (lab) .................. 5.0 $726.45 water bath, general purpose (lab) .................. 7 $726.45 LaboratoryWater Chiller .................................................. 7.0 $28,000.00 water chiller (radiation treatment) .................. 7 $28,000.00 RadiologyE51026 ..... Waterbath for Thermoplastic ImmobilizerSystem.5.0 $750.00 water bath, thermoplastic softener (20in x12in).7 $722.36 RadiologyWaterbath, Medtech ....................................... 5.0 $1,150.00 water bath, thermoplastic softener (20in x12in).7 $722.36 RadiologyE71008 ..... Weeks dark adaptometer ............................... 5.0 $16,100.00 Weeks dark adaptometer ............................... 7 $2,950.00 Other EquipmentE51076 ..... Well Counter .................................................. 5.0 $3,955.00 well counter .................................................... 7 $3,955.00 RadiologyE51074 ..... Well Ionization Chamber, Standard Imaging 5.0 $4,641.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE71108 ..... wheatstone trainer .......................................... 7.5 $895.00 stereo trainer (wheatstone) ............................ 7 $550.00 Other EquipmentE92005 ..... whirlpool ......................................................... 10.0 $3,700.00 whirlpool, lo-boy tank (whole body)............... 10 $3,296.40 Furniturewhitkit evaluation kit ....................................... 5.0 $1,400.00 augmentative communication - WhitKit headsupport.7 $1,400.00 Other EquipmentE53030 ..... Whole Body or Dual Head Camera ............... 5.0 $575,000.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsWIT thermotherapy unit ................................. 5.0 $18,500.00 WIT system (AquaTherm) .............................. 7 $16,400.00 Other Equipmentwork bench, orthotic, mobile .......................... 10.0 $750.00 cart-workbench, orthotic, mobile .................... 10 $752.50 Furniturework station, post processing for CTangiography.10.0 $180,000.00 Deleted (part of new system) ......................... .......... .............................. No DetailsE53022 ..... Xenon Delivery System .................................. 5.0 $5,450.00 Deleted through PEAC refinement. ......................... .............................. No Detailsxenon light source - cable for endoscope ..... 3.0


## 47721 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Ruleslight source, xenon ......................................... 5 $6,723.33 Other Equipment.E53024 ..... Xenon Monitor ................................................ 5.0 $2,775.00 Deleted through PEAC refinement. ............... .......... .............................. No DetailsE51003 ..... X-omat Film processor M35A ........................ 8.0 $10,900.00 film processor, x-omat (Kodak 2000A) .......... 8 $11,500.00 DocumentationE51002 ..... X-omat film processor M6B ........................... 8.0 $26,832.00 film processor, x-omat (M6B) ......................... 8 $34,865.00 DocumentationE55032 ..... x-ray lift ........................................................... 7.5 $800.00 lift, hydraulic, table assist ............................... 10 $1,111.00 FurnitureE51001 ..... X-ray View Box 4 panel ................................. 15.0 $909.49 x-ray view box, 4 panel .................................. 10 $889.17 RadiologyE72000 ..... YAG laser ....................................................... 5.0 $40,000.00 laser, YAG ...................................................... 5 $29,975.00 Other EquipmentE71009 ..... Zeiss slit lamp camera ................................... 10.0 $7,495.00 slit lamp (Haag-Streit) .................................... 10 $7,435.00 Other Equipmentzeiss visulas 690 PDT laser .......................... 5.0 $37,900.00 laser, photodynamic therapy .......................... 5 $35,000.00 Other Equipment


## 47722 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### E.

— R EVISED 

### 2005 O FFICE 

### R ENTAL 

### I NDEX 

### V ERSUS 

### C URRENT 

### O FFICE 

### R ENTAL 

### I NDEX BY 

### 2004 F EE 

### S CHEDULE 

### A REA

Carrier No. Loc. No. Locality name Current rental index Revised 2005 rental index Difference Percentage difference

00510 ....... 00 ALABAMA ............................................................................ 0.738 0.679 -0.059 -8.0 00831 ....... 01 ALASKA ............................................................................... 1.249 1.141 -0.108 -8.6 31146 ....... 26 ANAHEIM/SANTA ANA, CA ................................................ 1.422 1.586 0.164 11.5 00832 ....... 00 ARIZONA ............................................................................. 1.000 1.034 0.034 3.4 00520 ....... 13 ARKANSAS ......................................................................... 0.704 0.666 -0.038 -5.4 00511 ....... 01 ATLANTA, GA ..................................................................... 1.136 1.271 0.135 11.9 00900 ....... 31 AUSTIN, TX ......................................................................... 1.111 1.243 0.132 11.9 00901 ....... 01 BALTIMORE/SURR. CNTYS, MD ....................................... 1.026 1.159 0.133 13.0 00900 ....... 20 BEAUMONT, TX .................................................................. 0.758 0.700 -0.058 -7.7 00900 ....... 09 BRAZORIA, TX .................................................................... 1.018 0.991 -0.027 -2.7 00952 ....... 16 CHICAGO, IL ....................................................................... 1.216 1.274 0.058 4.8 00824 ....... 01 COLORADO ........................................................................ 1.066 1.100 0.034 3.2 00591 ....... 00 CONNECTICUT ................................................................... 1.215 1.275 0.060 4.9 00900 ....... 11 DALLAS, TX ........................................................................ 1.196 1.167 -0.029 -2.4 00903 ....... 01 DC + MD/VA SUBURBS ..................................................... 1.341 1.584 0.243 18.1 00902 ....... 01 DELAWARE ......................................................................... 1.051 0.983 -0.068 -6.5 00953 ....... 01 DETROIT, MI ....................................................................... 1.045 1.060 0.015 1.4 00952 ....... 12 EAST ST. LOUIS, IL ............................................................ 0.792 0.912 0.120 15.2 00590 ....... 03 FORT LAUDERDALE, FL .................................................... 1.090 1.041 -0.049 -4.5 00900 ....... 28 FORT WORTH, TX .............................................................. 0.977 1.017 0.040 4.1 00900 ....... 15 GALVESTON, TX ................................................................ 0.924 0.901 -0.023 -2.5 00833 ....... 01 HAWAII/GUAM .................................................................... 1.389 1.186 -0.203 -14.6 00900 ....... 18 HOUSTON, TX .................................................................... 0.988 1.024 0.036 3.6 05130 ....... 00 IDAHO .................................................................................. 0.791 0.730 -0.061 -7.7 00630 ....... 00 INDIANA .............................................................................. 0.847 0.789 -0.058 -6.8 00826 ....... 00 IOWA ................................................................................... 0.785 0.737 -0.048 -6.1 00650 ....... 00 KANSAS* ............................................................................. 0.793 0.765 -0.028 -3.5 00740 ....... 04 KANSAS* ............................................................................. 0.793 0.765 -0.028 -3.5 00660 ....... 00 KENTUCKY ......................................................................... 0.721 0.685 -0.036 -5.0 31146 ....... 18 LOS ANGELES, CA ............................................................ 1.223 1.328 0.105 8.6 00803 ....... 01 MANHATTAN, NY ............................................................... 1.744 1.676 -0.068 -3.9 31140 ....... 03 MARIN/NAPA/SOLANO, CA ............................................... 1.647 1.886 0.239 14.5 31143 ....... 01 METROPOLITAN BOSTON ................................................ 1.504 1.809 0.305 20.3 00740 ....... 02 METROPOLITAN KANSAS CITY, MO ............................... 0.916 0.962 0.046 5.0 00865 ....... 01 METROPOLITAN PHILADELPHIA, PA ............................... 1.178 1.196 0.018 1.5 00523 ....... 01 METROPOLITAN ST. LOUIS, MO ...................................... 0.814 0.949 0.135 16.6 00590 ....... 04 MIAMI, FL ............................................................................ 1.139 1.117 -0.022 -1.9 00954 ....... 00 MINNESOTA ........................................................................ 0.940 0.997 0.057 6.1 00512 ....... 00 MISSISSIPPI ........................................................................ 0.690 0.667 -0.023 -3.3 00751 ....... 01 MONTANA ........................................................................... 0.794 0.738 -0.056 -7.1 00655 ....... 00 NEBRASKA ......................................................................... 0.817 0.748 -0.069 -8.4 00834 ....... 00 NEVADA .............................................................................. 1.117 1.110 -0.007 -0.6 31144 ....... 40 NEW HAMPSHIRE .............................................................. 1.089 1.123 0.034 3.1 00521 ....... 05 NEW MEXICO ..................................................................... 0.837 0.788 -0.049 -5.9 00528 ....... 01 NEW ORLEANS, LA ............................................................ 0.832 0.905 0.073 8.8 05535 ....... 00 NORTH CAROLINA ............................................................. 0.869 0.826 -0.043 -4.9 00820 ....... 01 NORTH DAKOTA ................................................................ 0.800 0.751 -0.049 -6.1 00805 ....... 01 NORTHERN NJ ................................................................... 1.399 1.421 0.022 1.6 00803 ....... 02 NYC SUBURBS/LONG I., NY ............................................. 1.573 1.538 -0.035 -2.2 31140 ....... 07 OAKLAND/BERKELEY, CA ................................................. 1.470 1.886 0.416 28.3 00883 ....... 00 OHIO .................................................................................... 0.863 0.838 -0.025 -2.9 00522 ....... 00 OKLAHOMA ......................................................................... 0.725 0.717 -0.008 -1.1 00835 ....... 01 PORTLAND, OR .................................................................. 1.120 1.058 -0.062 -5.5 00803 ....... 03 POUGHKPSIE/N NYC SUBURBS, NY ............................... 1.254 1.201 -0.053 -4.2 00973 ....... 20 PUERTO RICO .................................................................... 0.688 0.631 -0.057 -8.3 14330 ....... 04 QUEENS, NY ....................................................................... 1.414 1.359 -0.055 -3.9 31146 ....... 99 REST OF CALIFORNIA* ..................................................... 1.050 1.110 0.060 5.7 31140 ....... 99 REST OF CALIFORNIA* ..................................................... 1.050 1.110 0.060 5.7 00590 ....... 99 REST OF FLORIDA ............................................................ 0.951 0.928 -0.023 -2.4 00511 ....... 99 REST OF GEORGIA ........................................................... 0.771 0.729 -0.042 -5.4 00952 ....... 99 REST OF ILLINOIS ............................................................. 0.797 0.741 -0.056 -7.0 00528 ....... 99 REST OF LOUISIANA ......................................................... 0.715 0.672 -0.043 -6.0 31142 ....... 99 REST OF MAINE ................................................................. 0.801 0.755 -0.046 -5.7 00901 ....... 99 REST OF MARYLAND ........................................................ 0.995 1.026 0.031 3.1 31143 ....... 99 REST OF MASSACHUSETTS ............................................ 1.308 1.239 -0.069 -5.3 00953 ....... 99 REST OF MICHIGAN .......................................................... 0.848 0.799 -0.049 -5.8 00740 ....... 99 REST OF MISSOURI* ......................................................... 0.662 0.613 -0.049 -7.4 00523 ....... 99 REST OF MISSOURI* ......................................................... 0.662 0.613 -0.049 -7.4 00805 ....... 99 REST OF NEW JERSEY .................................................... 1.312 1.256 -0.056 -4.3 00801 ....... 99 REST OF NEW YORK ........................................................ 0.875 0.812 -0.063 -7.2


## 47723 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### E.

— R EVISED 

### 2005 O FFICE 

### R ENTAL 

### I NDEX 

### V ERSUS 

### C URRENT 

### O FFICE 

### R ENTAL 

### I NDEX BY 

### 2004 F EE 

### S CHEDULE 

### A REA



### — Continued

Carrier No. Loc. No. Locality name Current rental index Revised 2005 rental index Difference Percentage difference

00835 ....... 99 REST OF OREGON ............................................................ 0.901 0.837 -0.064 -7.1 00865 ....... 99 REST OF PENNSYLVANIA ................................................ 0.844 0.785 -0.059 -7.0 00900 ....... 99 REST OF TEXAS ................................................................ 0.795 0.759 -0.036 -4.5 00836 ....... 99 REST OF WASHINGTON ................................................... 0.958 0.915 -0.043 -4.5 00870 ....... 01 RHODE ISLAND .................................................................. 1.098 0.931 -0.167 -15.2 31140 ....... 05 SAN FRANCISCO, CA ........................................................ 2.174 2.356 0.182 8.4 31140 ....... 06 SAN MATEO, CA ................................................................ 2.174 2.356 0.182 8.4 31140 ....... 09 SANTA CLARA, CA ............................................................. 1.949 2.416 0.467 24.0 00836 ....... 02 SEATTLE (KING CNTY), WA .............................................. 1.232 1.234 0.002 0.2 00880 ....... 01 SOUTH CAROLINA ............................................................. 0.825 0.763 -0.062 -7.5 00820 ....... 02 SOUTH DAKOTA ................................................................ 0.853 0.801 -0.052 -6.1 31142 ....... 03 SOUTHERN MAINE ............................................................ 1.009 1.098 0.089 8.8 00952 ....... 15 SUBURBAN CHICAGO, IL .................................................. 1.216 1.274 0.058 4.8 05440 ....... 35 TENNESSEE ....................................................................... 0.800 0.748 -0.052 -6.5 00910 ....... 09 UTAH ................................................................................... 0.978 0.950 -0.028 -2.9 31146 ....... 17 VENTURA, CA ..................................................................... 1.294 1.484 0.190 14.7 31145 ....... 50 VERMONT ........................................................................... 1.004 0.997 -0.007 -0.7 00973 ....... 50 VIRGIN ISLANDS ................................................................ 1.260 1.164 -0.096 -7.6 00904 ....... 00 VIRGINIA ............................................................................. 0.892 0.933 0.041 4.6 00884 ....... 16 WEST VIRGINIA .................................................................. 0.685 0.634 -0.051 -7.4 00951 ....... 00 WISCONSIN ........................................................................ 0.866 0.801 -0.065 -7.5 00825 ....... 21 WYOMING ........................................................................... 0.799 0.751 -0.048 -6.0

**Note:** Revised Rental Indices Based Upon 2004 HUD FMR Data.



### A DDENDUM 

### F.

— C URRENT 

### G EOGRAPHIC 

### P RACTICE 

### C OST 

### I NDICES BY 

### M EDICARE 

### C ARRIER AND 

### L OCALITY

Carrier No. Loc. No. Locality name Work GPCI PE GPCI MP GPCI

00510 ....... 00 ALABAMA ...................................................................................................... 1.00 0 0.870 0.779 00831 ....... 01 ALASKA ......................................................................................................... 1. 670 1.670 1.670 00832 ....... 00 ARIZONA ....................................................................................................... 1.0 00 0.978 1.090 00520 ....... 13 ARKANSAS ................................................................................................... 1.000 0 .847 0.389 31146 ....... 26 ANAHEIM/SANTA ANA, CA .......................................................................... 1.037 1.184 0.955 31146 ....... 18 LOS ANGELES, CA ...................................................................................... 1.056 1.139 0. 955 31140 ....... 03 MARIN/NAPA/SOLANO, CA ......................................................................... 1.015 1.248 0.669 31140 ....... 07 OAKLAND/BERKELEY, CA ........................................................................... 1.041 1.235 0.669 31140 ....... 05 SAN FRANCISCO, CA .................................................................................. 1.068 1.458 0.66 9 31140 ....... 06 SAN MATEO, CA .......................................................................................... 1.048 1.432 0.663 31140 ....... 09 SANTA CLARA, CA ....................................................................................... 1.063 1.380 0 .622 31146 ....... 17 VENTURA, CA ............................................................................................... 1.028 1. 125 0.763 31146 ....... 99 REST OF CALIFORNIA* ............................................................................... 1.007 1.034 0.740 31140 ....... 99 REST OF CALIFORNIA* ............................................................................... 1.007 1.034 0.740 00824 ....... 01 COLORADO .................................................................................................. 1.000 0. 992 0.821 00591 ....... 00 CONNECTICUT ............................................................................................. 1.050 1.15 6 0.933 00902 ....... 01 DELAWARE ................................................................................................... 1.019 1 .035 0.802 00903 ....... 01 DC + MD/VA SUBURBS ............................................................................... 1.050 1.166 0.917 00590 ....... 03 FORT LAUDERDALE, FL .............................................................................. 1.000 1.018 1.790 00590 ....... 04 MIAMI, FL ...................................................................................................... 1. 015 1.052 2.399 00590 ....... 99 REST OF FLORIDA ...................................................................................... 1.000 0.946 1. 268 00511 ....... 01 ATLANTA, GA ............................................................................................... 1.006 1. 059 0.951 00511 ....... 99 REST OF GEORGIA ..................................................................................... 1.000 0.892 0.9 51 00833 ....... 01 HAWAII/GUAM .............................................................................................. 1.000 1.1 24 0.817 05130 ....... 00 IDAHO ............................................................................................................ 1.000 0.881 0.478 00952 ....... 16 CHICAGO, IL ................................................................................................. 1.028 1.092 1.832 00952 ....... 12 EAST ST. LOUIS, IL ...................................................................................... 1.000 0.92 4 1.720 00952 ....... 15 SUBURBAN CHICAGO, IL ............................................................................ 1.006 1.071 1.648 00952 ....... 99 REST OF ILLINOIS ....................................................................................... 1.000 0.889 1.175 00630 ....... 00 INDIANA ........................................................................................................ 1. 000 0.922 0.459 00826 ....... 00 IOWA ............................................................................................................. 1.000 0.876 0.593 00650 ....... 00 KANSAS* ....................................................................................................... 1.0 00 0.895 0.738 00740 ....... 04 KANSAS* ....................................................................................................... 1.0 00 0.895 0.738 00660 ....... 00 KENTUCKY ................................................................................................... 1.000 0 .866 0.875 00528 ....... 01 NEW ORLEANS, LA ...................................................................................... 1.000 0.945 1. 240 00528 ....... 99 REST OF LOUISIANA ................................................................................... 1.000 0.870 1.0 66 31142 ....... 03 SOUTHERN MAINE ...................................................................................... 1.000 0.999 0.6 52 31142 ....... 99 REST OF MAINE ........................................................................................... 1.000 0.91 0 0.652 00901 ....... 01 BALTIMORE/SURR. CNTYS, MD ................................................................. 1.021 1.038 0.931 00901 ....... 99 REST OF MARYLAND .................................................................................. 1.000 0.972 0.767


## 47724 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### F.

— C URRENT 

### G EOGRAPHIC 

### P RACTICE 

### C OST 

### I NDICES BY 

### M EDICARE 

### C ARRIER AND 

### L OCALITY



### — Continued

Carrier No. Loc. No. Locality name Work GPCI PE GPCI MP GPCI

31143 ....... 01 METROPOLITAN BOSTON .......................................................................... 1.041 1.239 0.803 31143 ....... 99 REST OF MASSACHUSETTS ...................................................................... 1.010 1.129 0.803 00953 ....... 01 DETROIT, MI ................................................................................................. 1.043 1.038 2.741 00953 ....... 99 REST OF MICHIGAN .................................................................................... 1.000 0.938 1.5 45 00954 ....... 00 MINNESOTA .................................................................................................. 1.000 0 .974 0.431 00512 ....... 00 MISSISSIPPI .................................................................................................. 1.00 0 0.837 0.750 00740 ....... 02 METROPOLITAN KANSAS CITY, MO ......................................................... 1.000 0.967 0.896 00523 ....... 01 METROPOLITAN ST. LOUIS, MO ................................................................ 1.000 0.938 0.893 00740 ....... 99 REST OF MISSOURI* ................................................................................... 1.000 0.825 0.8 42 00523 ....... 99 REST OF MISSOURI* ................................................................................... 1.000 0.825 0.8 42 00751 ....... 01 MONTANA ..................................................................................................... 1.000 0.876 0.815 00655 ....... 00 NEBRASKA ................................................................................................... 1.000 0 .877 0.442 00834 ....... 00 NEVADA ........................................................................................................ 1.0 05 1.039 1.138 31144 ....... 40 NEW HAMPSHIRE ........................................................................................ 1.000 1.030 0. 883 00805 ....... 01 NORTHERN NJ ............................................................................................. 1.058 1.19 3 0.916 00805 ....... 99 REST OF NEW JERSEY .............................................................................. 1.029 1.110 0.916 00521 ....... 05 NEW MEXICO ............................................................................................... 1.000 0.9 00 0.898 00803 ....... 01 MANHATTAN, NY ......................................................................................... 1.094 1.351 1 .586 00803 ....... 02 NYC SUBURBS/LONG I., NY ....................................................................... 1.068 1.251 1.869 00803 ....... 03 POUGHKPSIE/N NYC SUBURBS, NY ......................................................... 1.011 1.075 1.221 14330 ....... 04 QUEENS, NY ................................................................................................. 1.058 1 .228 1.791 00801 ....... 99 REST OF NEW YORK .................................................................................. 1.000 0.944 0.720 05535 ....... 00 NORTH CAROLINA ....................................................................................... 1.000 0.931 0. 618 00820 ....... 01 NORTH DAKOTA .......................................................................................... 1.000 0.880 0 .630 00883 ....... 00 OHIO ............................................................................................................. . 1.000 0.944 0.967 00522 ....... 00 OKLAHOMA ................................................................................................... 1.000 0 .876 0.413 00835 ....... 01 PORTLAND, OR ............................................................................................ 1.000 1.04 9 0.438 00835 ....... 99 REST OF OREGON ...................................................................................... 1.000 0.933 0.4 38 00865 ....... 01 METROPOLITAN PHILADELPHIA, PA ......................................................... 1.023 1.092 1.400 00865 ....... 99 REST OF PENNSYLVANIA .......................................................................... 1.000 0.929 0.790 00973 ....... 20 PUERTO RICO .............................................................................................. 1.000 0.7 12 0.268 00870 ....... 01 RHODE ISLAND ............................................................................................ 1.017 1.06 5 0.896 00880 ....... 01 SOUTH CAROLINA ....................................................................................... 1.000 0.904 0. 336 00820 ....... 02 SOUTH DAKOTA .......................................................................................... 1.000 0.878 0 .385 05440 ....... 35 TENNESSEE ................................................................................................. 1.000 0. 900 0.612 00900 ....... 31 AUSTIN, TX ................................................................................................... 1.00 0 0.996 0.922 00900 ....... 20 BEAUMONT, TX ............................................................................................ 1.000 0.89 0 1.318 00900 ....... 09 BRAZORIA, TX .............................................................................................. 1.000 0. 978 1.318 00900 ....... 11 DALLAS, TX .................................................................................................. 1.010 1.065 0.996 00900 ....... 28 FORT WORTH, TX ........................................................................................ 1.000 0.981 0 .996 00900 ....... 15 GALVESTON, TX .......................................................................................... 1.000 0.969 1.318 00900 ....... 18 HOUSTON, TX .............................................................................................. 1.020 1.0 07 1.316 00900 ....... 99 REST OF TEXAS .......................................................................................... 1.000 0.880 1.047 00910 ....... 09 UTAH ............................................................................................................. 1.000 0.941 0.653 31145 ....... 50 VERMONT ..................................................................................................... 1.000 0.986 0.527 00973 ....... 50 VIRGIN ISLANDS .......................................................................................... 1.000 1.02 3 1.003 00904 ....... 00 VIRGINIA ....................................................................................................... 1. 000 0.938 0.540 00836 ....... 02 SEATTLE (KING CNTY), WA ........................................................................ 1.005 1.100 0.803 00836 ....... 99 REST OF WASHINGTON ............................................................................. 1.000 0.972 0.803 00884 ....... 16 WEST VIRGINIA ............................................................................................ 1.000 0.8 50 1.462 00951 ....... 00 WISCONSIN .................................................................................................. 1.000 0 .929 0.865 00825 ....... 21 WYOMING ..................................................................................................... 1.000 0.895 0.970

**Note:** Work GPCI is the 1/4 work GPCI required by section 1848(e)(1)(A)(iii) of the Act. 1.0 Floor on Work GPCI, 1.67 for all Alaska i ndices, set by MMA GPCIs are scaled by the following factors: Work= 0.9977, Practice Expense=0.9930, Malpractice Expense=1.0021.



### A DDENDUM 

### G.

— P ROPOSED 

### 2005 G EOGRAPHIC 

### P RACTICE 

### C OST 

### I NDICES BY 

### M EDICARE 

### C ARRIER AND 

### L OCALITY

Carrier No. Loc. No. Locality name Work GPCI PE GPCI MP GPCI

00510 ....... 00 ALABAMA ...................................................................................................... 1.00 0 0.860 0.779 00831 ....... 01 ALASKA ......................................................................................................... 1. 670 1.670 1.670 00832 ....... 00 ARIZONA ....................................................................................................... 1.0 00 0.983 1.090 00520 ....... 13 ARKANSAS ................................................................................................... 1.000 0 .841 0.389 31146 ....... 26 ANAHEIM/SANTA ANA, CA .......................................................................... 1.036 1.203 0.955 31146 ....... 18 LOS ANGELES, CA ...................................................................................... 1.049 1.142 0. 955 31140 ....... 03 MARIN/NAPA/SOLANO, CA ......................................................................... 1.026 1.292 0.669 31140 ....... 07 OAKLAND/BERKELEY, CA ........................................................................... 1.049 1.301 0.669 31140 ....... 05 SAN FRANCISCO, CA .................................................................................. 1.066 1.498 0.66 9 31140 ....... 06 SAN MATEO, CA .......................................................................................... 1.062 1.482 0.663


## 47725 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### G.

— P ROPOSED 

### 2005 G EOGRAPHIC 

### P RACTICE 

### C OST 

### I NDICES BY 

### M EDICARE 

### C ARRIER AND 

### L OCALITY



### — Continued

Carrier No. Loc. No. Locality name Work GPCI PE GPCI MP GPCI

31140 ....... 09 SANTA CLARA, CA ....................................................................................... 1.076 1.457 0 .622 31146 ....... 17 VENTURA, CA ............................................................................................... 1.029 1. 146 0.763 31146 ....... 99 REST OF CALIFORNIA* ............................................................................... 1.007 1.039 0.740 31140 ....... 99 REST OF CALIFORNIA* ............................................................................... 1.007 1.039 0.740 00824 ....... 01 COLORADO .................................................................................................. 1.000 1. 004 0.821 00591 ....... 00 CONNECTICUT ............................................................................................. 1.044 1.16 1 0.933 00902 ....... 01 DELAWARE ................................................................................................... 1.016 1 .027 0.802 00903 ....... 01 DC + MD/VA SUBURBS ............................................................................... 1.051 1.202 0.917 00590 ....... 03 FORT LAUDERDALE, FL .............................................................................. 1.000 1.005 1.790 00590 ....... 04 MIAMI, FL ...................................................................................................... 1. 007 1.036 2.399 00590 ....... 99 REST OF FLORIDA ...................................................................................... 1.000 0.941 1. 268 00511 ....... 01 ATLANTA, GA ............................................................................................... 1.009 1. 076 0.951 00511 ....... 99 REST OF GEORGIA ..................................................................................... 1.000 0.885 0.9 51 00833 ....... 01 HAWAII/GUAM .............................................................................................. 1.001 1.1 13 0.817 05130 ....... 00 IDAHO ............................................................................................................ 1.000 0.874 0.478 00952 ....... 16 CHICAGO, IL ................................................................................................. 1.027 1.110 1.832 00952 ....... 12 EAST ST. LOUIS, IL ...................................................................................... 1.000 0.93 4 1.720 00952 ....... 15 SUBURBAN CHICAGO, IL ............................................................................ 1.013 1.094 1.648 00952 ....... 99 REST OF ILLINOIS ....................................................................................... 1.000 0.883 1.175 00630 ....... 00 INDIANA ........................................................................................................ 1. 000 0.916 0.459 00826 ....... 00 IOWA ............................................................................................................. 1.000 0.874 0.593 00650 ....... 00 KANSAS* ....................................................................................................... 1.0 00 0.889 0.738 00740 ....... 04 KANSAS* ....................................................................................................... 1.0 00 0.889 0.738 00660 ....... 00 KENTUCKY ................................................................................................... 1.000 0 .862 0.875 00528 ....... 01 NEW ORLEANS, LA ...................................................................................... 1.000 0.947 1. 240 00528 ....... 99 REST OF LOUISIANA ................................................................................... 1.000 0.860 1.0 66 31142 ....... 03 SOUTHERN MAINE ...................................................................................... 1.000 1.006 0.6 52 31142 ....... 99 REST OF MAINE ........................................................................................... 1.000 0.89 9 0.652 00901 ....... 01 BALTIMORE/SURR. CNTYS, MD ................................................................. 1.017 1.054 0.931 00901 ....... 99 REST OF MARYLAND .................................................................................. 1.000 0.974 0.767 31143 ....... 01 METROPOLITAN BOSTON .......................................................................... 1.036 1.277 0.803 31143 ....... 99 REST OF MASSACHUSETTS ...................................................................... 1.009 1.113 0.803 00953 ....... 01 DETROIT, MI ................................................................................................. 1.040 1.044 2.741 00953 ....... 99 REST OF MICHIGAN .................................................................................... 1.000 0.930 1.5 45 00954 ....... 00 MINNESOTA .................................................................................................. 1.000 0 .990 0.431 00512 ....... 00 MISSISSIPPI .................................................................................................. 1.00 0 0.840 0.750 00740 ....... 02 METROPOLITAN KANSAS CITY, MO ......................................................... 1.000 0.972 0.896 00523 ....... 01 METROPOLITAN ST. LOUIS, MO ................................................................ 1.000 0.949 0.893 00740 ....... 99 REST OF MISSOURI* ................................................................................... 1.000 0.815 0.8 42 00523 ....... 99 REST OF MISSOURI* ................................................................................... 1.000 0.815 0.8 42 00751 ....... 01 MONTANA ..................................................................................................... 1.000 0.861 0.815 00655 ....... 00 NEBRASKA ................................................................................................... 1.000 0 .878 0.442 00834 ....... 00 NEVADA ........................................................................................................ 1.0 04 1.039 1.138 31144 ....... 40 NEW HAMPSHIRE ........................................................................................ 1.000 1.027 0. 883 00805 ....... 01 NORTHERN NJ ............................................................................................. 1.058 1.20 4 0.916 00805 ....... 99 REST OF NEW JERSEY .............................................................................. 1.036 1.114 0.916 00521 ....... 05 NEW MEXICO ............................................................................................... 1.000 0.8 95 0.898 00803 ....... 01 MANHATTAN, NY ......................................................................................... 1.080 1.346 1 .586 00803 ....... 02 NYC SUBURBS/LONG I., NY ....................................................................... 1.059 1.256 1.869 00803 ....... 03 POUGHKPSIE/N NYC SUBURBS, NY ......................................................... 1.012 1.072 1.221 14330 ....... 04 QUEENS, NY ................................................................................................. 1.045 1 .210 1.791 00801 ....... 99 REST OF NEW YORK .................................................................................. 1.000 0.934 0.720 05535 ....... 00 NORTH CAROLINA ....................................................................................... 1.000 0.928 0. 618 00820 ....... 01 NORTH DAKOTA .......................................................................................... 1.000 0.871 0 .630 00883 ....... 00 OHIO ............................................................................................................. . 1.000 0.940 0.967 00522 ....... 00 OKLAHOMA ................................................................................................... 1.000 0 .867 0.413 00835 ....... 01 PORTLAND, OR ............................................................................................ 1.000 1.05 2 0.438 00835 ....... 99 REST OF OREGON ...................................................................................... 1.000 0.929 0.4 38 00865 ....... 01 METROPOLITAN PHILADELPHIA, PA ......................................................... 1.020 1.098 1.400 00865 ....... 99 REST OF PENNSYLVANIA .......................................................................... 1.000 0.917 0.790 00973 ....... 20 PUERTO RICO .............................................................................................. 1.000 0.7 08 0.268 00870 ....... 01 RHODE ISLAND ............................................................................................ 1.030 1.02 8 0.896 00880 ....... 01 SOUTH CAROLINA ....................................................................................... 1.000 0.901 0. 336 00820 ....... 02 SOUTH DAKOTA .......................................................................................... 1.000 0.878 0 .385 05440 ....... 35 TENNESSEE ................................................................................................. 1.000 0. 892 0.612 00900 ....... 31 AUSTIN, TX ................................................................................................... 1.00 0 1.025 0.922 00900 ....... 20 BEAUMONT, TX ............................................................................................ 1.000 0.87 7 1.318 00900 ....... 09 BRAZORIA, TX .............................................................................................. 1.008 0. 971 1.318 00900 ....... 11 DALLAS, TX .................................................................................................. 1.011 1.064 0.996 00900 ....... 28 FORT WORTH, TX ........................................................................................ 1.000 0.985 0 .996


## 47726 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### G.

— P ROPOSED 

### 2005 G EOGRAPHIC 

### P RACTICE 

### C OST 

### I NDICES BY 

### M EDICARE 

### C ARRIER AND 

### L OCALITY



### — Continued

Carrier No. Loc. No. Locality name Work GPCI PE GPCI MP GPCI

00900 ....... 15 GALVESTON, TX .......................................................................................... 1.000 0.962 1.318 00900 ....... 18 HOUSTON, TX .............................................................................................. 1.020 1.0 12 1.316 00900 ....... 99 REST OF TEXAS .......................................................................................... 1.000 0.874 1.047 00910 ....... 09 UTAH ............................................................................................................. 1.000 0.940 0.653 31145 ....... 50 VERMONT ..................................................................................................... 1.000 0.979 0.527 00973 ....... 50 VIRGIN ISLANDS .......................................................................................... 1.000 1.00 8 1.003 00904 ....... 00 VIRGINIA ....................................................................................................... 1. 000 0.941 0.540 00836 ....... 02 SEATTLE (KING CNTY), WA ........................................................................ 1.011 1.115 0.803 00836 ....... 99 REST OF WASHINGTON ............................................................................. 1.000 0.975 0.803 00884 ....... 16 WEST VIRGINIA ............................................................................................ 1.000 0.8 36 1.462 00951 ....... 00 WISCONSIN .................................................................................................. 1.000 0 .925 0.865 00825 ....... 21 WYOMING ..................................................................................................... 1.000 0.875 0.970

**Note:** Work GPCI is the 1/4 work GPCI required by section 1848(e)(1)(A)(iii) of the Act. 1.0 Floor on Work GPCI, 1.67 for all Alaska i ndices, set by MMAMMA GPCIs are scaled by the following factors: Work= 0.9977, Practice Expense=0.9930, Malpractice Expense=1.0021.



### A DDENDUM 

### H.

— P ROPOSED 

### 2006 G EOGRAPHIC 

### P RACTICE 

### C OST 

### I NDICES BY 

### M EDICARE 

### C ARRIER AND 

### L OCALITY

Carrier No. Loc. No. Locality name Work GPCI PE GPCI MP GPCI

00510 ....... 00 ALABAMA ...................................................................................................... 1.00 0 0.850 0.752 00831 ....... 01 ALASKA ......................................................................................................... 1. 670 1.670 1.670 00832 ....... 00 ARIZONA ....................................................................................................... 1.0 00 0.988 1.069 00520 ....... 13 ARKANSAS ................................................................................................... 1.000 0 .835 0.438 31146 ....... 26 ANAHEIM/SANTA ANA, CA .......................................................................... 1.036 1.223 0.954 31146 ....... 18 LOS ANGELES, CA ...................................................................................... 1.043 1.144 0. 954 31140 ....... 03 MARIN/NAPA/SOLANO, CA ......................................................................... 1.037 1.336 0.651 31140 ....... 07 OAKLAND/BERKELEY, CA ........................................................................... 1.058 1.366 0.651 31140 ....... 05 SAN FRANCISCO, CA .................................................................................. 1.064 1.539 0.65 1 31140 ....... 06 SAN MATEO, CA .......................................................................................... 1.076 1.531 0.639 31140 ....... 09 SANTA CLARA, CA ....................................................................................... 1.088 1.534 0 .604 31146 ....... 17 VENTURA, CA ............................................................................................... 1.031 1. 167 0.744 31146 ....... 99 REST OF CALIFORNIA* ............................................................................... 1.007 1.044 0.733 31140 ....... 99 REST OF CALIFORNIA* ............................................................................... 1.007 1.044 0.733 00824 ....... 01 COLORADO .................................................................................................. 1.000 1. 016 0.803 00591 ....... 00 CONNECTICUT ............................................................................................. 1.039 1.16 7 0.900 00902 ....... 01 DELAWARE ................................................................................................... 1.013 1 .020 0.892 00903 ....... 01 DC + MD/VA SUBURBS ............................................................................... 1.052 1.238 0.926 00590 ....... 03 FORT LAUDERDALE, FL .............................................................................. 1.000 0.992 1.703 00590 ....... 04 MIAMI, FL ...................................................................................................... 1. 000 1.020 2.269 00590 ....... 99 REST OF FLORIDA ...................................................................................... 1.000 0.936 1. 272 00511 ....... 01 ATLANTA, GA ............................................................................................... 1.012 1. 093 0.966 00511 ....... 99 REST OF GEORGIA ..................................................................................... 1.000 0.877 0.9 66 00833 ....... 01 HAWAII/GUAM .............................................................................................. 1.006 1.1 01 0.800 05130 ....... 00 IDAHO ............................................................................................................ 1.000 0.868 0.459 00952 ....... 16 CHICAGO, IL ................................................................................................. 1.027 1.128 1.867 00952 ....... 12 EAST ST. LOUIS, IL ...................................................................................... 1.000 0.94 4 1.750 00952 ....... 15 SUBURBAN CHICAGO, IL ............................................................................ 1.021 1.117 1.652 00952 ....... 99 REST OF ILLINOIS ....................................................................................... 1.000 0.877 1.193 00630 ....... 00 INDIANA ........................................................................................................ 1. 000 0.910 0.436 00826 ....... 00 IOWA ............................................................................................................. 1.000 0.872 0.589 00650 ....... 00 KANSAS* ....................................................................................................... 1.0 00 0.882 0.721 00740 ....... 04 KANSAS* ....................................................................................................... 1.0 00 0.882 0.721 00660 ....... 00 KENTUCKY ................................................................................................... 1.000 0 .858 0.873 00528 ....... 01 NEW ORLEANS, LA ...................................................................................... 1.000 0.950 1. 197 00528 ....... 99 REST OF LOUISIANA ................................................................................... 1.000 0.849 1.0 58 31142 ....... 03 SOUTHERN MAINE ...................................................................................... 1.000 1.013 0.6 37 31142 ....... 99 REST OF MAINE ........................................................................................... 1.000 0.88 8 0.637 00901 ....... 01 BALTIMORE/SURR. CNTYS, MD ................................................................. 1.014 1.070 0.947 00901 ....... 99 REST OF MARYLAND .................................................................................. 1.000 0.977 0.760 31143 ....... 01 METROPOLITAN BOSTON .......................................................................... 1.032 1.314 0.823 31143 ....... 99 REST OF MASSACHUSETTS ...................................................................... 1.008 1.097 0.823 00953 ....... 01 DETROIT, MI ................................................................................................. 1.038 1.050 2.744 00953 ....... 99 REST OF MICHIGAN .................................................................................... 1.000 0.923 1.5 18 00954 ....... 00 MINNESOTA .................................................................................................. 1.000 1 .005 0.410 00512 ....... 00 MISSISSIPPI .................................................................................................. 1.00 0 0.843 0.722 00740 ....... 02 METROPOLITAN KANSAS CITY, MO ......................................................... 1.000 0.978 0.946 00523 ....... 01 METROPOLITAN ST. LOUIS, MO ................................................................ 1.000 0.961 0.941 00740 ....... 99 REST OF MISSOURI* ................................................................................... 1.000 0.805 0.8 92


## 47727 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### H.

— P ROPOSED 

### 2006 G EOGRAPHIC 

### P RACTICE 

### C OST 

### I NDICES BY 

### M EDICARE 

### C ARRIER AND 

### L OCALITY



### — Continued

Carrier No. Loc. No. Locality name Work GPCI PE GPCI MP GPCI

00523 ....... 99 REST OF MISSOURI* ................................................................................... 1.000 0.805 0.8 92 00751 ....... 01 MONTANA ..................................................................................................... 1.000 0.845 0.904 00655 ....... 00 NEBRASKA ................................................................................................... 1.000 0 .879 0.454 00834 ....... 00 NEVADA ........................................................................................................ 1.0 03 1.039 1.068 31144 ....... 40 NEW HAMPSHIRE ........................................................................................ 1.000 1.023 0. 942 00805 ....... 01 NORTHERN NJ ............................................................................................. 1.059 1.21 5 0.973 00805 ....... 99 REST OF NEW JERSEY .............................................................................. 1.043 1.117 0.973 00521 ....... 05 NEW MEXICO ............................................................................................... 1.000 0.8 90 0.895 00803 ....... 01 MANHATTAN, NY ......................................................................................... 1.067 1.341 1 .504 00803 ....... 02 NYC SUBURBS/LONG I., NY ....................................................................... 1.051 1.260 1.785 00803 ....... 03 POUGHKPSIE/N NYC SUBURBS, NY ......................................................... 1.013 1.070 1.167 14330 ....... 04 QUEENS, NY ................................................................................................. 1.032 1 .192 1.710 00801 ....... 99 REST OF NEW YORK .................................................................................. 1.000 0.923 0.677 05535 ....... 00 NORTH CAROLINA ....................................................................................... 1.000 0.926 0. 640 00820 ....... 01 NORTH DAKOTA .......................................................................................... 1.000 0.862 0 .602 00883 ....... 00 OHIO ............................................................................................................. . 1.000 0.937 0.976 00522 ....... 00 OKLAHOMA ................................................................................................... 1.000 0 .858 0.382 00835 ....... 01 PORTLAND, OR ............................................................................................ 1.004 1.05 5 0.441 00835 ....... 99 REST OF OREGON ...................................................................................... 1.000 0.926 0.4 41 00865 ....... 01 METROPOLITAN PHILADELPHIA, PA ......................................................... 1.018 1.105 1.386 00865 ....... 99 REST OF PENNSYLVANIA .......................................................................... 1.000 0.906 0.806 00973 ....... 20 PUERTO RICO .............................................................................................. 1.000 0.7 05 0.261 00870 ....... 01 RHODE ISLAND ............................................................................................ 1.044 0.99 2 0.909 00880 ....... 01 SOUTH CAROLINA ....................................................................................... 1.000 0.897 0. 394 00820 ....... 02 SOUTH DAKOTA .......................................................................................... 1.000 0.879 0 .365 05440 ....... 35 TENNESSEE ................................................................................................. 1.000 0. 884 0.631 00900 ....... 31 AUSTIN, TX ................................................................................................... 1.00 0 1.053 0.986 00900 ....... 20 BEAUMONT, TX ............................................................................................ 1.000 0.86 4 1.298 00900 ....... 09 BRAZORIA, TX .............................................................................................. 1.025 0. 964 1.298 00900 ....... 11 DALLAS, TX .................................................................................................. 1.013 1.063 1.061 00900 ....... 28 FORT WORTH, TX ........................................................................................ 1.000 0.989 1 .061 00900 ....... 15 GALVESTON, TX .......................................................................................... 1.000 0.956 1.298 00900 ....... 18 HOUSTON, TX .............................................................................................. 1.020 1.0 17 1.297 00900 ....... 99 REST OF TEXAS .......................................................................................... 1.000 0.868 1.138 00910 ....... 09 UTAH ............................................................................................................. 1.000 0.939 0.662 31145 ....... 50 VERMONT ..................................................................................................... 1.000 0.972 0.514 00973 ....... 50 VIRGIN ISLANDS .......................................................................................... 1.000 0.99 3 1.003 00904 ....... 00 VIRGINIA ....................................................................................................... 1. 000 0.944 0.579 00836 ....... 02 SEATTLE (KING CNTY), WA ........................................................................ 1.018 1.131 0.819 00836 ....... 99 REST OF WASHINGTON ............................................................................. 1.000 0.979 0.819 00884 ....... 16 WEST VIRGINIA ............................................................................................ 1.000 0.8 22 1.547 00951 ....... 00 WISCONSIN .................................................................................................. 1.000 0 .921 0.790 00825 ....... 21 WYOMING ..................................................................................................... 1.000 0.856 0.935

**Note:** Work GPCI is the 1/4 work GPCI required by section 1848(e)(1)(A)(iii) of the Act. 1.0 Floor on Work GPCI, 1.67 for all Alaska i ndices, set by MMA GPCIs are scaled by the following factors: Work= 0.9977, Practice Expense=0.9930, Malpractice Expense=1.0021.



### A DDENDUM 

### I.

— C OMPARISON OF 

### C URRENT 

### 2004 GAF S TO 

### P ROPOSED 

### 2005GAF S
[In descending order of difference]

Carrier No. Loc. No. Locality name Current 2004 GAF Proposed 2005 GAF Difference Percent difference

31140 ....... 09 SANTA CLARA, CA ............................................................. 1.184 1.225 0.040 3.41 31140 ....... 07 OAKLAND/BERKELEY, CA ................................................. 1.111 1.144 0.033 2.96 31140 ....... 06 SAN MATEO, CA ................................................................ 1.201 1.230 0.029 2.44 31140 ....... 03 MARIN/NAPA/SOLANO, CA ............................................... 1.104 1.128 0.025 2.25 31140 ....... 05 SAN FRANCISCO, CA ........................................................ 1.223 1.239 0.017 1.36 00903 ....... 01 DC + MD/VA SUBURBS ..................................................... 1.095 1.112 0.016 1.49 31143 ....... 01 METROPOLITAN BOSTON ................................................ 1.118 1.132 0.014 1.24 00952 ....... 15 SUBURBAN CHICAGO, IL .................................................. 1.059 1.073 0.014 1.31 00900 ....... 31 AUSTIN, TX ......................................................................... 0.995 1.008 0.013 1.26 00836 ....... 02 SEATTLE (KING CNTY), WA .............................................. 1.038 1.048 0.010 0.96 31146 ....... 17 VENTURA, CA ..................................................................... 1.060 1.070 0.010 0.91 00511 ....... 01 ATLANTA, GA ..................................................................... 1.027 1.036 0.009 0.88 31146 ....... 26 ANAHEIM/SANTA ANA, CA ................................................ 1.098 1.106 0.008 0.72 00952 ....... 16 CHICAGO, IL ....................................................................... 1.087 1.094 0.008 0.70 00954 ....... 00 MINNESOTA ........................................................................ 0.967 0.974 0.007 0.70 00805 ....... 99 REST OF NEW JERSEY .................................................... 1.060 1.065 0.005 0.50 00824 ....... 01 COLORADO ........................................................................ 0.990 0.995 0.005 0.51


## 47728 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### I.

— C OMPARISON OF 

### C URRENT 

### 2004 GAF S TO 

### P ROPOSED 

### 2005GAF S



### — Continued

[In descending order of difference]

Carrier No. Loc. No. Locality name Current 2004 GAF Proposed 2005 GAF Difference Percent difference

00805 ....... 01 NORTHERN NJ ................................................................... 1.111 1.116 0.005 0.45 00901 ....... 01 BALTIMORE/SURR. CNTYS, MD ....................................... 1.025 1.030 0.005 0.48 00523 ....... 01 METROPOLITAN ST. LOUIS, MO ...................................... 0.969 0.974 0.005 0.51 00952 ....... 12 EAST ST. LOUIS, IL ............................................................ 0.995 0.999 0.004 0.44 31142 ....... 03 SOUTHERN MAINE ............................................................ 0.986 0.989 0.003 0.31 00740 ....... 02 METROPOLITAN KANSAS CITY, MO ............................... 0.981 0.984 0.002 0.24 31146 ....... 99 REST OF CALIFORNIA* ..................................................... 1.008 1.011 0.002 0.22 31140 ....... 99 REST OF CALIFORNIA* ..................................................... 1.008 1.011 0.002 0.22 00900 ....... 18 HOUSTON, TX .................................................................... 1.026 1.028 0.002 0.21 00832 ....... 00 ARIZONA ............................................................................. 0.994 0.996 0.002 0.20 00900 ....... 28 FORT WORTH, TX .............................................................. 0.992 0.993 0.002 0.16 00836 ....... 99 REST OF WASHINGTON ................................................... 0.980 0.981 0.002 0.16 00512 ....... 00 MISSISSIPPI ........................................................................ 0.919 0.920 0.002 0.16 00835 ....... 01 PORTLAND, OR .................................................................. 1.000 1.001 0.001 0.13 00904 ....... 00 VIRGINIA ............................................................................. 0.955 0.956 0.001 0.14 00865 ....... 01 METROPOLITAN PHILADELPHIA, PA ............................... 1.067 1.069 0.001 0.12 00953 ....... 01 DETROIT, MI ....................................................................... 1.106 1.107 0.001 0.10 00901 ....... 99 REST OF MARYLAND ........................................................ 0.979 0.980 0.001 0.11 00528 ....... 01 NEW ORLEANS, LA ............................................................ 0.985 0.986 0.001 0.10 00900 ....... 09 BRAZORIA, TX .................................................................... 1.003 1.004 0.001 0.09 00655 ....... 00 NEBRASKA ......................................................................... 0.925 0.925 0.000 0.04 00900 ....... 11 DALLAS, TX ........................................................................ 1.033 1.034 0.000 0.02 00831 ....... 01 ALASKA ............................................................................... 1.670 1.670 0.000 0.00 00820 ....... 02 SOUTH DAKOTA ................................................................ 0.923 0.923 0.000 -0.01 00910 ....... 09 UTAH ................................................................................... 0.961 0.960 0.000 -0.03 00834 ....... 00 NEVADA .............................................................................. 1.025 1.024 -0.001 -0.05 00803 ....... 03 POUGHKPSIE/N NYC SUBURBS, NY ............................... 1.047 1.046 -0.001 -0.06 00591 ....... 00 CONNECTICUT ................................................................... 1.092 1.091 -0.001 -0.08 00826 ....... 00 IOWA ................................................................................... 0.930 0.929 -0.001 -0.11 05535 ....... 00 NORTH CAROLINA ............................................................. 0.955 0.954 -0.001 -0.13 00880 ....... 01 SOUTH CAROLINA ............................................................. 0.932 0.931 -0.001 -0.14 31144 ....... 40 NEW HAMPSHIRE .............................................................. 1.009 1.007 -0.001 -0.13 00883 ....... 00 OHIO .................................................................................... 0.974 0.973 -0.002 -0.17 00835 ....... 99 REST OF OREGON ............................................................ 0.949 0.947 -0.002 -0.18 00951 ....... 00 WISCONSIN ........................................................................ 0.964 0.962 -0.002 -0.17 00973 ....... 20 PUERTO RICO .................................................................... 0.846 0.844 -0.002 -0.21 00660 ....... 00 KENTUCKY ......................................................................... 0.937 0.935 -0.002 -0.20 00590 ....... 99 REST OF FLORIDA ............................................................ 0.987 0.985 -0.002 -0.21 00521 ....... 05 NEW MEXICO ..................................................................... 0.952 0.950 -0.002 -0.23 31146 ....... 18 LOS ANGELES, CA ............................................................ 1.088 1.086 -0.002 -0.22 00630 ....... 00 INDIANA .............................................................................. 0.945 0.942 -0.003 -0.27 00803 ....... 02 NYC SUBURBS/LONG I., NY ............................................. 1.179 1.176 -0.003 -0.22 00650 ....... 00 KANSAS* ............................................................................. 0.944 0.941 -0.003 -0.28 00740 ....... 04 KANSAS* ............................................................................. 0.944 0.941 -0.003 -0.28 00952 ....... 99 REST OF ILLINOIS ............................................................. 0.958 0.956 -0.003 -0.28 00900 ....... 99 REST OF TEXAS ................................................................ 0.950 0.947 -0.003 -0.29 00520 ....... 13 ARKANSAS ......................................................................... 0.910 0.907 -0.003 -0.31 00900 ....... 15 GALVESTON, TX ................................................................ 0.999 0.996 -0.003 -0.29 00511 ....... 99 REST OF GEORGIA ........................................................... 0.951 0.948 -0.003 -0.33 05130 ....... 00 IDAHO .................................................................................. 0.928 0.925 -0.003 -0.34 31145 ....... 50 VERMONT ........................................................................... 0.976 0.973 -0.003 -0.33 00953 ....... 99 REST OF MICHIGAN .......................................................... 0.994 0.990 -0.003 -0.34 05440 ....... 35 TENNESSEE ....................................................................... 0.941 0.938 -0.004 -0.37 00820 ....... 01 NORTH DAKOTA ................................................................ 0.933 0.929 -0.004 -0.43 00522 ....... 00 OKLAHOMA ......................................................................... 0.923 0.919 -0.004 -0.44 00740 ....... 99 REST OF MISSOURI* ......................................................... 0.917 0.913 -0.004 -0.46 00523 ....... 99 REST OF MISSOURI* ......................................................... 0.917 0.913 -0.004 -0.46 00801 ....... 99 REST OF NEW YORK ........................................................ 0.965 0.960 -0.004 -0.44 00833 ....... 01 HAWAII/GUAM .................................................................... 1.047 1.043 -0.004 -0.42 00510 ....... 00 ALABAMA ............................................................................ 0.935 0.930 -0.004 -0.48 00528 ....... 99 REST OF LOUISIANA ......................................................... 0.946 0.941 -0.004 -0.48 31142 ....... 99 REST OF MAINE ................................................................. 0.947 0.942 -0.005 -0.51 00902 ....... 01 DELAWARE ......................................................................... 1.018 1.013 -0.005 -0.49 00865 ....... 99 REST OF PENNSYLVANIA ................................................ 0.961 0.956 -0.005 -0.54 00900 ....... 20 BEAUMONT, TX .................................................................. 0.964 0.959 -0.006 -0.59 00590 ....... 03 FORT LAUDERDALE, FL .................................................... 1.038 1.033 -0.006 -0.55 00884 ....... 16 WEST VIRGINIA .................................................................. 0.953 0.946 -0.006 -0.66 00973 ....... 50 VIRGIN ISLANDS ................................................................ 1.010 1.004 -0.007 -0.65 00751 ....... 01 MONTANA ........................................................................... 0.939 0.932 -0.007 -0.71 31143 ....... 99 REST OF MASSACHUSETTS ............................................ 1.054 1.046 -0.008 -0.72


## 47729 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### I.

— C OMPARISON OF 

### C URRENT 

### 2004 GAF S TO 

### P ROPOSED 

### 2005GAF S



### — Continued

[In descending order of difference]

Carrier No. Loc. No. Locality name Current 2004 GAF Proposed 2005 GAF Difference Percent difference

00825 ....... 21 WYOMING ........................................................................... 0.953 0.944 -0.009 -0.92 00803 ....... 01 MANHATTAN, NY ............................................................... 1.225 1.216 -0.009 -0.75 00870 ....... 01 RHODE ISLAND .................................................................. 1.033 1.024 -0.009 -0.89 00590 ....... 04 MIAMI, FL ............................................................................ 1.085 1.073 -0.011 -1.02 14330 ....... 04 QUEENS, NY ....................................................................... 1.161 1.146 -0.015 -1.26

**Note:** GAFs based upon revised MEI weights as published in November 7, 2003 final rule; Work GPCI=52.466, Practice Expense GPCI=43.669, Malpractice GPCI=3.865



### A DDENDUM 

### J.

— C OMPARISON OF 

### C URRENT 

### 2004 GAF S TO 

### P ROPOSED 

### 2006 GAF S
[in descending order of difference]

Carrier No. Loc. No. Locality name Current 2004 GAF Proposed 2006 GAF Difference Percent difference

31140 ....... 09 SANTA CLARA, CA ............................................................. 1.184 1.264 0.080 6.72 31140 ....... 07 OAKLAND/BERKELEY, CA ................................................. 1.111 1.177 0.065 5.87 31140 ....... 06 SAN MATEO, CA ................................................................ 1.201 1.258 0.057 4.76 31140 ....... 03 MARIN/NAPA/SOLANO, CA ............................................... 1.104 1.153 0.049 4.45 00903 ....... 01 DC + MD/VA SUBURBS ..................................................... 1.095 1.128 0.033 3.01 31140 ....... 05 SAN FRANCISCO, CA ........................................................ 1.223 1.255 0.033 2.68 31143 ....... 01 METROPOLITAN BOSTON ................................................ 1.118 1.147 0.029 2.56 00952 ....... 15 SUBURBAN CHICAGO, IL .................................................. 1.059 1.087 0.028 2.67 00900 ....... 31 AUSTIN, TX ......................................................................... 0.995 1.023 0.027 2.74 00836 ....... 02 SEATTLE (KING CNTY), WA .............................................. 1.038 1.060 0.021 2.04 31146 ....... 17 VENTURA, CA ..................................................................... 1.060 1.079 0.019 1.80 00511 ....... 01 ATLANTA, GA ..................................................................... 1.027 1.046 0.019 1.82 00952 ....... 16 CHICAGO, IL ....................................................................... 1.087 1.104 0.017 1.54 31146 ....... 26 ANAHEIM/SANTA ANA, CA ................................................ 1.098 1.114 0.017 1.51 00805 ....... 01 NORTHERN NJ ................................................................... 1.111 1.124 0.013 1.13 00954 ....... 00 MINNESOTA ........................................................................ 0.967 0.979 0.013 1.29 00805 ....... 99 REST OF NEW JERSEY .................................................... 1.060 1.073 0.012 1.18 00523 ....... 01 METROPOLITAN ST. LOUIS, MO ...................................... 0.969 0.981 0.012 1.24 00901 ....... 01 BALTIMORE/SURR. CNTYS, MD ....................................... 1.025 1.036 0.011 1.07 00952 ....... 12 EAST ST. LOUIS, IL ............................................................ 0.995 1.005 0.010 1.00 00824 ....... 01 COLORADO ........................................................................ 0.990 0.999 0.010 0.97 00740 ....... 02 METROPOLITAN KANSAS CITY, MO ............................... 0.981 0.988 0.007 0.71 00900 ....... 09 BRAZORIA, TX .................................................................... 1.003 1.009 0.006 0.60 00900 ....... 28 FORT WORTH, TX .............................................................. 0.992 0.998 0.006 0.59 31142 ....... 03 SOUTHERN MAINE ............................................................ 0.986 0.992 0.006 0.56 00835 ....... 01 PORTLAND, OR .................................................................. 1.000 1.005 0.005 0.49 00904 ....... 00 VIRGINIA ............................................................................. 0.955 0.959 0.004 0.43 31146 ....... 99 REST OF CALIFORNIA* ..................................................... 1.008 1.013 0.004 0.41 31140 ....... 99 REST OF CALIFORNIA* ..................................................... 1.008 1.013 0.004 0.41 00836 ....... 99 REST OF WASHINGTON ................................................... 0.980 0.984 0.004 0.40 00900 ....... 18 HOUSTON, TX .................................................................... 1.026 1.029 0.004 0.35 00832 ....... 00 ARIZONA ............................................................................. 0.994 0.997 0.003 0.34 00900 ....... 11 DALLAS, TX ........................................................................ 1.033 1.037 0.003 0.32 00953 ....... 01 DETROIT, MI ....................................................................... 1.106 1.109 0.003 0.25 00865 ....... 01 METROPOLITAN PHILADELPHIA, PA ............................... 1.067 1.070 0.003 0.26 00901 ....... 99 REST OF MARYLAND ........................................................ 0.979 0.981 0.002 0.22 00512 ....... 00 MISSISSIPPI ........................................................................ 0.919 0.921 0.002 0.19 00655 ....... 00 NEBRASKA ......................................................................... 0.925 0.926 0.001 0.13 00528 ....... 01 NEW ORLEANS, LA ............................................................ 0.985 0.986 0.001 0.07 00831 ....... 01 ALASKA ............................................................................... 1.670 1.670 0.000 0.00 00910 ....... 09 UTAH ................................................................................... 0.961 0.960 0.000 -0.04 00820 ....... 02 SOUTH DAKOTA ................................................................ 0.923 0.923 0.000 -0.05 31144 ....... 40 NEW HAMPSHIRE .............................................................. 1.009 1.008 -0.001 -0.08 00880 ....... 01 SOUTH CAROLINA ............................................................. 0.932 0.932 -0.001 -0.09 05535 ....... 00 NORTH CAROLINA ............................................................. 0.955 0.954 -0.001 -0.13 00900 ....... 99 REST OF TEXAS ................................................................ 0.950 0.948 -0.002 -0.19 00826 ....... 00 IOWA ................................................................................... 0.930 0.928 -0.002 -0.22 00591 ....... 00 CONNECTICUT ................................................................... 1.092 1.090 -0.002 -0.20 00883 ....... 00 OHIO .................................................................................... 0.974 0.972 -0.003 -0.27 00835 ....... 99 REST OF OREGON ............................................................ 0.949 0.946 -0.003 -0.30 00803 ....... 03 POUGHKPSIE/N NYC SUBURBS, NY ............................... 1.047 1.044 -0.003 -0.29 00973 ....... 20 PUERTO RICO .................................................................... 0.846 0.843 -0.003 -0.39 00520 ....... 13 ARKANSAS ......................................................................... 0.910 0.906 -0.004 -0.39 00660 ....... 00 KENTUCKY ......................................................................... 0.937 0.933 -0.004 -0.40 00834 ....... 00 NEVADA .............................................................................. 1.025 1.021 -0.004 -0.36


## 47730 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules

A DDENDUM 

### J.

— C OMPARISON OF 

### C URRENT 

### 2004 GAF S TO 

### P ROPOSED 

### 2006 GAF S



### — Continued

[in descending order of difference]

Carrier No. Loc. No. Locality name Current 2004 GAF Proposed 2006 GAF Difference Percent difference

00590 ....... 99 REST OF FLORIDA ............................................................ 0.987 0.983 -0.004 -0.41 00521 ....... 05 NEW MEXICO ..................................................................... 0.952 0.948 -0.005 -0.47 00952 ....... 99 REST OF ILLINOIS ............................................................. 0.958 0.954 -0.005 -0.48 31146 ....... 18 LOS ANGELES, CA ............................................................ 1.088 1.084 -0.005 -0.43 00511 ....... 99 REST OF GEORGIA ........................................................... 0.951 0.945 -0.006 -0.63
00630 ....... 00 INDIANA .............................................................................. 0.945 0.939 -0.006 -0.64 00902 ....... 01 DELAWARE ......................................................................... 1.018 1.011 -0.006 -0.61 00900 ....... 15 GALVESTON, TX ................................................................ 0.999 0.992 -0.006 -0.63 05440 ....... 35 TENNESSEE ....................................................................... 0.941 0.935 -0.006 -0.67 00951 ....... 00 WISCONSIN ........................................................................ 0.964 0.957 -0.006 -0.66 00650 ....... 00 KANSAS* ............................................................................. 0.944 0.938 -0.006 -0.68 00740 ....... 04 KANSAS* ............................................................................. 0.944 0.938 -0.006 -0.68 05130 ....... 00 IDAHO .................................................................................. 0.928 0.921 -0.007 -0.70 00740 ....... 99 REST OF MISSOURI* ......................................................... 0.917 0.911 -0.007 -0.72 00523 ....... 99 REST OF MISSOURI* ......................................................... 0.917 0.911 -0.007 -0.72 31145 ....... 50 VERMONT ........................................................................... 0.976 0.969 -0.007 -0.70 00953 ....... 99 REST OF MICHIGAN .......................................................... 0.994 0.986 -0.007 -0.75 00833 ....... 01 HAWAII/GUAM .................................................................... 1.047 1.040 -0.008 -0.74 00803 ....... 02 NYC SUBURBS/LONG I., NY ............................................. 1.179 1.171 -0.008 -0.70 00820 ....... 01 NORTH DAKOTA ................................................................ 0.933 0.924 -0.009 -0.97 00884 ....... 16 WEST VIRGINIA .................................................................. 0.953 0.943 -0.009 -0.96 00522 ....... 00 OKLAHOMA ......................................................................... 0.923 0.914 -0.009 -0.99 00865 ....... 99 REST OF PENNSYLVANIA ................................................ 0.961 0.951 -0.009 -0.97 00528 ....... 99 REST OF LOUISIANA ......................................................... 0.946 0.936 -0.010 -1.02
00510 ....... 00 ALABAMA ............................................................................ 0.935 0.925 -0.010 -1.06 31142 ....... 99 REST OF MAINE ................................................................. 0.947 0.937 -0.010 -1.07 00751 ....... 01 MONTANA ........................................................................... 0.939 0.929 -0.010 -1.09 00801 ....... 99 REST OF NEW YORK ........................................................ 0.965 0.954 -0.011 -1.11 00900 ....... 20 BEAUMONT, TX .................................................................. 0.964 0.952 -0.012 -1.26 00973 ....... 50 VIRGIN ISLANDS ................................................................ 1.010 0.997 -0.013 -1.30 31143 ....... 99 REST OF MASSACHUSETTS ............................................ 1.054 1.040 -0.014 -1.36 00590 ....... 03 FORT LAUDERDALE, FL .................................................... 1.038 1.024 -0.015 -1.42 00870 ....... 01 RHODE ISLAND .................................................................. 1.033 1.016 -0.017 -1.65 00825 ....... 21 WYOMING ........................................................................... 0.953 0.935 -0.018 -1.93 00803 ....... 01 MANHATTAN, NY ............................................................... 1.225 1.204 -0.021 -1.74 00590 ....... 04 MIAMI, FL ............................................................................ 1.085 1.058 -0.027 -2.47 14330 ....... 04 QUEENS, NY ....................................................................... 1.161 1.128 -0.032 -2.80

**Note:** GAFs based upon revised MEI weights as published in November 7, 2003 final rule; Work GPCI=52.466, Practice Expense GPCI=43.669, Malpractice GPCI=3.865

[FR Doc. 04

– 17312 Filed 7

– 27

– 04; 8:45 am]

**BILLING CODE 4120**

**– 01** 

**– P**