31028 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

[HCFA–1170–PN]

RIN 0938–AK56

Medicare Program; Five-Year Review

of Work Relative Value Units Under the

Physician Fee Schedule

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Proposed notice.

SUMMARY: This proposed notice

discusses changes to work relative value

units (RVUs) affecting payment for

physicians’ services. Section

1848(c)(2)(B)(i) of the Social Security

Act requires that we review RVUs no

less often than every 5 years. This is the

second review of work RVUs since we

implemented the physician fee schedule

on January 1, 1992. These work RVUs

are proposed to be effective for services

furnished beginning January 1, 2002.

DATES: To be assured of consideration,

we must receive comments at the

appropriate address, as provided below,

no later than 5 p.m. on August 7, 2001.

ADDRESSES: Mail written comments (1

original and 3 copies) to the following

address only: Health Care Financing

Administration, Department of Health

and Human Services, Attention: HCFA–

1170–PN, P.O. Box 8013, Baltimore, MD

21244–8013.

Please allow sufficient time for mailed

comments to be timely received in the

event of delivery delays. If you prefer,

you may deliver your written comments

by courier (1 original and 3 copies) to

one of the following addresses:

Room 445–G, Hubert H. Humphrey

Building, 200 Independence Avenue,

SW., Washington, DC 20201,

or

Room C5–14–03, 7500 Security

Boulevard, Baltimore, MD 21244–

8013

Comments mailed to the above

addresses may be delayed and received

too late to be considered.

Because of staff and resource

limitations, we cannot accept comments

by facsimile (FAX) transmission. In

commenting, please refer to file code

HCFA–1170–PN. Comments received

timely will be available for public

inspection as they are received,

generally beginning approximately 3

weeks after publication of a document at

the headquarters of the Health Care

Financing Administration, 7500

Security Boulevard, Baltimore,

Maryland, on Monday through Friday of

each week from 8:30 a.m. to 5 p.m.

Please call (410) 786–7197 to make an

appointment to view the public

comments.

FOR FURTHER INFORMATION CONTACT:

Jim Menas, (410) 786–4507.

Rick Ensor, (410) 786–5617.

Diane Milstead, (410) 786–3355.

Marc Hartstein (Regulatory Impact

Analysis), (410) 786–4539.

SUPPLEMENTARY INFORMATION

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 by faxing to (202) 512–

2250. The cost for each copy is $9. 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 Website address is: http://

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

To assist readers in referencing

sections contained in the preamble, we

are providing the following table of

contents:

Table of Contents

I. Background

A. Legislative History

B. Published Changes to the Physician Fee

Schedule

C. Current Proposed Notice

D. The 5-Year Review Process

II. Discussion of Comments and Decisions

A. Review of Comments

B. Discussion of Comments by Clinical Area

1. Vascular Surgery

2. General Surgery/Colon and Rectal

Surgery

3. Thoracic Surgery

4. Orthopedic Surgery

5. Ophthalmology

6. Urology

7. Obstetrics/Gynecology

a. Specialty Comments

b. Other Concerns

8. Gastroenterology

9. Pulmonary Medicine/Critical Care

10. Cardiology

11. Pediatrics

12. Pediatric Surgery

13. Radiology

14. Plastic Surgery

C. Other Comments

1. Anesthesia Services

2. Spine Injection Procedures

3. Biofeedback

4. Surgical Management of Burn Wounds

5. Transplantation

6. Arthroscopy Services

7. Wheelchair Management

8. Psychological Testing

9. Podiatric Services

D. Other Issues

1. Critical Care Services in a Global Period

2. Codes Referred to CPT

3. Budget Neutrality

4. Calculation of Practice Expense and

Malpractice Relative Value Units

5. Nature and Format of Comments on

Work Relative Value Units

III. Collection of Information Requirements

IV. Response to Comments

V. Regulatory Impact Analysis

Because of the many organizations

and terms to which we refer by acronym

in this proposed notice, we are listing

these acronyms and their corresponding

terms in alphabetical order below:

AANA Arthroscopy Association of

North America

AAO American Academy of

Opthalmology

AAP American Academy of Pediatrics

ABA American Burn Association

ACG American College of

Gastroenterology

ACOG American College of Obstetrics

and Gynecology

ACR American College of Radiology

ACS American College of Surgeons

AGA American Gastrointestinal

Association

AMA American Medical Association

APMA American Podiatric Medical

Association

APSA American Pediatric Surgical

Association

APTA American Physical Therapy

Association

ASA American Society of

Anesthesiologists

ASCRS American Society of Colon and

Rectal Surgeons

ASGE American Society for

Gastrointestinal Endoscopy

ASPS American Society of Plastic

Surgery

ASTS American Society for Transplant

Surgeons

AUA American Urological Association

BBA Balanced Budget Act

CPT Current procedural terminology

CY Calendar year

ERCP Endoscopic retrograde

cholangio-pancreatography

FDA Food and Drug Administration

FR Federal Register

GAF Geographic adjustment factor

GCPI Geographic practice cost index

GPO Government Printing Office

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31029

HCFA Health Care Financing

Administration

HCPAC Health Care Professionals

Advisory Committee

HCPCS HCFA Common Procedure

Coding System

HHS Health and Human Services

IWPUT Intra-service work per unit of

time

MEI Medicare economic index

MQSA Mammography Quality

Standards Act of 1992

MSA Metropolitan statistical area

PE Practice expense

PEAC Practice Expense Advisory

Committee

RFA Regulatory Flexibility Act

RIA Regulatory impact analysis

RUC [AMA’s Specialty Society]

Relative [Value] Update Committee

RVU Relative value unit

STS Society of Thoracic Surgeons

SVS Society for Vascular Surgery

I. Background

A. Legislative History

Since January 1, 1992, Medicare has

paid for physician services under

section 1848 of the Social Security Act

(the Act), ‘‘Payment for Physicians’’

Services.’’ This section contains three

major elements, (1) a fee schedule for

the payment of physicians’ services; (2)

a sustainable growth rate for the rates of

increase in Medicare expenditures for

physicians’ services; and (3) limits on

the amounts that nonparticipating

physicians can charge beneficiaries. 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 this tolerance is exceeded, we

must make adjustments to the

conversion factors (CFs) to preserve

budget neutrality.

B. Published Changes to the Physician

Fee Schedule

In the July 2000 proposed rule (65 FR

44177), we listed all of the final rules

published through November 1999,

relating to updates to the RVUs and

revisions to the payment policies under

the physician fee schedule. In the

November 2000 final rule (65 FR 65376),

we finalized the calendar year (CY) 2000

interim physician work RVUs and

issued new interim work RVUs for new

and revised codes for CY 2001. The final

rule also discussed the activities

underway with respect to the second 5-

year refinement of work RVUs.

C. Current Proposed Notice

This proposed notice discusses

changes to work RVUs affecting

payment for physicians’ services.

Section 1848(c)(2)(B)(i) of the Act

requires that we review RVUs no less

often than every 5 years. We

implemented the physician fee schedule

effective for services furnished

beginning January 1, 1992: the first 5-

year review of work was initiated in

December 1994 and was effective for

services furnished beginning January 1,

1997. The revisions proposed in this

notice are subject to a 60-day public

comment period. We will review public

comments, make adjustments as

appropriate, and include revised values

in our physician fee schedule final rule,

to be published by November 1, 2001,

effective for services furnished

beginning January 1, 2002.

D. The 5-Year Review Process

We initiated the second 5-year review

by soliciting public comments on

potentially misvalued work RVUs for all

services in the 2000 physician fee

schedule in our November 2, 1999 final

rule (64 FR 59427). To allow sufficient

time for recommendations, we provided

a 120-day comment period. We

included a discussion of the activities

underway with respect to the second 5-

year refinement of work RVUs in the

July 17, 2000 proposed rule (65 FR

44201).

We received comments from

approximately 30 specialty groups,

organizations, and individuals involving

over 900 CPT and HCPCS codes. We

also received comments on the

proposed process for the 5-year review.

As we indicated in the November 2,

1999 final rule and in the July 17, 2000

proposed rule, we shared these

comments with the AMA Specialty

Society Relative Value Update

Committee (RUC). The RUC was formed

in November 1991 and grew out of a

series of discussions between the AMA

and major national medical specialty

societies. The work of the RUC is

supported by the RUC Advisory

Committee, which is made up of

representatives of 100 specialty societies

in the AMA’s House of Delegates.

The RUC currently makes

recommendations to us on RVUs for

new and revised CPT codes (hereafter

referred to as codes). This process was

used during the first 5-year review, and

we believe that it was beneficial. We

indicated that we believe the

perspective of the RUC is helpful

because of its experience in

recommending RVUs for the codes that

have been added to, or revised by, the

CPT panel since we implemented the

physician fee schedule in 1992. By

virtue of its multispecialty membership

and consultation with specialty

societies, the RUC involves the medical

community in formulating its

recommendations. For codes used only

by non-physician practitioners, the

Health Care Professionals Advisory

Committee (HCPAC), a companion to

the RUC, has made recommendations to

us.

As we stated in the first 5-year review,

we retain the responsibility for

analyzing the comments and

recommendations, developing the

proposed rule, evaluating comments on

the proposed rule, and deciding

whether to revise RVUs.

After we sent the RUC the comments

we received on potentially misvalued

services, the RUC identified specialty

societies interested in making

presentations concerning those

misvalued services. In making

presentations to the RUC, specialty

societies compiled data using a standard

survey instrument whereby respondents

compared the surveyed service with

similar ‘‘reference’’ services that have

established, agreed upon work values.

Respondents were asked to estimate the

work for the survey code, the time to

perform pre-, intra-, and postservice

activities, and the technical skill, risk,

and judgement involved with

performing the service. Postservice

activities were broken down into

hospital and office visits and were

assigned an appropriate evaluation and

management code by the respondent.

Each specialty society selected the

physician sample that was surveyed. A

minimum of 30 responses was required

by the RUC for the survey to be

considered valid.

For this 5-year review, the RUC

permitted a specialty society to use a

‘‘minisurvey’’ for some codes if the

number of codes a specialty was

reviewing was extremely high. These

minisurveys required less information

from the respondent but were similar in

design.

Some specialty societies used a

‘‘building-block’’ approach to validate

the survey results for surgical services.

In constructing the building blocks, a

service is divided into ‘‘pre-’’, ‘‘intra-’’,

and ‘‘post-’’ service components. The

preservice component consists of all

services furnished before the physician

makes the skin incision (for example,

preoperative evaluation and scrubbing)

31030 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

the intraservice component consists of

the ‘‘skin-to-skin’’ time, and the

postservice component includes

immediate postsurgery services and

subsequent hospital and office visits.

Each component (or building block) is

then assigned work RVUs. Preservice

and intraservice work RVUs are based

on time and intensity, and postservice

work is based on the specified

evaluation and management service for

each postoperative visit. These three

values are then summed to compute

‘‘building-block’’ work RVUs.

The results of the surveys were

reviewed and organized by the specialty

society and then presented to the RUC.

Based on the survey results and a

discussion, the RUC developed a

recommendation. The RUC used six

workgroups to evaluate the codes. Each

workgroup evaluated a series of related

codes and submitted its report to the

full RUC. The RUC then evaluated those

reports and sent recommendations to us.

Both the workgroups and the RUC

evaluated the relative work (time and

intensity) for each service compared to

other services on the fee schedule.

We received recommendations on

work RVUs from the RUC for all of the

codes we forwarded, with the exception

of the anesthesia codes and conscious

sedation codes.

II. Discussion of Comments and

Decisions

A. Review of Comments

During the comment period for our

November 2, 1999 final rule, we

received approximately 35 public

comments on approximately 900 codes.

After review by our medical staff, we

forwarded all of the comments we

received concerning misvalued services

to the RUC. The RUC submitted work

RVU recommendations for all of the

codes we forwarded with the exception

of the anesthesia codes and conscious

sedation codes. The RUC used six

workgroups to evaluate the codes. Each

workgroup evaluated a series of related

codes and submitted its report to the

full RUC. The RUC then evaluated those

reports and sent its recommendations to

us. Both the workgroups and the RUC

evaluated the relative work (time and

intensity) for each service compared to

other services on the fee schedule.

As discussed below, we further

analyzed all of the RUC

recommendations; we evaluated both

the recommended work RVUs and the

rationale for the recommendations. If we

had concerns about the application of a

particular methodology, we verified that

the recommended work RVUs were

appropriate by using alternative

methodologies.

Table 1, Five-Year Review of Work

Relative Value Units, lists the codes

reviewed during the 5-year review. This

table includes the following

information:

• CPT/HCPCS Code. This is the CPT

or alphanumeric HCPCS code for a

service.

• Modifier. A modifier-26 is shown if

the work RVUs represent the

professional component of the service.

• Description. This is an abbreviated

version of the narrative description of

the code.

• 2000 Work RVUs. The work RVUs

that appeared in the November 2, 1999

final rule are shown for each reviewed

code.

• Requested Work RVUs. This

column identifies the work RVUs

requested by the commenting specialty

or individual commenter. If we received

more than one comment on a code, the

code is listed more than once with the

recommended RVUs. If the commenters

did not recommend specific RVUs, we

indicate this by ‘‘N/A’’. A ‘‘WD’’

(withdrawal) indicates the commenter

withdrew the request for review of a

code and chose not to pursue review of

the code under the 5-year review.

• RUC Recommendation. This

column identifies the work RVUs

recommended by the RUC. ‘‘CPT’’

indicates that that the RUC referred this

code to the AMA CPT Editorial Panel

for review and clarification and

recommended maintaining the current

work RVUs. An ‘‘(e)’’ indicates the

commenting specialty withdrew the

proposal; therefore, the RUC

recommends maintaining the current

work RVUs.

• HCPAC Recommendation. This

column identifies the work RVUs

recommended by the HCPAC. An ‘‘(a)’’

in this column indicates there was no

HCPAC recommendation.

• HCFA Decision. This column

indicates whether we agreed with the

RUC recommendation (‘‘agree’’); we are

proposing work RVUs higher than the

RUC recommendation (‘‘increase’’); or

we are proposing work RVUs that are

less than the RUC recommendation

(‘‘decrease’’). Codes for which we did

not accept the RUC recommendation are

discussed in greater detail following

Table 1. An ‘‘(a)’’ in this column

indicates that in the absence of a RUC

recommendation we are proposing to

maintain the present work RVUs. A

‘‘(b)’’ in this column indicates that these

services were reviewed as part of the

July 2000 Multispecialty Refinement

Panels for new and/or revised services.

(Meetings of Multispecialty Refinement

Panels are conducted as needed to allow

specialty representatives the

opportunity to discuss the comments

they submitted on our decisions on new

or revised services published in the

final rule. The goal of multispecialty

refinement panels is to consider the

interests of those who commented on

the work RVUs against the redistributive

effects that would occur in other

specialties. Following each discussion

of a specific service, panel members

were instructed to individually rate the

service under discussion. We then used

a statistical analysis of these ratings to

create final work RVUs for the services

under discussion.) A ‘‘(d)’’ indicates

there was no HCPAC recommendation.

We propose maintaining current work

RVUs.

• Proposed work RVUs: This column

contains the 2002 proposed work RVUs.

The following is a categorization of

our proposals as related to the RUC

recommended work RVUs from the 5-

year review of work RVUs. The RUC

supplied us with recommendations on

857 services. We accepted RUC’s

recommended work RVUs for 792 of the

services reviewed and disagreed with

RUC’s recommended work RVUs for 65

of the services reviewed. This is an

acceptance percentage of 92 percent. Of

the 65 services for which we did not

accept the RUC’s recommended work

RVUs we increased the work RVUs for

37 services, decreased the work RVUs

for 22 services, and rejected the RUC

recommendation of an increase for 6

services that had already been reviewed

at the Multispecialty Refinement Panel

for CY 2000.

Additionally, the HCPAC reviewed a

total of 12 services as part of the 5-year

review. For 5 of the services reviewed,

the HCPAC did not offer a

recommendation. Of the remaining 7

services reviewed by the HCPAC, we

have accepted the HCPAC

recommendations.

31031

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1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

11055 ....... ......... Trim skin lesion ......................................... 0.27 0.43 .................. (a) (a) 0.27

11056 ....... ......... Trim skin lesion, 2 to 4 ............................. 0.39 0.61 .................. (a) (a) 0.39

11057 ....... ......... Trim skin lesions, over 4 .......................... 0.50 0.79 .................. (a) (a) 0.50

11100 ....... ......... Biopsy of skin lesion ................................. 0.81 WD (e) .................. (a) 0.81

11402 ....... ......... Removal of skin lesion ............................. 1.61 2.20 1.61 .................. agree 1.61

11642 ....... ......... Removal of skin lesion ............................. 2.93 3.05 2.93 .................. agree 2.93

11642 ....... ......... Removal of skin lesion ............................. 2.93 3.87 2.93 .................. agree 2.93

11719 ....... ......... Trim nail(s) ................................................ 0.11 0.17 .................. (a) (a) 0.11

11730 ....... ......... Removal of nail plate ................................ 1.13 WD (e) .................. (a) 1.13

12001 ....... ......... Repair superficial wound(s) ...................... 1.70 N/A CPT .................. CPT 1.70

12002 ....... ......... Repair superficial wound(s) ...................... 1.86 N/A CPT .................. CPT 1.86

12011 ....... ......... Repair superficial wound(s) ...................... 1.76 2.37 1.76 .................. agree 1.76

13101 ....... ......... Repair of wound or lesion ........................ 3.92 5.43 3.92 .................. agree 3.92

13131 ....... ......... Repair of wound or lesion ........................ 3.79 4.79 3.79 .................. agree 3.79

13132 ....... ......... Repair of wound or lesion ........................ 5.95 6.95 5.95 .................. agree 5.95

15000 ....... ......... Skin graft ................................................... 4.00 5.95 CPT .................. CPT 4.00

15001 ....... ......... Skin graft add-on ...................................... 1.00 2.50 CPT .................. CPT 1.00

15100 ....... ......... Skin split graft ........................................... 9.05 9.05 CPT .................. CPT 9.05

15101 ....... ......... Skin split graft add-on ............................... 1.72 1.72 CPT .................. CPT 1.72

15120 ....... ......... Skin split graft ........................................... 9.83 9.83 CPT .................. CPT 9.83

15121 ....... ......... Skin split graft add-on ............................... 2.67 2.67 CPT .................. CPT 2.67

15350 ....... ......... Skin homograft .......................................... 4.00 4.00 CPT .................. CPT 4.00

15351 ....... ......... Skin homograft add-on ............................. 1.00 1.00 CPT .................. CPT 1.00

15400 ....... ......... Skin heterograft ........................................ 4.00 4.00 CPT .................. CPT 4.00

15401 ....... ......... Skin heterograft add-on ............................ 1.00 1.00 CPT .................. CPT 1.00

17000 ....... ......... Destroy benign/premal lesion ................... 0.60 WD (e) .................. (a) 0.60

17003 ....... ......... Destroy lesions, 2-14 ................................ 0.15 WD (e) .................. (a) 0.15

17004 ....... ......... Destroy lesions, 15 or more ..................... 2.79 WD (e) .................. (a) 2.79

19000 ....... ......... Drainage of breast lesion ......................... 0.84 1.27 0.84 .................. agree 0.84

19100 ....... ......... Biopsy of breast ........................................ 1.27 3.88 1.27 .................. agree 1.27

19125 ....... ......... Excision, breast lesion .............................. 6.06 9.00 6.06 .................. agree 6.06

19160 ....... ......... Removal of breast tissue .......................... 5.99 8.38 5.99 .................. agree 5.99

19162 ....... ......... Remove breast tissue, nodes ................... 13.53 15.68 13.53 .................. agree 13.53

19240 ....... ......... Removal of breast .................................... 16.00 18.87 16.00 .................. agree 16.00

20205 ....... ......... Deep muscle biopsy ................................. 2.35 3.42 CPT .................. CPT 2.35

20245 ....... ......... Bone biopsy, excisional ............................ 3.95 7.97 8.50 .................. decrease 7.78

20600 ....... ......... Drain/inject, joint/bursa ............................. 0.66 WD (e) .................. (a) 0.66

20605 ....... ......... Drain/inject, joint/bursa ............................. 0.68 WD (e) .................. (a) 0.68

21740 ....... ......... Reconstruction of sternum ........................ 16.50 21.00 CPT .................. CPT 16.50

21800 ....... ......... Treatment of rib fracture ........................... 0.96 1.77 0.96 .................. agree 0.96

23076 ....... ......... Removal of shoulder lesion ...................... 7.63 13.40 CPT .................. CPT 7.63

23472 ....... ......... Reconstruct shoulder joint ........................ 16.92 21.27 21.10 .................. agree 21.10

23485 ....... ......... Revision of collar bone ............................. 13.43 18.73 13.43 .................. agree 13.43

23585 ....... ......... Treat scapula fracture ............................... 8.96 11.46 8.96 .................. agree 8.96

23615 ....... ......... Treat humerus fracture ............................. 9.35 15.85 9.35 .................. agree 9.35

23630 ....... ......... Treat humerus fracture ............................. 7.35 12.45 7.35 .................. agree 7.35

23680 ....... ......... Treat dislocation/fracture .......................... 10.06 13.10 10.06 .................. agree 10.06

24076 ....... ......... Remove arm/elbow lesion ........................ 6.30 10.20 CPT .................. CPT 6.30

24435 ....... ......... Repair humerus with graft ........................ 13.17 20.36 13.17 .................. agree 13.17

24545 ....... ......... Treat humerus fracture ............................. 10.46 12.26 10.46 .................. agree 10.46

25076 ....... ......... Removal of forearm lesion ....................... 4.92 12.96 CPT .................. CPT 4.92

26562 ....... ......... Repair of web finger ................................. 9.68 12.56 15.00 .................. agree 15.00

27048 ....... ......... Remove hip/pelvis lesion .......................... 6.25 13.01 CPT .................. CPT 6.25

27075 ....... ......... Extensive hip surgery ............................... 17.23 28.52 35.00 .................. agree 35.00

27077 ....... ......... Extensive hip surgery ............................... 23.13 30.00 40.00 .................. agree 40.00

27216 ....... ......... Treat pelvic ring fracture ........................... 15.19 25.00 15.19 .................. agree 15.19

27217 ....... ......... Treat pelvic ring fracture ........................... 14.11 17.11 14.11 .................. agree 14.11

27218 ....... ......... Treat pelvic ring fracture ........................... 20.15 22.15 20.15 .................. agree 20.15

27226 ....... ......... Treat hip wall fracture ............................... 14.91 19.91 14.91 .................. agree 14.91

27236 ....... ......... Treat thigh fracture ................................... 15.60 17.60 15.60 .................. agree 15.60

27280 ....... ......... Fusion of sacroiliac joint ........................... 13.39 21.00 13.39 .................. agree 13.39

27282 ....... ......... Fusion of pubic bones .............................. 11.34 21.66 11.34 .................. agree 11.34

27284 ....... ......... Fusion of hip joint ..................................... 16.76 20.12 23.45 .................. agree 23.45

27328 ....... ......... Removal of thigh lesion ............................ 5.57 8.70 CPT .................. CPT 5.57

31032

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1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

27472 ....... ......... Repair/graft of thigh .................................. 17.72 23.62 17.72 .................. agree 17.72

27513 ....... ......... Treatment of thigh fracture ....................... 17.92 20.92 17.92 .................. agree 17.92

27536 ....... ......... Treat knee fracture ................................... 15.65 19.00 15.65 .................. agree 15.65

27590 ....... ......... Amputate leg at thigh ............................... 12.03 15.52 12.03 .................. agree 12.03

27619 ....... ......... Remove lower leg lesion .......................... 8.40 10.02 CPT .................. CPT 8.40

27724 ....... ......... Repair/graft of tibia ................................... 14.99 19.34 18.20 .................. agree 18.20

27822 ....... ......... Treatment of ankle fracture ...................... 9.20 10.68 11.00 .................. agree 11.00

27823 ....... ......... Treatment of ankle fracture ...................... 11.80 13.27 13.00 .................. agree 13.00

27828 ....... ......... Treat lower leg fracture ............................ 16.23 19.00 16.23 .................. agree 16.23

28299 ....... ......... Correction of bunion ................................. 8.88 11.90 9.18 .................. agree 9.18

28322 ....... ......... Repair of metatarsals ............................... 8.34 13.26 8.34 .................. agree 8.34

28420 ....... ......... Treat/graft heel fracture ............................ 16.64 23.52 16.64 .................. agree 16.64

28445 ....... ......... Treat ankle fracture .................................. 9.33 15.97 15.62 .................. agree 15.62

28705 ....... ......... Fusion of foot bones ................................. 15.21 20.46 18.80 .................. agree 18.80

29450 ....... ......... Application of leg cast .............................. 1.02 3.00 2.08 .................. agree 2.08

29450 ....... ......... Application of leg cast .............................. 1.02 N/A 2.08 .................. agree 2.08

29881 ....... ......... Knee arthroscopy/surgery ......................... 7.76 WD (e) .................. (a) 7.76

29883 ....... ......... Knee arthroscopy/surgery ......................... 9.46 12.00 11.05 .................. agree 11.05

29889 ....... ......... Knee arthroscopy/surgery ......................... 15.13 16.68 16.00 .................. agree 16.00

29889 ....... ......... Knee arthroscopy/surgery ......................... 15.13 18.47 16.00 .................. agree 16.00

31600 ....... ......... Incision of windpipe .................................. 3.62 6.42 7.18 .................. agree 7.18

31622 ....... ......... Dx bronchoscope/wash ............................ 2.78 4.17 2.78 .................. agree 2.78

31622 ....... ......... Dx bronchoscope/wash ............................ 2.78 N/A 2.78 .................. agree 2.78

31625 ....... ......... Bronchoscopy with biopsy ........................ 3.37 N/A 3.37 .................. agree 3.37

31645 ....... ......... Bronchoscopy, clear airways .................... 3.16 N/A 3.16 .................. agree 3.16

32000 ....... ......... Drainage of chest ..................................... 1.54 2.88 1.54 .................. agree 1.54

32000 ....... ......... Drainage of chest ..................................... 1.54 N/A 1.54 .................. agree 1.54

32005 ....... ......... Treat lung lining chemically ...................... 2.19 N/A 2.19 .................. agree 2.19

32020 ....... ......... Insertion of chest tube .............................. 3.98 N/A 3.98 .................. agree 3.98

32035 ....... ......... Exploration of chest .................................. 8.67 N/A 8.67 .................. agree 8.67

32095 ....... ......... Biopsy through chest wall ......................... 8.36 N/A 8.36 .................. agree 8.36

32100 ....... ......... Exploration/biopsy of chest ....................... 11.84 N/A 15.24 .................. agree 15.24

32110 ....... ......... Explore/repair chest .................................. 13.62 N/A 23.00 .................. agree 23.00

32220 ....... ......... Release of lung ......................................... 19.27 N/A 24.00 .................. agree 24.00

32225 ....... ......... Partial release of lung ............................... 13.96 N/A 13.96 .................. agree 13.96

32320 ....... ......... Free/remove chest lining .......................... 20.54 N/A 24.00 .................. agree 24.00

32440 ....... ......... Removal of lung ........................................ 21.02 35.08 25.00 .................. agree 25.00

32440 ....... ......... Removal of lung ........................................ 21.02 N/A 25.00 .................. agree 25.00

32480 ....... ......... Partial removal of lung .............................. 18.32 27.17 23.75 .................. agree 23.75

32480 ....... ......... Partial removal of lung .............................. 18.32 N/A 23.75 .................. agree 23.75

32482 ....... ......... Bilobectomy .............................................. 19.71 N/A 25.00 .................. agree 25.00

32491 ....... ......... Lung volume reduction ............................. 21.25 N/A 21.25 .................. agree 21.25

32500 ....... ......... Partial removal of lung .............................. 14.30 N/A 22.00 .................. agree 22.00

32520 ....... ......... Remove lung & revise chest .................... 21.68 N/A 21.68 .................. agree 21.68

32602 ....... ......... Thoracoscopy, diagnostic ......................... 5.96 N/A 5.96 .................. agree 5.96

32651 ....... ......... Thoracoscopy, surgical ............................. 12.91 N/A 12.91 .................. agree 12.91

32652 ....... ......... Thoracoscopy, surgical ............................. 18.66 N/A 18.66 .................. agree 18.66

32655 ....... ......... Thoracoscopy, surgical ............................. 13.10 N/A 13.10 .................. agree 13.10

32657 ....... ......... Thoracoscopy, surgical ............................. 13.65 N/A 13.65 .................. agree 13.65

33207 ....... ......... Insertion of heart pacemaker .................... 8.04 WD (e) .................. (a) 8.04

33234 ....... ......... Removal of pacemaker system ................ 7.82 N/A 7.82 .................. agree 7.82

33235 ....... ......... Removal of pacemaker electrode ............. 9.40 N/A 9.40 .................. agree 9.40

33400 ....... ......... Repair of aortic valve ................................ 25.34 N/A 28.50 .................. agree 28.50

33405 ....... ......... Replacement of aortic valve ..................... 30.61 N/A 35.00 .................. agree 35.00

33406 ....... ......... Replacement of aortic valve ..................... 32.30 N/A 37.50 .................. agree 37.50

33410 ....... ......... Replacement of aortic valve ..................... 32.46 N/A 32.46 .................. agree 32.46

33411 ....... ......... Replacement of aortic valve ..................... 32.47 N/A 36.25 .................. agree 36.25

33412 ....... ......... Replacement of aortic valve ..................... 34.79 N/A 42.00 .................. agree 42.00

33413 ....... ......... Replacement of aortic valve ..................... 35.24 N/A 43.50 .................. agree 43.50

33415 ....... ......... Revision, subvalvular tissue ..................... 27.15 N/A 27.15 .................. agree 27.15

33425 ....... ......... Repair of mitral valve ................................ 27.00 N/A 27.00 .................. agree 27.00

33426 ....... ......... Repair of mitral valve ................................ 31.03 N/A 33.00 .................. agree 33.00

33427 ....... ......... Repair of mitral valve ................................ 33.72 N/A 40.00 .................. agree 40.00

33430 ....... ......... Replacement of mitral valve ..................... 31.43 N/A 33.50 .................. agree 33.50

33468 ....... ......... Revision of tricuspid valve ........................ 30.12 N/A 30.12 .................. agree 30.12

33475 ....... ......... Replacement, pulmonary valve ................ 28.41 N/A 33.00 .................. agree 33.00

31033

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

33506 ....... ......... Repair artery, translocation ...................... 26.71 N/A 35.50 .................. agree 35.50

33510 ....... ......... CABG, vein, single ................................... 25.12 N/A 29.00 .................. agree 29.00

33511 ....... ......... CABG, vein, two ....................................... 27.40 N/A 30.00 .................. agree 30.00

33512 ....... ......... CABG, vein, three ..................................... 29.67 N/A 31.80 .................. agree 31.80

33513 ....... ......... CABG, vein, four ....................................... 31.95 N/A 32.00 .................. agree 32.00

33514 ....... ......... CABG, vein, five ....................................... 35.00 N/A 32.75 .................. agree 32.75

33516 ....... ......... Cabg, vein, six or more ............................ 37.40 N/A 35.00 .................. agree 35.00

33517 ....... ......... CABG, artery-vein, single ......................... 2.57 N/A 2.57 .................. agree 2.57

33518 ....... ......... CABG, artery-vein, two ............................. 4.85 N/A 4.85 .................. agree 4.85

33519 ....... ......... CABG, artery-vein, three .......................... 7.12 N/A 7.12 .................. agree 7.12

33521 ....... ......... CABG, artery-vein, four ............................ 9.40 N/A 9.40 .................. agree 9.40

33522 ....... ......... CABG, artery-vein, five ............................. 11.67 N/A 11.67 .................. agree 11.67

33523 ....... ......... Cabg, art-vein, six or more ....................... 13.95 N/A 13.95 .................. agree 13.95

33530 ....... ......... Coronary artery, bypass/reop ................... 5.86 N/A 5.86 .................. agree 5.86

33533 ....... ......... CABG, arterial, single ............................... 25.83 N/A 30.00 .................. agree 30.00

33534 ....... ......... CABG, arterial, two ................................... 28.82 N/A 32.20 .................. agree 32.20

33535 ....... ......... CABG, arterial, three ................................ 31.81 N/A 34.50 .................. agree 34.50

33536 ....... ......... Cabg, arterial, four or more ...................... 34.79 N/A 37.50 .................. agree 37.50

33611 ....... ......... Repair double ventricle ............................. 32.30 N/A 34.00 .................. agree 34.00

33612 ....... ......... Repair double ventricle ............................. 33.26 N/A 35.00 .................. agree 35.00

33615 ....... ......... Repair, simple fontan ................................ 32.06 N/A 34.00 .................. agree 34.00

33617 ....... ......... Repair, modified fontan ............................ 34.03 N/A 37.00 .................. agree 37.00

33619 ....... ......... Repair single ventricle .............................. 37.57 N/A 45.00 .................. agree 45.00

33641 ....... ......... Repair heart septum defect ...................... 21.39 N/A 21.39 .................. agree 21.39

33660 ....... ......... Repair of heart defects ............................. 25.54 N/A 30.00 .................. agree 30.00

33670 ....... ......... Repair of heart chambers ......................... 32.73 N/A 35.00 .................. agree 35.00

33681 ....... ......... Repair heart septum defect ...................... 27.67 N/A 30.61 .................. agree 30.61

33694 ....... ......... Repair of heart defects ............................. 31.73 N/A 34.00 .................. agree 34.00

33697 ....... ......... Repair of heart defects ............................. 33.71 N/A 36.00 .................. agree 36.00

33730 ....... ......... Repair heart-vein defect(s) ....................... 31.67 N/A 34.25 .................. agree 34.25

33750 ....... ......... Major vessel shunt .................................... 21.41 N/A 21.41 .................. agree 21.41

33767 ....... ......... Major vessel shunt .................................... 24.50 N/A 24.50 .................. agree 24.50

33770 ....... ......... Repair great vessels defect ...................... 33.29 N/A 37.00 .................. agree 37.00

33778 ....... ......... Repair great vessels defect ...................... 35.82 N/A 40.00 .................. agree 40.00

33780 ....... ......... Repair great vessels defect ...................... 36.94 N/A 41.75 .................. agree 41.75

33786 ....... ......... Repair arterial trunk .................................. 34.84 N/A 39.00 .................. agree 39.00

33820 ....... ......... Revise major vessel ................................. 16.29 N/A 16.29 .................. agree 16.29

33840 ....... ......... Remove aorta constriction ........................ 20.63 N/A 20.63 .................. agree 20.63

33860 ....... ......... Ascending aortic graft ............................... 33.96 N/A 38.00 .................. agree 38.00

33861 ....... ......... Ascending aortic graft ............................... 34.52 N/A 42.00 .................. agree 42.00

33863 ....... ......... Ascending aortic graft ............................... 36.47 N/A 45.00 .................. agree 45.00

33870 ....... ......... Transverse aortic arch graft ..................... 40.31 N/A 44.00 .................. agree 44.00

33875 ....... ......... Thoracic aortic graft .................................. 33.06 N/A CPT .................. CPT 33.06

33877 ....... ......... Thoracoabdominal graft ............................ 42.60 N/A CPT .................. CPT 42.60

33917 ....... ......... Repair pulmonary artery ........................... 24.50 N/A 24.50 .................. agree 24.50

33919 ....... ......... Repair pulmonary atresia ......................... 32.67 N/A 40.00 .................. agree 40.00

33945 ....... ......... Transplantation of heart ............................ 42.10 N/A 42.10 .................. agree 42.10

34001 ....... ......... Removal of artery clot .............................. 12.91 WD (e) .................. (a) 12.91

34101 ....... ......... Removal of artery clot .............................. 9.97 N/A 10.00 .................. agree 10.00

34111 ....... ......... Removal of arm artery clot ....................... 8.07 N/A 10.00 .................. agree 10.00

34151 ....... ......... Removal of artery clot .............................. 16.86 27.51 25.00 .................. agree 25.00

34151 ....... ......... Removal of artery clot .............................. 16.86 28.00 25.00 .................. agree 25.00

34201 ....... ......... Removal of artery clot .............................. 9.13 10.40 10.03 .................. agree 10.03

34201 ....... ......... Removal of artery clot .............................. 9.13 10.58 10.03 .................. agree 10.03

34203 ....... ......... Removal of leg artery clot ........................ 12.21 14.99 16.50 .................. agree 16.50

34203 ....... ......... Removal of leg artery clot ........................ 12.21 16.50 16.50 .................. agree 16.50

34401 ....... ......... Removal of vein clot ................................. 12.86 26.63 25.00 .................. agree 25.00

34401 ....... ......... Removal of vein clot ................................. 12.86 28.00 25.00 .................. agree 25.00

34421 ....... ......... Removal of vein clot ................................. 9.93 15.75 12.00 .................. agree 12.00

34421 ....... ......... Removal of vein clot ................................. 9.93 15.94 12.00 .................. agree 12.00

34451 ....... ......... Removal of vein clot ................................. 14.44 29.05 27.00 .................. agree 27.00

34451 ....... ......... Removal of vein clot ................................. 14.44 30.00 27.00 .................. agree 27.00

34490 ....... ......... Removal of vein clot ................................. 7.60 N/A 9.86 .................. agree 9.86

34501 ....... ......... Repair valve, femoral vein ........................ 10.93 N/A 16.00 .................. agree 16.00

34510 ....... ......... Transposition of vein valve ....................... 13.25 N/A 18.95 .................. agree 18.95

34520 ....... ......... Cross-over vein graft ................................ 13.74 N/A 17.95 .................. agree 17.95

31034

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

34530 ....... ......... Leg vein fusion ......................................... 17.61 N/A 16.64 .................. agree 16.64

35011 ....... ......... Repair defect of artery .............................. 11.65 14.10 18.00 .................. agree 18.00

35011 ....... ......... Repair defect of artery .............................. 11.65 18.00 18.00 .................. agree 18.00

35013 ....... ......... Repair artery rupture, arm ........................ 17.40 15.38 22.00 .................. agree 22.00

35013 ....... ......... Repair artery rupture, arm ........................ 17.40 20.00 22.00 .................. agree 22.00

35045 ....... ......... Repair defect of arm artery ...................... 11.26 11.05 17.57 .................. agree 17.57

35045 ....... ......... Repair defect of arm artery ...................... 11.26 16.50 17.57 .................. agree 17.57

35081 ....... ......... Repair defect of artery .............................. 28.01 33.13 28.01 .................. agree 28.01

35082 ....... ......... Repair artery rupture, aorta ...................... 36.35 37.00 38.50 .................. agree 38.50

35082 ....... ......... Repair artery rupture, aorta ...................... 36.35 41.80 38.50 .................. agree 38.50

35092 ....... ......... Repair artery rupture, aorta ...................... 38.39 50.00 45.00 .................. agree 45.00

35092 ....... ......... Repair artery rupture, aorta ...................... 38.39 58.61 45.00 .................. agree 45.00

35103 ....... ......... Repair artery rupture, groin ...................... 33.57 41.00 40.50 .................. agree 40.50

35103 ....... ......... Repair artery rupture, groin ...................... 33.57 44.12 40.50 .................. agree 40.50

35111 ....... ......... Repair defect of artery .............................. 16.43 23.24 25.00 .................. agree 25.00

35111 ....... ......... Repair defect of artery .............................. 16.43 28.00 25.00 .................. agree 25.00

35112 ....... ......... Repair artery rupture,spleen ..................... 18.69 29.20 30.00 .................. agree 30.00

35112 ....... ......... Repair artery rupture,spleen ..................... 18.69 30.00 30.00 .................. agree 30.00

35121 ....... ......... Repair defect of artery .............................. 25.99 30.29 30.00 .................. agree 30.00

35121 ....... ......... Repair defect of artery .............................. 25.99 32.00 30.00 .................. agree 30.00

35122 ....... ......... Repair artery rupture, belly ....................... 33.45 36.83 35.00 .................. agree 35.00

35122 ....... ......... Repair artery rupture, belly ....................... 33.45 37.00 35.00 .................. agree 35.00

35131 ....... ......... Repair defect of artery .............................. 18.55 23.15 25.00 .................. agree 25.00

35131 ....... ......... Repair defect of artery .............................. 18.55 28.00 25.00 .................. agree 25.00

35132 ....... ......... Repair artery rupture, groin ...................... 21.95 30.00 30.00 .................. agree 30.00

35132 ....... ......... Repair artery rupture, groin ...................... 21.95 30.54 30.00 .................. agree 30.00

35141 ....... ......... Repair defect of artery .............................. 14.46 19.38 20.00 .................. agree 20.00

35141 ....... ......... Repair defect of artery .............................. 14.46 20.00 20.00 .................. agree 20.00

35142 ....... ......... Repair artery rupture, thigh ...................... 15.86 23.36 23.30 .................. agree 23.30

35142 ....... ......... Repair artery rupture, thigh ...................... 15.86 25.00 23.30 .................. agree 23.30

35151 ....... ......... Repair defect of artery .............................. 17.00 20.26 22.64 .................. agree 22.64

35151 ....... ......... Repair defect of artery .............................. 17.00 22.00 22.64 .................. agree 22.64

35152 ....... ......... Repair artery rupture, knee ...................... 16.70 24.98 25.62 .................. agree 25.62

35152 ....... ......... Repair artery rupture, knee ...................... 16.70 27.50 25.62 .................. agree 25.62

35182 ....... ......... Repair blood vessel lesion ....................... 17.74 N/A 30.00 .................. agree 30.00

35184 ....... ......... Repair blood vessel lesion ....................... 12.25 N/A 18.00 .................. agree 18.00

35189 ....... ......... Repair blood vessel lesion ....................... 18.43 N/A 28.00 .................. agree 28.00

35190 ....... ......... Repair blood vessel lesion ....................... 12.75 N/A 12.75 .................. agree 12.75

35201 ....... ......... Repair blood vessel lesion ....................... 9.99 12.74 16.14 .................. agree 16.14

35201 ....... ......... Repair blood vessel lesion ....................... 9.99 18.35 16.14 .................. agree 16.14

35206 ....... ......... Repair blood vessel lesion ....................... 9.25 N/A 13.25 .................. agree 13.25

35221 ....... ......... Repair blood vessel lesion ....................... 16.42 26.00 24.39 .................. agree 24.39

35221 ....... ......... Repair blood vessel lesion ....................... 16.42 28.95 24.39 .................. agree 24.39

35226 ....... ......... Repair blood vessel lesion ....................... 9.06 14.00 14.50 .................. agree 14.50

35226 ....... ......... Repair blood vessel lesion ....................... 9.06 15.82 14.50 .................. agree 14.50

35231 ....... ......... Repair blood vessel lesion ....................... 12.00 15.64 20.00 .................. agree 20.00

35231 ....... ......... Repair blood vessel lesion ....................... 12.00 18.90 20.00 .................. agree 20.00

35236 ....... ......... Repair blood vessel lesion ....................... 10.54 12.85 17.11 .................. agree 17.11

35236 ....... ......... Repair blood vessel lesion ....................... 10.54 18.00 17.11 .................. agree 17.11

35246 ....... ......... Repair blood vessel lesion ....................... 19.84 26.00 26.45 .................. agree 26.45

35246 ....... ......... Repair blood vessel lesion ....................... 19.84 N/A 26.45 .................. agree 26.45

35251 ....... ......... Repair blood vessel lesion ....................... 17.49 31.00 30.20 .................. agree 30.20

35251 ....... ......... Repair blood vessel lesion ....................... 17.49 34.04 30.20 .................. agree 30.20

35256 ....... ......... Repair blood vessel lesion ....................... 11.38 N/A 18.36 .................. agree 18.36

35261 ....... ......... Repair blood vessel lesion ....................... 11.63 15.51 17.80 .................. agree 17.80

35261 ....... ......... Repair blood vessel lesion ....................... 11.63 18.90 17.80 .................. agree 17.80

35266 ....... ......... Repair blood vessel lesion ....................... 10.30 15.79 14.91 .................. agree 14.91

35266 ....... ......... Repair blood vessel lesion ....................... 10.30 17.00 14.91 .................. agree 14.91

35276 ....... ......... Repair blood vessel lesion ....................... 18.75 22.00 24.25 .................. agree 24.25

35276 ....... ......... Repair blood vessel lesion ....................... 18.75 N/A 24.25 .................. agree 24.25

35281 ....... ......... Repair blood vessel lesion ....................... 16.48 29.00 28.00 .................. agree 28.00

35281 ....... ......... Repair blood vessel lesion ....................... 16.48 32.01 28.00 .................. agree 28.00

35286 ....... ......... Repair blood vessel lesion ....................... 11.87 N/A 16.16 .................. agree 16.16

35311 ....... ......... Rechanneling of artery ............................. 23.85 30.00 27.00 .................. agree 27.00

35311 ....... ......... Rechanneling of artery ............................. 23.85 N/A 27.00 .................. agree 27.00

35321 ....... ......... Rechanneling of artery ............................. 11.97 16.47 16.00 .................. agree 16.00

31035

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

35321 ....... ......... Rechanneling of artery ............................. 11.97 18.35 16.00 .................. agree 16.00

35331 ....... ......... Rechanneling of artery ............................. 23.52 24.81 26.20 .................. agree 26.20

35331 ....... ......... Rechanneling of artery ............................. 23.52 28.01 26.20 .................. agree 26.20

35351 ....... ......... Rechanneling of artery ............................. 20.11 24.09 23.00 .................. agree 23.00

35351 ....... ......... Rechanneling of artery ............................. 20.11 25.50 23.00 .................. agree 23.00

35355 ....... ......... Rechanneling of artery ............................. 16.09 20.01 18.50 .................. agree 18.50

35355 ....... ......... Rechanneling of artery ............................. 16.09 20.75 18.50 .................. agree 18.50

35361 ....... ......... Rechanneling of artery ............................. 23.59 29.08 28.20 .................. agree 28.20

35361 ....... ......... Rechanneling of artery ............................. 23.59 30.00 28.20 .................. agree 28.20

35363 ....... ......... Rechanneling of artery ............................. 24.66 32.00 30.20 .................. agree 30.20

35363 ....... ......... Rechanneling of artery ............................. 24.66 35.67 30.20 .................. agree 30.20

35371 ....... ......... Rechanneling of artery ............................. 11.64 12.97 14.72 .................. agree 14.72

35371 ....... ......... Rechanneling of artery ............................. 11.64 17.75 14.72 .................. agree 14.72

35372 ....... ......... Rechanneling of artery ............................. 13.56 18.04 18.00 .................. agree 18.00

35372 ....... ......... Rechanneling of artery ............................. 13.56 19.53 18.00 .................. agree 18.00

35381 ....... ......... Rechanneling of artery ............................. 15.81 N/A CPT .................. CPT 15.81

35511 ....... ......... Artery bypass graft ................................... 16.83 19.75 21.20 .................. agree 21.20

35511 ....... ......... Artery bypass graft ................................... 16.83 21.50 21.20 .................. agree 21.20

35518 ....... ......... Artery bypass graft ................................... 15.42 18.59 21.20 .................. agree 21.20

35518 ....... ......... Artery bypass graft ................................... 15.42 23.00 21.20 .................. agree 21.20

35521 ....... ......... Artery bypass graft ................................... 16.17 20.46 22.20 .................. agree 22.20

35521 ....... ......... Artery bypass graft ................................... 16.17 25.25 22.20 .................. agree 22.20

35526 ....... ......... Artery bypass graft ................................... 20.00 30.00 29.95 .................. agree 29.95

35526 ....... ......... Artery bypass graft ................................... 20.00 N/A 29.95 .................. agree 29.95

35531 ....... ......... Artery bypass graft ................................... 25.61 33.62 36.20 .................. agree 36.20

35531 ....... ......... Artery bypass graft ................................... 25.61 38.00 36.20 .................. agree 36.20

35533 ....... ......... Artery bypass graft ................................... 20.52 28.00 28.00 .................. agree 28.00

35533 ....... ......... Artery bypass graft ................................... 20.52 29.99 28.00 .................. agree 28.00

35536 ....... ......... Artery bypass graft ................................... 23.11 25.33 31.70 .................. agree 31.70

35536 ....... ......... Artery bypass graft ................................... 23.11 33.00 31.70 .................. agree 31.70

35541 ....... ......... Artery bypass graft ................................... 25.80 N/A CPT .................. CPT 25.80

35546 ....... ......... Artery bypass graft ................................... 25.54 N/A CPT .................. CPT 25.54

35551 ....... ......... Artery bypass graft ................................... 26.67 N/A CPT .................. CPT 26.67

35556 ....... ......... Artery bypass graft ................................... 21.76 24.50 21.76 .................. agree 21.76

35556 ....... ......... Artery bypass graft ................................... 21.76 24.50 21.76 .................. agree 21.76

35558 ....... ......... Artery bypass graft ................................... 14.04 22.00 21.20 .................. agree 21.20

35558 ....... ......... Artery bypass graft ................................... 14.04 22.08 21.20 .................. agree 21.20

35560 ....... ......... Artery bypass graft ................................... 23.56 28.19 32.00 .................. agree 32.00

35560 ....... ......... Artery bypass graft ................................... 23.56 35.50 32.00 .................. agree 32.00

35563 ....... ......... Artery bypass graft ................................... 15.14 24.00 24.20 .................. agree 24.20

35563 ....... ......... Artery bypass graft ................................... 15.14 25.00 24.20 .................. agree 24.20

35565 ....... ......... Artery bypass graft ................................... 15.14 23.65 23.20 .................. agree 23.20

35565 ....... ......... Artery bypass graft ................................... 15.14 24.00 23.20 .................. agree 23.20

35571 ....... ......... Artery bypass graft ................................... 18.58 23.65 24.06 .................. agree 24.06

35571 ....... ......... Artery bypass graft ................................... 18.58 26.92 24.06 .................. agree 24.06

35582 ....... ......... Vein bypass graft ...................................... 27.13 N/A CPT .................. CPT 27.13

35587 ....... ......... Vein bypass graft ...................................... 19.05 24.47 24.75 .................. agree 24.75

35587 ....... ......... Vein bypass graft ...................................... 19.05 27.00 24.75 .................. agree 24.75

35621 ....... ......... Artery bypass graft ................................... 14.54 16.53 20.00 .................. agree 20.00

35621 ....... ......... Artery bypass graft ................................... 14.54 21.50 20.00 .................. agree 20.00

35623 ....... ......... Bypass graft, not vein ............................... 16.62 17.62 24.00 .................. agree 24.00

35623 ....... ......... Bypass graft, not vein ............................... 16.62 25.75 24.00 .................. agree 24.00

35626 ....... ......... Artery bypass graft ................................... 23.63 27.58 27.75 .................. agree 27.75

35626 ....... ......... Artery bypass graft ................................... 23.63 30.00 27.75 .................. agree 27.75

35631 ....... ......... Artery bypass graft ................................... 24.60 32.51 34.00 .................. agree 34.00

35631 ....... ......... Artery bypass graft ................................... 24.60 36.00 34.00 .................. agree 34.00

35636 ....... ......... Artery bypass graft ................................... 22.46 27.32 29.50 .................. agree 29.50

35636 ....... ......... Artery bypass graft ................................... 22.46 36.00 29.50 .................. agree 29.50

35641 ....... ......... Artery bypass graft ................................... 24.57 N/A CPT .................. CPT 24.57

35646 ....... ......... Artery bypass graft ................................... 25.81 N/A CPT .................. CPT 25.81

35650 ....... ......... Artery bypass graft ................................... 14.36 15.74 19.00 .................. agree 19.00

35650 ....... ......... Artery bypass graft ................................... 14.36 19.80 19.00 .................. agree 19.00

35654 ....... ......... Artery bypass graft ................................... 18.61 23.54 25.00 .................. agree 25.00

35654 ....... ......... Artery bypass graft ................................... 18.61 26.00 25.00 .................. agree 25.00

35661 ....... ......... Artery bypass graft ................................... 13.18 17.89 19.00 .................. agree 19.00

35661 ....... ......... Artery bypass graft ................................... 13.18 19.53 19.00 .................. agree 19.00

31036

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

35663 ....... ......... Artery bypass graft ................................... 14.17 20.90 22.00 .................. agree 22.00

35663 ....... ......... Artery bypass graft ................................... 14.17 23.00 22.00 .................. agree 22.00

35665 ....... ......... Artery bypass graft ................................... 15.40 19.84 21.00 .................. agree 21.00

35665 ....... ......... Artery bypass graft ................................... 15.40 22.00 21.00 .................. agree 21.00

35666 ....... ......... Artery bypass graft ................................... 19.19 20.00 22.19 .................. agree 22.19

35666 ....... ......... Artery bypass graft ................................... 19.19 22.00 22.19 .................. agree 22.19

35671 ....... ......... Artery bypass graft ................................... 14.80 17.80 19.33 .................. agree 19.33

35671 ....... ......... Artery bypass graft ................................... 14.80 24.00 19.33 .................. agree 19.33

35701 ....... ......... Exploration, carotid artery ......................... 5.55 9.38 8.50 .................. agree 8.50

35701 ....... ......... Exploration, carotid artery ......................... 5.55 15.00 8.50 .................. agree 8.50

35721 ....... ......... Exploration, femoral artery ....................... 5.28 N/A 7.18 .................. agree 7.18

35741 ....... ......... Exploration popliteal artery ....................... 5.37 N/A 8.00 .................. agree 8.00

35840 ....... ......... Explore abdominal vessels ....................... 9.77 N/A CPT .................. CPT 9.77

35860 ....... ......... Explore limb vessels ................................. 5.55 N/A CPT .................. CPT 5.55

35905 ....... ......... Excision, graft, thorax ............................... 18.19 32.00 31.25 .................. agree 31.25

35905 ....... ......... Excision, graft, thorax ............................... 18.19 N/A 31.25 .................. agree 31.25

35907 ....... ......... Excision, graft, abdomen .......................... 19.24 37.33 35.00 .................. agree 35.00

35907 ....... ......... Excision, graft, abdomen .......................... 19.24 40.00 35.00 .................. agree 35.00

36400 ....... ......... Drawing blood ........................................... 0.18 N/A 0.38 .................. decrease 0.18

36405 ....... ......... Drawing blood ........................................... 0.18 N/A 0.32 .................. decrease 0.18

36406 ....... ......... Drawing blood ........................................... 0.18 N/A CPT .................. CPT 0.18

36489 ....... ......... Insertion of catheter, vein ......................... 1.22 2.75 2.50 .................. agree 2.50

36489 ....... ......... Insertion of catheter, vein ......................... 1.22 3.41 2.50 .................. agree 2.50

36520 ....... ......... Plasma and/or cell exchange ................... 1.74 N/A CPT .................. CPT 1.74

36533 ....... ......... Insertion of access device ........................ 5.32 5.28 CPT .................. CPT 5.32

36534 ....... ......... Revision of access device ........................ 2.80 5.15 CPT .................. CPT 2.80

36535 ....... ......... Removal of access device ........................ 2.27 3.89 CPT .................. CPT 2.27

36600 ....... ......... Withdrawal of arterial blood ...................... 0.32 WD (e) .................. (a) 0.32

36620 ....... ......... Insertion catheter, artery ........................... 1.15 2.25 CPT .................. CPT 1.15

36625 ....... ......... Insertion catheter, artery ........................... 2.11 2.65 2.11 .................. agree 2.11

36822 ....... ......... Insertion of cannula(s) .............................. 5.42 19.00 5.42 .................. agree 5.42

37565 ....... ......... Ligation of neck vein ................................. 4.44 9.01 10.88 .................. agree 10.88

37565 ....... ......... Ligation of neck vein ................................. 4.44 14.50 10.88 .................. agree 10.88

37600 ....... ......... Ligation of neck artery .............................. 4.57 9.19 11.25 .................. agree 11.25

37600 ....... ......... Ligation of neck artery .............................. 4.57 14.00 11.25 .................. agree 11.25

37605 ....... ......... Ligation of neck artery .............................. 6.19 11.85 13.11 .................. agree 13.11

37605 ....... ......... Ligation of neck artery .............................. 6.19 17.50 13.11 .................. agree 13.11

37609 ....... ......... Temporal artery procedure ....................... 2.30 3.38 3.00 .................. agree 3.00

37609 ....... ......... Temporal artery procedure ....................... 2.30 N/A 3.00 .................. agree 3.00

37615 ....... ......... Ligation of neck artery .............................. 5.73 12.31 CPT .................. CPT 5.73

37615 ....... ......... Ligation of neck artery .............................. 5.73 18.00 CPT .................. CPT 5.73

37617 ....... ......... Ligation of abdomen artery ....................... 15.95 N/A 22.06 .................. agree 22.06

37618 ....... ......... Ligation of extremity artery ....................... 4.84 N/A CPT .................. CPT 4.84

37650 ....... ......... Revision of major vein .............................. 5.13 N/A 7.80 .................. agree 7.80

37660 ....... ......... Revision of major vein .............................. 10.61 N/A 21.00 .................. agree 21.00

37700 ....... ......... Revise leg vein ......................................... 3.73 N/A CPT .................. CPT 3.73

37720 ....... ......... Removal of leg vein .................................. 5.66 10.71 CPT .................. CPT 5.66

37730 ....... ......... Removal of leg veins ................................ 7.33 N/A CPT .................. CPT 7.33

37735 ....... ......... Removal of leg veins/lesion ...................... 10.53 N/A CPT .................. CPT 10.53

37760 ....... ......... Revision of leg veins ................................ 10.47 N/A CPT .................. CPT 10.47

37785 ....... ......... Revision secondary varicosity .................. 3.84 N/A CPT .................. CPT 3.84

38100 ....... ......... Removal of spleen, total ........................... 13.01 14.70 14.50 .................. agree 14.50

38100 ....... ......... Removal of spleen, total ........................... 13.01 16.21 14.50 .................. agree 14.50

38101 ....... ......... Removal of spleen, partial ........................ 13.74 14.79 15.31 .................. agree 15.31

38115 ....... ......... Repair of ruptured spleen ......................... 14.19 15.55 15.82 .................. agree 15.82

38300 ....... ......... Drainage, lymph node lesion .................... 1.53 1.01 1.99 .................. agree 1.99

38305 ....... ......... Drainage, lymph node lesion .................... 4.61 6.59 6.00 .................. agree 6.00

38308 ....... ......... Incision of lymph channels ....................... 4.95 7.35 6.45 .................. agree 6.45

38500 ....... ......... Biopsy/removal, lymph nodes ................... 2.88 3.29 3.75 .................. agree 3.75

38500 ....... ......... Biopsy/removal, lymph nodes ................... 2.88 4.58 3.75 .................. agree 3.75

38510 ....... ......... Biopsy/removal, lymph nodes ................... 4.14 6.28 6.43 .................. agree 6.43

38520 ....... ......... Biopsy/removal, lymph nodes ................... 5.12 6.93 6.67 .................. agree 6.67

38525 ....... ......... Biopsy/removal, lymph nodes ................... 4.66 5.30 6.07 .................. agree 6.07

38530 ....... ......... Biopsy/removal, lymph nodes ................... 6.13 9.58 7.98 .................. agree 7.98

38571 ....... ......... Laparoscopy, lymphadenectomy .............. 12.38 19.84 12.38 .................. agree 12.38

38572 ....... ......... Laparoscopy, lymphadenectomy .............. 14.32 23.17 16.59 .................. agree 16.59

31037

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

38740 ....... ......... Remove armpit lymph nodes .................... 6.77 10.68 8.42 .................. increase 10.02

38745 ....... ......... Remove armpit lymph nodes .................... 8.84 12.78 11.00 .................. increase 13.00

38746 ....... ......... Remove thoracic lymph nodes ................. 4.39 N/A 4.89 .................. agree 4.89

38760 ....... ......... Remove groin lymph nodes ...................... 8.74 11.35 10.88 .................. increase 12.94

38765 ....... ......... Remove groin lymph nodes ...................... 16.06 18.77 19.98 .................. agree 19.98

38780 ....... ......... Remove abdomen lymph nodes ............... 16.59 N/A 16.59 .................. agree 16.59

39010 ....... ......... Exploration of chest .................................. 11.79 N/A 11.79 .................. agree 11.79

39220 ....... ......... Removal chest lesion ............................... 17.42 N/A 17.42 .................. agree 17.42

39400 ....... ......... Visualization of chest ................................ 5.61 N/A 5.61 .................. agree 5.61

39503 ....... ......... Repair of diaphragm hernia ...................... 34.85 122.75 95.00 .................. decrease 34.85

42205 ....... ......... Reconstruct cleft palate ............................ 9.59 12.00 13.29 .................. agree 13.29

43107 ....... ......... Removal of esophagus ............................. 28.79 N/A 40.00 .................. agree 40.00

43112 ....... ......... Removal of esophagus ............................. 31.22 N/A 43.50 .................. agree 43.50

43117 ....... ......... Partial removal of esophagus ................... 30.02 N/A 40.00 .................. agree 40.00

43122 ....... ......... Parital removal of esophagus ................... 29.11 N/A 40.00 .................. agree 40.00

43215 ....... ......... Esophagus endoscopy ............................. 2.60 4.91 CPT .................. CPT 2.60

43217 ....... ......... Esophagus endoscopy ............................. 2.90 3.63 2.90 .................. agree 2.90

43219 ....... ......... Esophagus endoscopy ............................. 2.80 3.50 3.18 .................. decrease 2.80

43228 ....... ......... Esoph endoscopy, ablation ...................... 3.77 4.72 3.77 .................. agree 3.77

43239 ....... ......... Upper GI endoscopy, biopsy .................... 2.69 2.96 2.87 .................. decrease 2.69

43239 ....... ......... Upper GI endoscopy, biopsy .................... 2.69 3.79 2.87 .................. decrease 2.69

43244 ....... ......... Upper GI endoscopy/ligation .................... 4.59 5.05 5.05 .................. decrease 4.59

43246 ....... ......... Place gastrostomy tube ............................ 4.33 4.76 4.33 .................. agree 4.33

43246 ....... ......... Place gastrostomy tube ............................ 4.33 5.04 4.33 .................. agree 4.33

43247 ....... ......... Operative upper GI endoscopy ................ 3.39 4.51 3.59 .................. decrease 3.39

43249 ....... ......... Esoph endoscopy, dilation ........................ 2.90 5.01 3.35 .................. decrease 2.90

43251 ....... ......... Operative upper GI endoscopy ................ 3.70 4.44 3.70 .................. agree 3.70

43255 ....... ......... Operative upper GI endoscopy ................ 4.40 5.40 4.82 .................. decrease 4.40

43258 ....... ......... Operative upper GI endoscopy ................ 4.55 5.01 4.55 .................. agree 4.55

43259 ....... ......... Endoscopic ultrasound exam ................... 4.89 N/A 8.59 .................. decrease 4.89

43263 ....... ......... Endo cholangiopancreatograph ................ 6.19 7.12 7.29 .................. decrease 6.19

43265 ....... ......... Endo cholangiopancreatograph ................ 8.90 N/A 10.02 .................. decrease 8.90

43269 ....... ......... Endo cholangiopancreatograph ................ 6.04 7.50 8.21 .................. decrease 6.04

43305 ....... ......... Repair esophagus and fistula ................... 17.15 WD (e) .................. (a) 17.15

43310 ....... ......... Repair of esophagus ................................ 25.39 50.50 CPT .................. CPT 25.39

43312 ....... ......... Repair esophagus and fistula ................... 28.42 56.75 CPT .................. CPT 28.42

43320 ....... ......... Fuse esophagus & stomach ..................... 16.07 26.45 19.93 .................. agree 19.93

43324 ....... ......... Revise esophagus & stomach .................. 16.58 17.75 20.57 .................. agree 20.57

43325 ....... ......... Revise esophagus & stomach .................. 16.17 21.65 20.06 .................. agree 20.06

43326 ....... ......... Revise esophagus & stomach .................. 15.91 20.53 19.74 .................. agree 19.74

43330 ....... ......... Repair of esophagus ................................ 15.94 15.44 19.77 .................. agree 19.77

43331 ....... ......... Repair of esophagus ................................ 16.23 17.60 20.13 .................. agree 20.13

43340 ....... ......... Fuse esophagus & intestine ..................... 15.81 26.72 19.61 .................. agree 19.61

43341 ....... ......... Fuse esophagus & intestine ..................... 16.81 29.07 20.85 .................. agree 20.85

43350 ....... ......... Surgical opening, esophagus ................... 12.72 32.97 15.78 .................. agree 15.78

43351 ....... ......... Surgical opening, esophagus ................... 14.79 31.92 18.35 .................. agree 18.35

43352 ....... ......... Surgical opening, esophagus ................... 12.30 25.47 15.26 .................. agree 15.26

43360 ....... ......... Gastrointestinal repair ............................... 28.78 61.17 35.70 .................. agree 35.70

43361 ....... ......... Gastrointestinal repair ............................... 32.65 65.83 40.50 .................. agree 40.50

43400 ....... ......... Ligate esophagus veins ............................ 17.09 29.96 21.20 .................. agree 21.20

43401 ....... ......... Esophagus surgery for veins .................... 17.81 34.94 22.09 .................. agree 22.09

43405 ....... ......... Ligate/staple esophagus ........................... 16.13 36.67 20.01 .................. agree 20.01

43410 ....... ......... Repair esophagus wound ......................... 10.86 13.65 13.47 .................. agree 13.47

43415 ....... ......... Repair esophagus wound ......................... 17.06 30.45 25.00 .................. agree 25.00

43420 ....... ......... Repair esophagus opening ....................... 11.57 14.10 14.35 .................. agree 14.35

43425 ....... ......... Repair esophagus opening ....................... 16.95 26.93 21.03 .................. agree 21.03

43500 ....... ......... Surgical opening of stomach .................... 8.44 11.81 11.05 .................. agree 11.05

43501 ....... ......... Surgical repair of stomach ........................ 15.31 20.44 20.04 .................. agree 20.04

43502 ....... ......... Surgical repair of stomach ........................ 17.67 21.20 23.13 .................. agree 23.13

43510 ....... ......... Surgical opening of stomach .................... 9.99 18.81 13.08 .................. agree 13.08

43520 ....... ......... Incision of pyloric muscle ......................... 7.63 8.88 9.99 .................. agree 9.99

43605 ....... ......... Biopsy of stomach .................................... 9.15 10.41 11.98 .................. agree 11.98

43610 ....... ......... Excision of stomach lesion ....................... 11.15 17.37 14.60 .................. agree 14.60

43611 ....... ......... Excision of stomach lesion ....................... 13.63 23.82 17.84 .................. agree 17.84

43620 ....... ......... Removal of stomach ................................. 22.54 33.61 30.04 .................. agree 30.04

43621 ....... ......... Removal of stomach ................................. 23.06 35.55 30.73 .................. agree 30.73

31038

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

43622 ....... ......... Removal of stomach ................................. 24.41 35.56 32.53 .................. agree 32.53

43631 ....... ......... Removal of stomach, partial ..................... 19.66 23.28 22.59 .................. agree 22.59

43632 ....... ......... Removal of stomach, partial ..................... 19.66 25.92 22.59 .................. agree 22.59

43633 ....... ......... Removal of stomach, partial ..................... 20.10 27.68 23.10 .................. agree 23.10

43634 ....... ......... Removal of stomach, partial ..................... 21.86 34.19 25.12 .................. agree 25.12

43638 ....... ......... Removal of stomach, partial ..................... 21.76 29.96 29.00 .................. agree 29.00

43638 ....... ......... Removal of stomach, partial ..................... 21.76 39.80 29.00 .................. agree 29.00

43639 ....... ......... Removal of stomach, partial ..................... 22.25 39.80 29.65 .................. agree 29.65

43640 ....... ......... Vagotomy & pylorus repair ....................... 14.81 17.32 17.02 .................. agree 17.02

43641 ....... ......... Vagotomy & pylorus repair ....................... 15.03 21.34 17.27 .................. agree 17.27

43651 ....... ......... Laparoscopy, vagus nerve ....................... 10.15 15.17 10.15 .................. agree 10.15

43652 ....... ......... Laparoscopy, vagus nerve ....................... 12.15 19.21 12.15 .................. agree 12.15

43800 ....... ......... Reconstruction of pylorus ......................... 10.46 11.86 13.69 .................. agree 13.69

43810 ....... ......... Fusion of stomach and bowel .................. 11.19 13.81 14.65 .................. agree 14.65

43820 ....... ......... Fusion of stomach and bowel .................. 11.74 15.78 15.37 .................. agree 15.37

43825 ....... ......... Fusion of stomach and bowel .................. 14.68 18.16 19.22 .................. agree 19.22

43830 ....... ......... Place gastrostomy tube ............................ 7.28 7.28 9.53 .................. agree 9.53

43832 ....... ......... Place gastrostomy tube ............................ 11.92 11.92 15.60 .................. agree 15.60

43840 ....... ......... Repair of stomach lesion .......................... 11.89 11.89 15.56 .................. agree 15.56

43842 ....... ......... Gastroplasty for obesity ............................ 14.71 17.14 18.47 .................. agree 18.47

43843 ....... ......... Gastroplasty for obesity ............................ 14.85 20.62 18.65 .................. agree 18.65

43846 ....... ......... Gastric bypass for obesity ........................ 19.15 23.43 24.05 .................. agree 24.05

43847 ....... ......... Gastric bypass for obesity ........................ 21.44 29.95 26.92 .................. agree 26.92

43848 ....... ......... Revision gastroplasty ................................ 23.41 27.07 29.39 .................. agree 29.39

43850 ....... ......... Revise stomach-bowel fusion ................... 19.69 23.27 24.72 .................. agree 24.72

43855 ....... ......... Revise stomach-bowel fusion ................... 20.83 24.15 26.16 .................. agree 26.16

43860 ....... ......... Revise stomach-bowel fusion ................... 19.91 26.08 25.00 .................. agree 25.00

43865 ....... ......... Revise stomach-bowel fusion ................... 21.12 27.30 26.52 .................. agree 26.52

43870 ....... ......... Repair stomach opening ........................... 7.40 9.65 9.69 .................. agree 9.69

43880 ....... ......... Repair stomach-bowel fistula ................... 19.63 23.60 24.65 .................. agree 24.65

44005 ....... ......... Freeing of bowel adhesion ....................... 13.84 15.43 16.23 .................. agree 16.23

44010 ....... ......... Incision of small bowel ............................. 10.68 15.90 12.52 .................. agree 12.52

44020 ....... ......... Exploration of small bowel ........................ 11.93 15.04 13.99 .................. agree 13.99

44021 ....... ......... Decompress small bowel .......................... 12.01 15.18 14.08 .................. agree 14.08

44025 ....... ......... Incision of large bowel .............................. 12.18 14.08 14.28 .................. agree 14.28

44050 ....... ......... Reduce bowel obstruction ........................ 11.40 13.75 14.03 .................. agree 14.03

44050 ....... ......... Reduce bowel obstruction ........................ 11.40 14.58 14.03 .................. agree 14.03

44055 ....... ......... Correct malrotation of bowel .................... 13.14 22.00 22.00 .................. agree 22.00

44110 ....... ......... Excision of bowel lesion(s) ....................... 10.07 14.39 11.81 .................. agree 11.81

44111 ....... ......... Excision of bowel lesion(s) ....................... 12.19 16.32 14.29 .................. agree 14.29

44120 ....... ......... Removal of small intestine ....................... 14.50 15.82 17.00 .................. agree 17.00

44125 ....... ......... Removal of small intestine ....................... 14.96 17.54 17.54 .................. agree 17.54

44130 ....... ......... Bowel to bowel fusion ............................... 12.36 17.87 14.49 .................. agree 14.49

44130 ....... ......... Bowel to bowel fusion ............................... 12.36 N/A 14.49 .................. agree 14.49

44140 ....... ......... Partial removal of colon ............................ 18.35 20.94 18.35 .................. increase 21.00

44140 ....... ......... Partial removal of colon ............................ 18.35 24.58 18.35 .................. increase 21.00

44143 ....... ......... Partial removal of colon ............................ 20.17 30.36 20.17 .................. increase 22.99

44144 ....... ......... Partial removal of colon ............................ 18.89 29.46 18.89 .................. increase 21.53

44144 ....... ......... Partial removal of colon ............................ 18.89 N/A 18.89 .................. increase 21.53

44145 ....... ......... Partial removal of colon ............................ 23.18 27.91 23.18 .................. increase 26.42

44146 ....... ......... Partial removal of colon ............................ 24.16 30.97 24.16 .................. increase 27.54

44147 ....... ......... Partial removal of colon ............................ 18.17 N/A 18.17 .................. increase 20.71

44150 ....... ......... Removal of colon ...................................... 21.01 27.41 21.01 .................. increase 23.95

44151 ....... ......... Removal of colon/ileostomy ...................... 20.04 32.89 20.04 .................. increase 26.88

44151 ....... ......... Removal of colon/ileostomy ...................... 20.04 N/A 20.04 .................. increase 26.88

44152 ....... ......... Removal of colon/ileostomy ...................... 24.41 33.61 24.41 .................. increase 27.83

44153 ....... ......... Removal of colon/ileostomy ...................... 26.83 33.11 26.83 .................. increase 30.59

44155 ....... ......... Removal of colon/ileostomy ...................... 24.44 33.61 24.44 .................. increase 27.86

44156 ....... ......... Removal of colon/ileostomy ...................... 23.01 36.27 23.01 .................. increase 30.79

44156 ....... ......... Removal of colon/ileostomy ...................... 23.01 N/A 23.01 .................. increase 30.79

44160 ....... ......... Removal of colon ...................................... 15.88 17.45 18.62 .................. agree 18.62

44200 ....... ......... Laparoscopy, enterolysis .......................... 14.44 16.11 14.44 .................. agree 14.44

44300 ....... ......... Open bowel to skin ................................... 8.88 13.09 12.11 .................. agree 12.11

44310 ....... ......... Ileostomy/jejunostomy .............................. 11.70 18.14 15.95 .................. agree 15.95

44312 ....... ......... Revision of ileostomy ................................ 5.88 6.79 8.02 .................. agree 8.02

44314 ....... ......... Revision of ileostomy ................................ 11.04 14.45 15.05 .................. agree 15.05

31039

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

44316 ....... ......... Devise bowel pouch ................................. 15.47 26.57 21.09 .................. agree 21.09

44320 ....... ......... Colostomy ................................................. 12.94 18.84 17.64 .................. agree 17.64

44340 ....... ......... Revision of colostomy ............................... 5.66 6.79 7.72 .................. agree 7.72

44345 ....... ......... Revision of colostomy ............................... 11.32 14.45 15.43 .................. agree 15.43

44346 ....... ......... Revision of colostomy ............................... 12.46 17.19 16.99 .................. agree 16.99

44388 ....... ......... Colon endoscopy ...................................... 2.82 3.10 3.70 .................. decrease 2.82

44389 ....... ......... Colonoscopy with biopsy .......................... 3.13 3.44 4.26 .................. decrease 3.13

44390 ....... ......... Colonoscopy for foreign body ................... 3.83 4.21 4.81 .................. decrease 3.83

44391 ....... ......... Colonoscopy for bleeding ......................... 4.32 4.75 5.18 .................. decrease 4.32

44392 ....... ......... Colonoscopy and polypectomy ................. 3.82 4.20 4.81 .................. decrease 3.82

44393 ....... ......... Colonoscopy, lesion removal .................... 4.84 5.32 5.00 .................. decrease 4.84

44394 ....... ......... Colonoscopy w/snare ............................... 4.43 4.87 4.43 .................. agree 4.43

44394 ....... ......... Colonoscopy w/snare ............................... 4.43 N/A 4.43 .................. agree 4.43

44602 ....... ......... Suture, small intestine .............................. 10.61 15.26 11.91 .................. increase 16.03

44603 ....... ......... Suture, small intestine .............................. 14.00 19.50 15.72 .................. increase 18.66

44604 ....... ......... Suture, large intestine ............................... 14.28 16.59 16.03 .................. agree 16.03

44605 ....... ......... Repair of bowel lesion .............................. 15.37 25.03 17.25 .................. increase 19.53

44615 ....... ......... Intestinal stricturoplasty ............................ 14.19 18.97 15.93 .................. agree 15.93

44620 ....... ......... Repair bowel opening ............................... 10.87 14.99 12.20 .................. agree 12.20

44625 ....... ......... Repair bowel opening ............................... 13.41 16.79 15.05 .................. agree 15.05

44626 ....... ......... Repair bowel opening ............................... 22.59 24.43 25.36 .................. agree 25.36

44640 ....... ......... Repair bowel-skin fistula ........................... 14.83 22.29 16.65 .................. increase 21.65

44650 ....... ......... Repair bowel fistula .................................. 15.25 22.29 17.12 .................. increase 22.27

44660 ....... ......... Repair bowel-bladder fistula ..................... 14.63 24.70 16.42 .................. increase 21.36

44661 ....... ......... Repair bowel-bladder fistula ..................... 16.99 25.63 19.07 .................. increase 24.81

44680 ....... ......... Surgical revision, intestine ........................ 13.72 21.32 15.40 .................. agree 15.40

44700 ....... ......... Suspend bowel w/prosthesis .................... 14.35 19.35 16.11 .................. agree 16.11

44800 ....... ......... Excision of bowel pouch ........................... 11.23 10.85 11.23 .................. agree 11.23

44820 ....... ......... Excision of mesentery lesion .................... 10.31 11.23 12.09 .................. agree 12.09

44850 ....... ......... Repair of mesentery ................................. 9.57 12.00 10.74 .................. agree 10.74

44900 ....... ......... Drain app abscess, open .......................... 8.82 11.79 10.14 .................. agree 10.14

44950 ....... ......... Appendectomy .......................................... 8.70 8.37 10.00 .................. agree 10.00

44960 ....... ......... Appendectomy .......................................... 10.74 13.67 12.34 .................. agree 12.34

44970 ....... ......... Laparoscopy, appendectomy .................... 8.70 10.26 8.70 .................. agree 8.70

45000 ....... ......... Drainage of pelvic abscess ...................... 4.52 10.29 3.88 .................. increase 4.52

45020 ....... ......... Drainage of rectal abscess ....................... 4.72 7.71 4.05 .................. increase 4.72

45100 ....... ......... Biopsy of rectum ....................................... 3.68 4.34 3.16 .................. increase 3.68

45108 ....... ......... Removal of anorectal lesion ..................... 4.76 5.25 4.09 .................. increase 4.76

45110 ....... ......... Removal of rectum ................................... 23.80 29.53 28.00 .................. agree 28.00

45111 ....... ......... Partial removal of rectum ......................... 16.48 N/A 16.48 .................. agree 16.48

45112 ....... ......... Removal of rectum ................................... 25.96 32.46 30.54 .................. agree 30.54

45113 ....... ......... Partial proctectomy ................................... 25.99 33.11 30.58 .................. agree 30.58

45114 ....... ......... Partial removal of rectum ......................... 23.22 29.46 27.32 .................. agree 27.32

45116 ....... ......... Partial removal of rectum ......................... 20.89 21.98 24.58 .................. agree 24.58

45119 ....... ......... Remove rectum w/reservoir ...................... 26.21 31.60 30.84 .................. agree 30.84

45120 ....... ......... Removal of rectum ................................... 24.60 31.09 24.60 .................. agree 24.60

45121 ....... ......... Removal of rectum and colon .................. 27.04 32.14 27.04 .................. agree 27.04

45123 ....... ......... Partial proctectomy ................................... 14.20 22.51 16.71 .................. agree 16.71

45126 ....... ......... Pelvic exenteration ................................... 38.39 47.99 45.16 .................. agree 45.16

45130 ....... ......... Excision of rectal prolapse ....................... 13.97 14.26 16.44 .................. agree 16.44

45135 ....... ......... Excision of rectal prolapse ....................... 16.39 30.14 19.28 .................. agree 19.28

45160 ....... ......... Excision of rectal lesion ............................ 13.02 19.86 15.32 .................. agree 15.32

45170 ....... ......... Excision of rectal lesion ............................ 9.77 12.81 11.49 .................. agree 11.49

45190 ....... ......... Destruction, rectal tumor .......................... 8.28 9.09 9.74 .................. agree 9.74

45305 ....... ......... Proctosigmoidoscopy & biopsy ................. 1.01 1.22 1.01 .................. agree 1.01

45309 ....... ......... Proctosigmoidoscopy ................................ 2.01 2.45 2.01 .................. agree 2.01

45330 ....... ......... Diagnostic sigmoidoscopy ........................ 0.96 1.39 0.96 .................. agree 0.96

45337 ....... ......... Sigmoidoscopy & decompress ................. 2.36 N/A 2.36 .................. agree 2.36

45339 ....... ......... Sigmoidoscopy .......................................... 3.14 N/A 3.14 .................. agree 3.14

45378 ....... ......... Diagnostic colonoscopy ............................ 3.70 4.66 3.70 .................. agree 3.70

45380 ....... ......... Colonoscopy and biopsy .......................... 4.01 5.01 4.44 .................. decrease 4.01

45383 ....... ......... Lesion removal colonoscopy .................... 5.87 7.34 5.87 .................. agree 5.87

45384 ....... ......... Colonoscopy ............................................. 4.70 5.88 4.70 .................. agree 4.70

45385 ....... ......... Lesion removal colonoscopy .................... 5.31 6.64 5.31 .................. agree 5.31

45505 ....... ......... Repair of rectum ....................................... 6.02 7.57 7.58 .................. agree 7.58

45540 ....... ......... Correct rectal prolapse ............................. 12.92 17.79 16.27 .................. agree 16.27

31040

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

45541 ....... ......... Correct rectal prolapse ............................. 10.64 13.23 13.40 .................. agree 13.40

45550 ....... ......... Repair rectum/remove sigmoid ................. 18.26 27.91 23.00 .................. agree 23.00

45560 ....... ......... Repair of rectocele ................................... 8.40 7.70 10.58 .................. agree 10.58

45562 ....... ......... Exploration/repair of rectum ..................... 12.21 12.09 15.38 .................. agree 15.38

45563 ....... ......... Exploration/repair of rectum ..................... 18.63 21.50 23.47 .................. agree 23.47

45800 ....... ......... Repair rect/bladder fistula ......................... 14.11 14.36 17.77 .................. agree 17.77

45805 ....... ......... Repair fistula w/colostomy ........................ 16.50 20.94 20.78 .................. agree 20.78

45820 ....... ......... Repair rectourethral fistula ....................... 14.67 13.81 18.48 .................. agree 18.48

45825 ....... ......... Repair fistula w/colostomy ........................ 16.87 20.38 21.25 .................. agree 21.25

45900 ....... ......... Reduction of rectal prolapse ..................... 1.83 3.27 2.61 .................. agree 2.61

45905 ....... ......... Dilation of anal sphincter .......................... 1.61 3.15 2.30 .................. agree 2.30

45910 ....... ......... Dilation of rectal narrowing ....................... 1.96 3.23 2.80 .................. agree 2.80

45910 ....... ......... Dilation of rectal narrowing ....................... 1.96 N/A 2.80 .................. agree 2.80

45915 ....... ......... Remove rectal obstruction ........................ 2.20 3.58 3.14 .................. agree 3.14

46040 ....... ......... Incision of rectal abscess ......................... 4.96 5.53 4.26 .................. increase 4.96

46045 ....... ......... Incision of rectal abscess ......................... 4.32 5.38 3.71 .................. increase 4.32

46060 ....... ......... Incision of rectal abscess ......................... 5.69 8.55 4.89 .................. increase 5.69

46083 ....... ......... Incise external hemorrhoid ....................... 1.40 1.52 1.40 .................. agree 1.40

46083 ....... ......... Incise external hemorrhoid ....................... 1.40 2.34 1.40 .................. agree 1.40

46221 ....... ......... Ligation of hemorrhoid(s) .......................... 1.43 1.94 2.04 .................. agree 2.04

46230 ....... ......... Removal of anal tabs ................................ 2.57 1.94 2.57 .................. agree 2.57

46250 ....... ......... Hemorrhoidectomy .................................... 4.53 4.13 3.89 .................. agree 3.89

46255 ....... ......... Hemorrhoidectomy .................................... 5.36 4.98 4.60 .................. agree 4.60

46257 ....... ......... Remove hemorrhoids & fissure ................ 6.28 5.43 5.40 .................. agree 5.40

46258 ....... ......... Remove hemorrhoids & fistula ................. 6.67 5.86 5.73 .................. agree 5.73

46258 ....... ......... Remove hemorrhoids & fistula ................. 6.67 N/A 5.73 .................. agree 5.73

46260 ....... ......... Hemorrhoidectomy .................................... 7.42 6.18 6.37 .................. agree 6.37

46261 ....... ......... Remove hemorrhoids & fissure ................ 8.24 7.11 7.08 .................. agree 7.08

46262 ....... ......... Remove hemorrhoids & fistula ................. 8.73 7.11 7.50 .................. agree 7.50

46270 ....... ......... Removal of anal fistula ............................. 3.72 4.28 3.20 .................. increase 3.72

46275 ....... ......... Removal of anal fistula ............................. 4.56 5.18 3.92 .................. increase 4.56

46280 ....... ......... Removal of anal fistula ............................. 5.98 5.95 5.14 .................. increase 5.98

46288 ....... ......... Repair anal fistula ..................................... 7.13 8.08 6.13 .................. increase 7.13

46320 ....... ......... Removal of hemorrhoid clot ..................... 1.61 1.52 1.61 .................. agree 1.61

46320 ....... ......... Removal of hemorrhoid clot ..................... 1.61 2.63 1.61 .................. agree 1.61

46700 ....... ......... Repair of anal stricture ............................. 7.25 10.22 9.13 .................. agree 9.13

46705 ....... ......... Repair of anal stricture ............................. 7.17 6.90 6.90 .................. agree 6.90

46715 ....... ......... Repair of anovaginal fistula ...................... 7.46 7.20 7.20 .................. agree 7.20

46716 ....... ......... Repair of anovaginal fistula ...................... 12.15 15.15 15.07 .................. agree 15.07

46730 ....... ......... Construction of absent anus ..................... 21.57 25.50 26.75 .................. agree 26.75

46735 ....... ......... Construction of absent anus ..................... 25.94 36.00 32.17 .................. agree 32.17

46740 ....... ......... Construction of absent anus ..................... 23.11 35.00 30.00 .................. agree 30.00

46742 ....... ......... Repair of imperforated anus ..................... 29.67 38.00 35.80 .................. agree 35.80

46744 ....... ......... Repair of cloacal anomaly ........................ 33.21 52.00 52.63 .................. agree 52.63

46746 ....... ......... Repair of cloacal anomaly ........................ 36.74 53.50 58.22 .................. agree 58.22

46748 ....... ......... Repair of cloacal anomaly ........................ 40.52 55.00 64.21 .................. agree 64.21

46750 ....... ......... Repair of anal sphincter ........................... 8.14 10.99 10.25 .................. agree 10.25

46753 ....... ......... Reconstruction of anus ............................. 6.58 5.45 8.29 .................. agree 8.29

46754 ....... ......... Removal of suture from anus ................... 1.54 2.93 2.20 .................. agree 2.20

46760 ....... ......... Repair of anal sphincter ........................... 11.46 21.77 14.43 .................. agree 14.43

46761 ....... ......... Repair of anal sphincter ........................... 10.99 12.15 13.84 .................. agree 13.84

46762 ....... ......... Implant artificial sphincter ......................... 10.09 15.01 12.71 .................. agree 12.71

46900 ....... ......... Destruction, anal lesion(s) ........................ 1.91 1.32 1.91 .................. agree 1.91

46910 ....... ......... Destruction, anal lesion(s) ........................ 1.86 1.72 1.86 .................. agree 1.86

46916 ....... ......... Cryosurgery, anal lesion(s) ....................... 1.86 1.72 1.86 .................. agree 1.86

46917 ....... ......... Laser surgery, anal lesions ...................... 1.86 3.32 1.86 .................. agree 1.86

46922 ....... ......... Excision of anal lesion(s) .......................... 1.86 3.12 1.86 .................. agree 1.86

46924 ....... ......... Destruction, anal lesion(s) ........................ 2.76 3.93 2.76 .................. agree 2.76

46924 ....... ......... Destruction, anal lesion(s) ........................ 2.76 4.24 2.76 .................. agree 2.76

46934 ....... ......... Destruction of hemorrhoids ...................... 4.08 4.63 3.51 .................. agree 3.51

46935 ....... ......... Destruction of hemorrhoids ...................... 2.43 4.17 2.43 .................. agree 2.43

46936 ....... ......... Destruction of hemorrhoids ...................... 4.30 5.12 3.69 .................. agree 3.69

46940 ....... ......... Treatment of anal fissure .......................... 2.32 1.71 2.32 .................. agree 2.32

46942 ....... ......... Treatment of anal fissure .......................... 2.04 1.71 2.04 .................. agree 2.04

46945 ....... ......... Ligation of hemorrhoids ............................ 2.14 2.37 1.84 .................. agree 1.84

46946 ....... ......... Ligation of hemorrhoids ............................ 3.00 2.57 2.58 .................. agree 2.58

31041

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

47010 ....... ......... Open drainage, liver lesion ....................... 10.28 16.25 16.01 .................. agree 16.01

47015 ....... ......... Inject/aspirate liver cyst ............................ 9.70 19.15 15.11 .................. agree 15.11

47100 ....... ......... Wedge biopsy of liver ............................... 7.49 9.24 11.67 .................. agree 11.67

47120 ....... ......... Partial removal of liver .............................. 22.79 39.57 35.50 .................. agree 35.50

47122 ....... ......... Extensive removal of liver ........................ 35.39 53.02 55.13 .................. agree 55.13

47125 ....... ......... Partial removal of liver .............................. 31.58 44.50 49.19 .................. agree 49.19

47130 ....... ......... Partial removal of liver .............................. 34.25 46.45 53.35 .................. agree 53.35

47134 ....... ......... Partial removal, donor liver ....................... 39.15 49.00 CPT .................. CPT 39.15

47300 ....... ......... Surgery for liver lesion .............................. 9.68 12.45 15.08 .................. agree 15.08

47350 ....... ......... Repair liver wound .................................... 12.56 19.16 19.56 .................. agree 19.56

47360 ....... ......... Repair liver wound .................................... 17.28 28.64 26.92 .................. agree 26.92

47361 ....... ......... Repair liver wound .................................... 30.25 40.14 47.12 .................. agree 47.12

47362 ....... ......... Repair liver wound .................................... 11.88 24.94 18.51 .................. agree 18.51

47400 ....... ......... Incision of liver duct .................................. 20.86 35.12 32.49 .................. agree 32.49

47420 ....... ......... Incision of bile duct ................................... 16.72 27.63 19.88 .................. agree 19.88

47425 ....... ......... Incision of bile duct ................................... 16.68 32.49 19.83 .................. agree 19.83

47460 ....... ......... Incise bile duct sphincter .......................... 15.17 25.74 18.04 .................. agree 18.04

47480 ....... ......... Incision of gallbladder ............................... 9.10 15.26 10.82 .................. agree 10.82

47562 ....... ......... Laparoscopic cholecystectomy ................. 11.09 9.59 11.09 .................. agree 11.09

47563 ....... ......... Laparoscopic cholecystectomy ................. 11.94 12.40 11.94 .................. agree 11.94

47564 ....... ......... Laparo cholecystectomy/explr .................. 14.23 17.67 14.23 .................. agree 14.23

47570 ....... ......... Laparo cholecystoenterostomy ................. 12.58 18.62 12.58 .................. agree 12.58

47600 ....... ......... Removal of gallbladder ............................. 11.42 11.67 13.58 .................. agree 13.58

47605 ....... ......... Removal of gallbladder ............................. 12.36 13.26 14.69 .................. agree 14.69

47610 ....... ......... Removal of gallbladder ............................. 15.83 17.97 18.82 .................. agree 18.82

47612 ....... ......... Removal of gallbladder ............................. 15.80 22.68 18.78 .................. agree 18.78

47620 ....... ......... Removal of gallbladder ............................. 17.36 24.70 20.64 .................. agree 20.64

47701 ....... ......... Bile duct revision ...................................... 27.81 36.50 27.81 .................. agree 27.81

47711 ....... ......... Excision of bile duct tumor ....................... 19.37 31.38 23.03 .................. agree 23.03

47712 ....... ......... Excision of bile duct tumor ....................... 25.44 38.58 30.24 .................. agree 30.24

47715 ....... ......... Excision of bile duct cyst .......................... 15.81 32.81 18.80 .................. agree 18.80

47716 ....... ......... Fusion of bile duct cyst ............................. 13.83 19.34 16.44 .................. agree 16.44

47720 ....... ......... Fuse gallbladder & bowel ......................... 13.38 18.16 15.91 .................. agree 15.91

47721 ....... ......... Fuse upper gi structures ........................... 16.08 21.91 19.12 .................. agree 19.12

47740 ....... ......... Fuse gallbladder & bowel ......................... 15.54 20.63 18.48 .................. agree 18.48

47741 ....... ......... Fuse gallbladder & bowel ......................... 17.95 24.39 21.34 .................. agree 21.34

47760 ....... ......... Fuse bile ducts and bowel ........................ 21.74 21.91 25.85 .................. agree 25.85

47765 ....... ......... Fuse liver ducts & bowel .......................... 20.93 30.62 24.88 .................. agree 24.88

47780 ....... ......... Fuse bile ducts and bowel ........................ 22.29 26.86 26.50 .................. agree 26.50

47785 ....... ......... Fuse bile ducts and bowel ........................ 26.23 36.32 31.18 .................. agree 31.18

47800 ....... ......... Reconstruction of bile ducts ..................... 19.60 26.89 23.30 .................. agree 23.30

47801 ....... ......... Placement, bile duct support .................... 12.76 23.47 15.17 .................. agree 15.17

47802 ....... ......... Fuse liver duct & intestine ........................ 18.13 34.11 21.55 .................. agree 21.55

47900 ....... ......... Suture bile duct injury ............................... 16.74 20.50 19.90 .................. agree 19.90

48000 ....... ......... Drainage of abdomen ............................... 14.91 40.79 28.07 .................. agree 28.07

48001 ....... ......... Placement of drain, pancreas ................... 18.83 55.20 35.45 .................. agree 35.45

48005 ....... ......... Resect/debride pancreas .......................... 22.40 57.70 42.17 .................. agree 42.17

48020 ....... ......... Removal of pancreatic stone .................... 14.22 23.50 15.70 .................. agree 15.70

48100 ....... ......... Biopsy of pancreas ................................... 11.08 14.57 12.23 .................. agree 12.23

48120 ....... ......... Removal of pancreas lesion ..................... 14.36 26.05 15.85 .................. agree 15.85

48140 ....... ......... Partial removal of pancreas ...................... 20.78 28.60 22.94 .................. agree 22.94

48145 ....... ......... Partial removal of pancreas ...................... 21.76 34.32 24.02 .................. agree 24.02

48146 ....... ......... Pancreatectomy ........................................ 23.91 45.57 26.40 .................. agree 26.40

48148 ....... ......... Removal of pancreatic duct ...................... 15.71 25.00 17.34 .................. agree 17.34

48150 ....... ......... Partial removal of pancreas ...................... 43.48 54.73 48.00 .................. agree 48.00

48150 ....... ......... Partial removal of pancreas ...................... 43.48 54.75 48.00 .................. agree 48.00

48152 ....... ......... Pancreatectomy ........................................ 39.63 39.63 43.75 .................. agree 43.75

48153 ....... ......... Pancreatectomy ........................................ 43.38 54.73 47.89 .................. agree 47.89

48154 ....... ......... Pancreatectomy ........................................ 39.95 51.80 44.10 .................. agree 44.10

48155 ....... ......... Removal of pancreas ................................ 22.32 44.70 24.64 .................. agree 24.64

48180 ....... ......... Fuse pancreas and bowel ........................ 22.39 32.52 24.72 .................. agree 24.72

48500 ....... ......... Surgery of pancreas cyst .......................... 13.84 18.99 15.28 .................. agree 15.28

48510 ....... ......... Drain pancreatic pseudocyst .................... 12.96 16.08 14.31 .................. agree 14.31

48520 ....... ......... Fuse pancreas cyst and bowel ................. 14.12 19.68 15.59 .................. agree 15.59

48540 ....... ......... Fuse pancreas cyst and bowel ................. 17.86 21.28 19.72 .................. agree 19.72

48545 ....... ......... Pancreatorrhaphy ..................................... 16.47 33.39 18.18 .................. agree 18.18

31042

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

48547 ....... ......... Duodenal exclusion .................................. 23.40 41.76 25.83 .................. agree 25.83

49000 ....... ......... Exploration of abdomen ............................ 11.68 13.42 11.68 .................. agree 11.68

49002 ....... ......... Reopening of abdomen ............................ 10.49 12.67 10.49 .................. agree 10.49

49010 ....... ......... Exploration behind abdomen .................... 12.28 15.06 12.28 .................. agree 12.28

49020 ....... ......... Drain abdominal abscess ......................... 16.79 28.33 20.73 .................. increase 22.84

49040 ....... ......... Drain, open, abdom abscess .................... 9.94 23.60 12.27 .................. increase 13.52

49060 ....... ......... Drain, open, retrop abscess ..................... 11.66 19.52 14.40 .................. increase 15.86

49085 ....... ......... Remove abdomen foreign body ............... 8.93 14.23 11.03 .................. increase 12.14

49200 ....... ......... Removal of abdominal lesion ................... 10.25 12.19 10.25 .................. agree 10.25

49201 ....... ......... Removal of abdominal lesion ................... 14.84 16.27 14.84 .................. agree 14.84

49215 ....... ......... Excise sacral spine tumor ........................ 22.36 24.96 33.50 .................. agree 33.50

49215 ....... ......... Excise sacral spine tumor ........................ 22.36 30.00 33.50 .................. agree 33.50

49220 ....... ......... Multiple surgery, abdomen ....................... 14.88 17.39 14.88 .................. agree 14.88

49255 ....... ......... Removal of omentum ............................... 11.14 13.42 11.14 .................. agree 11.14

49320 ....... ......... Diag laparo separate proc ........................ 5.10 5.95 5.10 .................. agree 5.10

49321 ....... ......... Laparoscopy; biopsy ................................. 5.40 N/A 5.40 .................. agree 5.40

49322 ....... ......... Laparoscopy; aspiration ............................ 5.70 N/A 5.70 .................. agree 5.70

49421 ....... ......... Insert abdominal drain .............................. 5.54 6.99 5.54 .................. agree 5.54

49422 ....... ......... Remove perm cannula/catheter ............... 6.25 6.35 6.25 .................. agree 6.25

49425 ....... ......... Insert abdomen-venous drain ................... 11.37 13.82 11.37 .................. agree 11.37

49426 ....... ......... Revise abdomen-venous shunt ................ 9.63 11.10 9.63 .................. agree 9.63

49428 ....... ......... Ligation of shunt ....................................... 2.38 5.38 6.06 .................. agree 6.06

49429 ....... ......... Removal of shunt ...................................... 7.40 9.57 7.40 .................. agree 7.40

49495 ....... ......... Repair inguinal hernia, init ........................ 5.89 6.96 CPT .................. CPT 5.89

49495 ....... ......... Repair inguinal hernia, init ........................ 5.89 12.50 CPT .................. CPT 5.89

49496 ....... ......... Repair inguinal hernia, init ........................ 8.79 10.56 CPT .................. CPT 8.79

49496 ....... ......... Repair inguinal hernia, init ........................ 8.79 14.00 CPT .................. CPT 8.79

49500 ....... ......... Repair inguinal hernia ............................... 4.68 7.61 5.48 .................. agree 5.48

49501 ....... ......... Repair inguinal hernia, init ........................ 7.58 9.26 8.88 .................. agree 8.88

49505 ....... ......... Repair inguinal hernia ............................... 6.49 8.31 7.60 .................. agree 7.60

49505 ....... ......... Repair inguinal hernia ............................... 6.49 11.50 7.60 .................. agree 7.60

49507 ....... ......... Repair inguinal hernia ............................... 8.17 11.38 9.57 .................. agree 9.57

49520 ....... ......... Rerepair inguinal hernia ........................... 8.22 11.02 9.63 .................. agree 9.63

49521 ....... ......... Repair inguinal hernia, rec ....................... 10.22 13.97 11.97 .................. agree 11.97

49525 ....... ......... Repair inguinal hernia ............................... 7.32 8.36 8.57 .................. agree 8.57

49540 ....... ......... Repair lumbar hernia ................................ 8.87 8.52 10.39 .................. agree 10.39

49550 ....... ......... Repair femoral hernia ............................... 7.37 8.36 8.63 .................. agree 8.63

49553 ....... ......... Repair femoral hernia, init ........................ 8.06 10.31 9.44 .................. agree 9.44

49555 ....... ......... Repair femoral hernia ............................... 7.71 8.50 9.03 .................. agree 9.03

49557 ....... ......... Repair femoral hernia, recur ..................... 9.52 11.82 11.15 .................. agree 11.15

49560 ....... ......... Repair abdominal hernia .......................... 9.88 11.69 11.57 .................. agree 11.57

49561 ....... ......... Repair incisional hernia ............................ 12.17 15.67 14.25 .................. agree 14.25

49565 ....... ......... Rerepair abdominal hernia ....................... 9.88 14.03 11.57 .................. agree 11.57

49566 ....... ......... Repair incisional hernia ............................ 12.30 16.43 14.40 .................. agree 14.40

49570 ....... ......... Repair epigastric hernia ............................ 4.86 7.00 5.69 .................. agree 5.69

49572 ....... ......... Repair epigastric hernia ............................ 5.75 9.77 6.73 .................. agree 6.73

49580 ....... ......... Repair umbilical hernia ............................. 3.51 5.71 4.11 .................. agree 4.11

49582 ....... ......... Repair umbilical hernia ............................. 5.68 9.99 6.65 .................. agree 6.65

49585 ....... ......... Repair umbilical hernia ............................. 5.32 5.71 6.23 .................. agree 6.23

49587 ....... ......... Repair umbilical hernia ............................. 6.46 9.34 7.56 .................. agree 7.56

49590 ....... ......... Repair abdominal hernia .......................... 7.29 9.54 8.54 .................. agree 8.54

49605 ....... ......... Repair umbilical lesion .............................. 22.66 97.62 76.00 .................. decrease 22.66

49606 ....... ......... Repair umbilical lesion .............................. 18.60 21.31 18.60 .................. agree 18.60

49650 ....... ......... Laparo hernia repair initial ........................ 6.27 7.66 6.27 .................. agree 6.27

49651 ....... ......... Laparo hernia repair recur ........................ 8.24 7.88 8.24 .................. agree 8.24

49900 ....... ......... Repair of abdominal wall .......................... 12.28 16.92 12.28 .................. agree 12.28

49905 ....... ......... Omental flap ............................................. 6.55 17.79 CPT .................. CPT 6.55

50200 ....... ......... Biopsy of kidney ....................................... 2.63 N/A CPT .................. CPT 2.63

50230 ....... ......... Removal of kidney .................................... 22.07 N/A CPT .................. CPT 22.07

51595 ....... ......... Remove bladder/revise tract ..................... 37.14 N/A 37.14 .................. agree 37.14

51596 ....... ......... Remove bladder/create pouch ................. 39.52 N/A 39.52 .................. agree 39.52

52300 ....... ......... Cystoscopy and treatment ........................ 5.31 WD (e) .................. (a) 5.31

52327 ....... ......... Cystoscopy, inject material ....................... 5.19 WD (e) .................. (a) 5.19

52340 ....... ......... Cystoscopy and treatment ........................ 9.68 WD (e) .................. (a) 9.68

56515 ....... ......... Destruction, vulva lesion(s) ...................... 1.88 3.09 2.76 .................. agree 2.76

56740 ....... ......... Remove vagina gland lesion .................... 3.76 5.74 4.57 .................. agree 4.57

31043

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

57100 ....... ......... Biopsy of vagina ....................................... 0.97 1.90 1.20 .................. agree 1.20

57130 ....... ......... Remove vagina lesion .............................. 2.43 5.67 2.43 .................. agree 2.43

57292 ....... ......... Construct vagina with graft ....................... 13.09 N/A 13.09 .................. agree 13.09

57307 ....... ......... Fistula repair & colostomy ........................ 15.93 20.24 15.93 .................. agree 15.93

57410 ....... ......... Pelvic examination .................................... 1.75 4.08 1.75 .................. agree 1.75

57505 ....... ......... Endocervical curettage ............................. 1.14 0.97 1.14 .................. agree 1.14

57555 ....... ......... Remove cervix/repair vagina .................... 8.95 WD (e) .................. (a) 8.95

58150 ....... ......... Total hysterectomy ................................... 15.24 17.75 15.24 .................. agree 15.24

58152 ....... ......... Total hysterectomy ................................... 15.09 20.60 20.60 .................. agree 20.60

58260 ....... ......... Vaginal hysterectomy ............................... 12.20 12.98 12.98 .................. agree 12.98

58262 ....... ......... Vaginal hysterectomy ............................... 13.99 17.88 14.77 .................. agree 14.77

58263 ....... ......... Vaginal hysterectomy ............................... 15.28 21.26 16.06 .................. agree 16.06

58267 ....... ......... Hysterectomy & vagina repair .................. 15.00 17.55 17.04 .................. agree 17.04

58270 ....... ......... Hysterectomy & vagina repair .................. 13.48 15.58 14.26 .................. agree 14.26

58275 ....... ......... Hysterectomy/revise vagina ...................... 14.98 N/A 15.76 .................. agree 15.76

58280 ....... ......... Hysterectomy/revise vagina ...................... 15.41 N/A 17.01 .................. agree 17.01

58285 ....... ......... Extensive hysterectomy ............................ 18.57 N/A 22.26 .................. agree 22.26

58323 ....... ......... Sperm washing ......................................... 0.23 0.55 0.23 .................. agree 0.23

58400 ....... ......... Suspension of uterus ................................ 6.36 11.68 6.36 .................. agree 6.36

58600 ....... ......... Division of fallopian tube .......................... 3.84 4.60 5.60 .................. agree 5.60

58605 ....... ......... Division of fallopian tube .......................... 3.34 4.60 5.00 .................. agree 5.00

58611 ....... ......... Ligate oviduct(s) add-on ........................... 0.63 N/A 1.45 .................. agree 1.45

58700 ....... ......... Removal of fallopian tube ......................... 6.49 11.68 12.05 .................. agree 12.05

58740 ....... ......... Revise fallopian tube(s) ............................ 5.83 11.29 14.00 .................. agree 14.00

58805 ....... ......... Drainage of ovarian cyst(s) ...................... 5.88 11.68 5.88 .................. agree 5.88

58820 ....... ......... Drain ovary abscess, open ....................... 4.22 6.03 4.22 .................. agree 4.22

58825 ....... ......... Transposition, ovary(s) ............................. 6.13 11.68 10.98 .................. agree 10.98

58920 ....... ......... Partial removal of ovary(s) ....................... 6.78 11.68 11.36 .................. agree 11.36

58950 ....... ......... Resect ovarian malignancy ...................... 15.27 16.93 16.93 .................. agree 16.93

58951 ....... ......... Resect ovarian malignancy ...................... 21.81 28.99 22.38 .................. agree 22.38

59150 ....... ......... Treat ectopic pregnancy ........................... 6.89 11.67 11.67 .................. agree 11.67

59151 ....... ......... Treat ectopic pregnancy ........................... 7.86 11.49 11.49 .................. agree 11.49

59812 ....... ......... Treatment of miscarriage .......................... 3.25 4.01 4.01 .................. agree 4.01

59870 ....... ......... Evacuate mole of uterus ........................... 4.28 5.00 6.01 .................. agree 6.01

60100 ....... ......... Biopsy of thyroid ....................................... 0.97 1.88 1.56 .................. agree 1.56

60220 ....... ......... Partial removal of thyroid .......................... 10.53 11.82 11.90 .................. agree 11.90

60220 ....... ......... Partial removal of thyroid .......................... 10.53 14.24 11.90 .................. agree 11.90

60252 ....... ......... Removal of thyroid .................................... 18.20 22.32 20.57 .................. agree 20.57

60254 ....... ......... Extensive thyroid surgery ......................... 23.88 27.43 26.99 .................. agree 26.99

60260 ....... ......... Repeat thyroid surgery ............................. 15.46 18.83 17.47 .................. agree 17.47

60270 ....... ......... Removal of thyroid .................................... 17.94 23.05 20.27 .................. agree 20.27

60271 ....... ......... Removal of thyroid .................................... 14.89 18.68 16.83 .................. agree 16.83

60280 ....... ......... Remove thyroid duct lesion ...................... 6.08 WD (e) .................. (a) 6.08

60540 ....... ......... Explore adrenal gland ............................... 17.03 20.53 17.03 .................. agree 17.03

60545 ....... ......... Explore adrenal gland ............................... 19.88 25.66 19.88 .................. agree 19.88

62263 ....... ......... Lysis epidural adhesions .......................... 6.14 7.20 7.20 .................. (b) 6.14

62310 ....... ......... Inject spine c/t ........................................... 1.91 1.95 2.20 .................. (b) 1.91

62311 ....... ......... Inject spine l/s (cd) ................................... 1.54 1.57 1.78 .................. (b) 1.54

62318 ....... ......... Inject spine w/cath, c/t .............................. 2.04 2.26 2.35 .................. (b) 2.04

62319 ....... ......... Inject spine w/cath l/s (cd) ........................ 1.87 1.88 2.15 .................. (b) 1.87

65855 ....... ......... Laser surgery of eye ................................. 4.30 N/A 3.85 .................. agree 3.85

66170 ....... ......... Glaucoma surgery .................................... 12.16 WD (e) .................. (a) 12.16

66172 ....... ......... Incision of eye ........................................... 15.04 WD (e) .................. (a) 15.04

66180 ....... ......... Implant eye shunt ..................................... 14.55 N/A 14.55 .................. agree 14.55

66986 ....... ......... Exchange lens prosthesis ......................... 12.28 N/A 12.28 .................. agree 12.28

67028 ....... ......... Injection eye drug ..................................... 2.52 N/A 2.52 .................. agree 2.52

67108 ....... ......... Repair detached retina ............................. 20.82 WD (e) .................. (a) 20.82

67218 ....... ......... Treatment of retinal lesion ........................ 13.52 N/A 18.53 .................. agree 18.53

67904 ....... ......... Repair eyelid defect .................................. 6.26 N/A 6.26 .................. agree 6.26

69000 ....... ......... Drain external ear lesion .......................... 1.45 WD (e) .................. (a) 1.45

69005 ....... ......... Drain external ear lesion .......................... 2.11 WD (e) .................. (a) 2.11

69020 ....... ......... Drain outer ear canal lesion ..................... 1.48 WD (e) .................. (a) 1.48

69100 ....... ......... Biopsy of external ear ............................... 0.81 WD (e) .................. (a) 0.81

69105 ....... ......... Biopsy of external ear canal ..................... 0.85 WD (e) .................. (a) 0.85

69110 ....... ......... Remove external ear, partial .................... 3.44 WD (e) .................. (a) 3.44

69120 ....... ......... Removal of external ear ........................... 4.05 WD (e) .................. (a) 4.05

31044

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

69140 ....... ......... Remove ear canal lesion(s) ...................... 7.97 WD (e) .................. (a) 7.97

69145 ....... ......... Remove ear canal lesion(s) ...................... 2.62 WD (e) .................. (a) 2.62

69150 ....... ......... Extensive ear canal surgery ..................... 13.43 WD (e) .................. (a) 13.43

69155 ....... ......... Extensive ear/neck surgery ...................... 20.80 WD (e) .................. (a) 20.80

69200 ....... ......... Clear outer ear canal ................................ 0.77 WD (e) .................. (a) 0.77

69205 ....... ......... Clear outer ear canal ................................ 1.20 WD (e) .................. (a) 1.20

69210 ....... ......... Remove impacted ear wax ....................... 0.61 WD (e) .................. (a) 0.61

69220 ....... ......... Clean out mastoid cavity .......................... 0.83 WD (e) .................. (a) 0.83

69222 ....... ......... Clean out mastoid cavity .......................... 1.40 WD (e) .................. (a) 1.40

69300 ....... ......... Revise external ear ................................... 6.36 WD (e) .................. (a) 6.36

69310 ....... ......... Rebuild outer ear canal ............................ 10.79 WD (e) .................. (a) 10.79

69320 ....... ......... Rebuild outer ear canal ............................ 16.96 WD (e) .................. (a) 16.96

69400 ....... ......... Inflate middle ear canal ............................ 0.83 WD (e) .................. (a) 0.83

69401 ....... ......... Inflate middle ear canal ............................ 0.63 WD (e) .................. (a) 0.63

69405 ....... ......... Catheterize middle ear canal .................... 2.63 WD (e) .................. (a) 2.63

69410 ....... ......... Inset middle ear (baffle) ............................ 0.33 WD (e) .................. (a) 0.33

69420 ....... ......... Incision of eardrum ................................... 1.33 WD (e) .................. (a) 1.33

69421 ....... ......... Incision of eardrum ................................... 1.73 WD (e) .................. (a) 1.73

69424 ....... ......... Remove ventilating tube ........................... 0.85 WD (e) .................. (a) 0.85

69433 ....... ......... Create eardrum opening ........................... 1.52 WD (e) .................. (a) 1.52

69436 ....... ......... Create eardrum opening ........................... 1.96 WD (e) .................. (a) 1.96

69440 ....... ......... Exploration of middle ear .......................... 7.57 WD (e) .................. (a) 7.57

69450 ....... ......... Eardrum revision ....................................... 5.57 WD (e) .................. (a) 5.57

69501 ....... ......... Mastoidectomy .......................................... 9.07 WD (e) .................. (a) 9.07

69502 ....... ......... Mastoidectomy .......................................... 12.38 WD (e) .................. (a) 12.38

69505 ....... ......... Remove mastoid structures ...................... 12.99 WD (e) .................. (a) 12.99

69511 ....... ......... Extensive mastoid surgery ....................... 13.52 WD (e) .................. (a) 13.52

69530 ....... ......... Extensive mastoid surgery ....................... 19.19 WD (e) .................. (a) 19.19

69535 ....... ......... Remove part of temporal bone ................. 36.14 WD (e) .................. (a) 36.14

69540 ....... ......... Remove ear lesion .................................... 1.20 WD (e) .................. (a) 1.20

69550 ....... ......... Remove ear lesion .................................... 10.99 WD (e) .................. (a) 10.99

69552 ....... ......... Remove ear lesion .................................... 19.46 WD (e) .................. (a) 19.46

69554 ....... ......... Remove ear lesion .................................... 33.16 WD (e) .................. (a) 33.16

69601 ....... ......... Mastoid surgery revision ........................... 13.24 WD (e) .................. (a) 13.24

69602 ....... ......... Mastoid surgery revision ........................... 13.58 WD (e) .................. (a) 13.58

69603 ....... ......... Mastoid surgery revision ........................... 14.02 WD (e) .................. (a) 14.02

69604 ....... ......... Mastoid surgery revision ........................... 14.02 WD (e) .................. (a) 14.02

69605 ....... ......... Remove mastoid structures ...................... 18.49 WD (e) .................. (a) 18.49

69610 ....... ......... Repair of eardrum ..................................... 4.43 WD (e) .................. (a) 4.43

69620 ....... ......... Repair of eardrum ..................................... 5.89 WD (e) .................. (a) 5.89

69631 ....... ......... Rebuild eardrum structures ...................... 9.86 WD (e) .................. (a) 9.86

69632 ....... ......... Rebuild eardrum structures ...................... 12.75 WD (e) .................. (a) 12.75

69633 ....... ......... Rebuild eardrum structures ...................... 12.10 WD (e) .................. (a) 12.10

69635 ....... ......... Repair eardrum structures ........................ 13.33 WD (e) .................. (a) 13.33

69636 ....... ......... Rebuild eardrum structures ...................... 15.22 WD (e) .................. (a) 15.22

69637 ....... ......... Rebuild eardrum structures ...................... 15.11 WD (e) .................. (a) 15.11

69641 ....... ......... Revise middle ear & mastoid ................... 12.71 WD (e) .................. (a) 12.71

69642 ....... ......... Revise middle ear & mastoid ................... 16.84 WD (e) .................. (a) 16.84

69643 ....... ......... Revise middle ear & mastoid ................... 15.32 WD (e) .................. (a) 15.32

69644 ....... ......... Revise middle ear & mastoid ................... 16.97 WD (e) .................. (a) 16.97

69645 ....... ......... Revise middle ear & mastoid ................... 16.38 WD (e) .................. (a) 16.38

69646 ....... ......... Revise middle ear & mastoid ................... 17.99 WD (e) .................. (a) 17.99

69650 ....... ......... Release middle ear bone ......................... 9.66 WD (e) .................. (a) 9.66

69660 ....... ......... Revise middle ear bone ............................ 11.90 WD (e) .................. (a) 11.90

69661 ....... ......... Revise middle ear bone ............................ 15.74 WD (e) .................. (a) 15.74

69662 ....... ......... Revise middle ear bone ............................ 15.44 WD (e) .................. (a) 15.44

69666 ....... ......... Repair middle ear structures .................... 9.75 WD (e) .................. (a) 9.75

69667 ....... ......... Repair middle ear structures .................... 9.76 WD (e) .................. (a) 9.76

69670 ....... ......... Remove mastoid air cells ......................... 11.51 WD (e) .................. (a) 11.51

69676 ....... ......... Remove middle ear nerve ........................ 9.52 WD (e) .................. (a) 9.52

69700 ....... ......... Close mastoid fistula ................................ 8.23 WD (e) .................. (a) 8.23

69711 ....... ......... Remove/repair hearing aid ....................... 10.44 WD (e) .................. (a) 10.44

69720 ....... ......... Release facial nerve ................................. 14.38 WD (e) .................. (a) 14.38

69725 ....... ......... Release facial nerve ................................. 25.38 WD (e) .................. (a) 25.38

69740 ....... ......... Repair facial nerve .................................... 15.96 WD (e) .................. (a) 15.96

69745 ....... ......... Repair facial nerve .................................... 16.69 WD (e) .................. (a) 16.69

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31045

TABLE 1.—FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor 2000

work RVU

Requested

work RVU

RUC

REC

HCPAC

REC

HCFA

decision

Proposed

work RVU

69801 ....... ......... Incise inner ear ......................................... 8.56 WD (e) .................. (a) 8.56

69802 ....... ......... Incise inner ear ......................................... 13.10 WD (e) .................. (a) 13.10

69805 ....... ......... Explore inner ear ...................................... 13.82 WD (e) .................. (a) 13.82

69806 ....... ......... Explore inner ear ...................................... 12.35 WD (e) .................. (a) 12.35

69820 ....... ......... Establish inner ear window ....................... 10.34 WD (e) .................. (a) 10.34

69840 ....... ......... Revise inner ear window .......................... 10.26 WD (e) .................. (a) 10.26

69905 ....... ......... Remove inner ear ..................................... 11.10 WD (e) .................. (a) 11.10

69910 ....... ......... Remove inner ear & mastoid .................... 13.63 WD (e) .................. (a) 13.63

69915 ....... ......... Incise inner ear nerve ............................... 21.23 WD (e) .................. (a) 21.23

69930 ....... ......... Implant cochlear device ............................ 16.81 WD (e) .................. (a) 16.81

69950 ....... ......... Incise inner ear nerve ............................... 25.64 WD (e) .................. (a) 25.64

69955 ....... ......... Release facial nerve ................................. 27.04 WD (e) .................. (a) 27.04

69960 ....... ......... Release inner ear canal ........................... 27.04 WD (e) .................. (a) 27.04

69970 ....... ......... Remove inner ear lesion .......................... 30.04 WD (e) .................. (a) 30.04

69990 ....... ......... Microsurgery add-on ................................. 3.47 N/A 3.47 .................. agree 3.47

72275 ....... ......... Epidurography ........................................... 0.76 0.83 0.83 .................. (b) 0.76

76005 ....... ......... Fluoroguide for spine inject ...................... 0.60 0.60 10.60 .................. agree 0.60

76065 ....... ......... X-rays, bone evaluation ............................ 0.28 0.60 0.70 .................. agree 0.70

76090 ....... ......... Mammogram, one breast ......................... 0.58 0.64 0.70 .................. agree 0.70

76091 ....... ......... Mammogram, both breasts ....................... 0.69 0.76 0.87 .................. agree 0.87

76095 ....... ......... Stereotactic breast biopsy ........................ 1.59 3.58 1.59 .................. agree 1.59

88170 ....... ......... Fine needle aspiration .............................. 1.27 3.28 1.27 .................. agree 1.27

88171 ....... ......... Fine needle aspiration .............................. 1.27 2.63 1.27 .................. agree 1.27

90901 ....... ......... Biofeedback train, any meth ..................... 0.41 N/A .................. 0.41 agree 0.41

90911 ....... ......... Biofeedback peri/uro/rectal ....................... 0.89 N/A 0.89 .................. agree 0.89

90935 ....... ......... Hemodialysis, one evaluation ................... 1.22 N/A CPT .................. CPT 1.22

90937 ....... ......... Hemodialysis, repeated eval .................... 2.11 N/A CPT .................. CPT 2.11

90945 ....... ......... Dialysis, one evaluation ............................ 1.28 N/A CPT .................. CPT 1.28

90947 ....... ......... Dialysis, repeated eval ............................. 2.16 N/A CPT .................. CPT 2.16

90989 ....... ......... Dialysis training, complete ........................ 0.00 N/A CPT .................. CPT 0.00

90993 ....... ......... Dialysis training, incompl .......................... 0.00 N/A CPT .................. CPT 0.00

90997 ....... ......... Hemoperfusion .......................................... 1.84 N/A CPT .................. CPT 1.84

92018 ....... ......... New eye exam & treatment ...................... 1.51 N/A 2.50 .................. agree 2.50

93350 ....... ......... Echo transthoracic .................................... 0.78 N/A 1.48 .................. agree 1.48

94640 ....... ......... Airway inhalation treatment ...................... 0.00 N/A 0.00 .................. agree 0.00

94664 ....... ......... Aerosol or vapor inhalations ..................... 0.00 N/A CPT .................. CPT 0.00

94665 ....... ......... Aerosol or vapor inhalations ..................... 0.00 N/A CPT .................. CPT 0.00

96100 ....... ......... Psychological testing ................................ 0.00 2.00 .................. (a) agree 0.00

96105 ....... ......... Assessment of aphasia ............................ 0.00 2.00 .................. (a) agree 0.00

96110 ....... ......... Developmental test, lim ............................ 0.00 2.00 .................. (a) agree 0.00

96115 ....... ......... Neurobehavior status exam ...................... 0.00 2.20 .................. (a) agree 0.00

96117 ....... ......... Neuropsych test battery ............................ 0.00 2.20 .................. (a) agree 0.00

97542 ....... ......... Wheelchair mngmnt training ..................... 0.25 0.45 .................. 0.45 agree 0.45

99233 ....... ......... Subsequent hospital care ......................... 1.51 N/A 1.51 .................. agree 1.51

99273 ....... ......... Confirmatory consultation ......................... 1.19 N/A 1.19 .................. agree 1.19

99274 ....... ......... Confirmatory consultation ......................... 1.73 N/A 1.73 .................. agree 1.73

99291 ....... ......... Critical care, first hour .............................. 3.60 4.00 4.00 .................. agree 4.00

99291 ....... ......... Critical care, first hour .............................. 3.60 5.50 4.00 .................. agree 4.00

99291 ....... ......... Critical care, first hour .............................. 3.60 N/A 4.00 .................. agree 4.00

99292 ....... ......... Critical care, addl 30 min .......................... 1.80 2.00 2.00 .................. agree 2.00

99292 ....... ......... Critical care, addl 30 min .......................... 1.80 2.77 2.00 .................. agree 2.00

99292 ....... ......... Critical care, addl 30 min .......................... 1.80 N/A 2.00 .................. agree 2.00

99295 ....... ......... Neonatal critical care ................................ 16.00 N/A 16.00 .................. agree 16.00

99296 ....... ......... Neonatal critical care ................................ 8.00 N/A 8.00 .................. agree 8.00

99297 ....... ......... Neonatal critical care ................................ 4.00 N/A 4.00 .................. agree 4.00

99298 ....... ......... Neonatal critical care ................................ 2.75 N/A 2.75 .................. agree 2.75

99436 ....... ......... Attendance, birth ....................................... 1.50 N/A 1.50 .................. agree 1.50

99440 ....... ......... Newborn resuscitation .............................. 2.93 N/A 2.93 .................. agree 2.93

G0127 ...... ......... Trim nail(s) ................................................ 0.11 N/A .................. (a) (a) 0.11

31046 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

B. Discussion of Comments by Clinical

Area

1. Vascular Surgery

Comment: The Society for Vascular

Surgery (SVS) and the North American

Chapter of the International Society for

Cardiovascular Surgery requested

increases in work RVUs for 95 codes.

Both groups commented that vascular

surgery procedures were undervalued in

the original Harvard Study and that only

a small number of these RVUs have

been adjusted since that time.

The SVS’s recommendations were

based on surveys, a full RUC survey of

39 higher volume codes and

minisurveys for 56 less frequently

performed codes. (The full and

minisurveys included estimates for each

code of pre-, intra-, and postservice

times and visits as well as estimates of

physician work. The effect of these

recommendations would be to correct

current rank-order anomalies, while

avoiding creation of new rank-order

anomalies.) The SVS used a buildingblock approach to validate the survey

results for each of their codes.

RUC Recommendation

Of the 95 codes, the RUC

recommended increases for 91 codes, a

decrease for 1 code and no changes for

3 codes. In 60 percent of cases, the RUC

recommendations to increase the work

RVUs were based on physician surveys.

The recommendations were based on

either the 25th percentile or the median

of survey responses. In almost all other

cases, the RUC recommendation for a

specific code work RVU was based on

the work value of another comparable

code. The building-block approach was

used only to corroborate findings from

the surveys or validate a comparison to

another procedure. The following are

the RUC recommendations for the codes

submitted. (Please note that throughout

this document the value in parentheses

represents the RUC-recommended work

RVUs unless they are shown in

columns.)

CPT codes Work RVUs

Family 1 Aneurysm Repairs in Abdomen

35111 .............................................................................................................................................................................. 25.00

35131 .............................................................................................................................................................................. 25.00

35112 .............................................................................................................................................................................. 30.00

35132 .............................................................................................................................................................................. 30.00

35121 .............................................................................................................................................................................. 30.00

35122 .............................................................................................................................................................................. 35.00

35082 .............................................................................................................................................................................. 38.50

35103 .............................................................................................................................................................................. 40.50

35092 .............................................................................................................................................................................. 45.00

Family 2 Bypass Grafts in the Abdomen

35665 .............................................................................................................................................................................. 21.00

35663 .............................................................................................................................................................................. 22.00

35565 .............................................................................................................................................................................. 23.20

35563 .............................................................................................................................................................................. 24.20

35636 .............................................................................................................................................................................. 29.50

35536 .............................................................................................................................................................................. 31.70

35560 .............................................................................................................................................................................. 32.00

35631 .............................................................................................................................................................................. 34.00

35531 .............................................................................................................................................................................. 36.20

Family 3 Embolectomy/Thrombectomy in the Abdomen

34401 .............................................................................................................................................................................. 25.00

34151 .............................................................................................................................................................................. 25.00

34451 .............................................................................................................................................................................. 27.00

Family 4 Endarterectomy in the Abdomen

35351 .............................................................................................................................................................................. 23.00

35331 .............................................................................................................................................................................. 26.20

35361 .............................................................................................................................................................................. 28.20

35363 .............................................................................................................................................................................. 30.20

Family 5 Repair Blood Vessels in the Abdomen

37660 .............................................................................................................................................................................. 21.00

37617 .............................................................................................................................................................................. 22.06

35221 .............................................................................................................................................................................. 24.39

35281 .............................................................................................................................................................................. 28.00

35251 .............................................................................................................................................................................. 30.20

Family 6 Explorations, Revisions, Other in Chest & Abdomen

35189 .............................................................................................................................................................................. 28.00

35182 .............................................................................................................................................................................. 30.00

35905 .............................................................................................................................................................................. 31.25

35907 .............................................................................................................................................................................. 35.00

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31047

CPT codes Work RVUs

Family 7 Extra-anatomic Bypass Grafts

35661 .............................................................................................................................................................................. 19.00

35650 .............................................................................................................................................................................. 19.00

35621 .............................................................................................................................................................................. 20.00

35558 .............................................................................................................................................................................. 21.20

35511 .............................................................................................................................................................................. 21.20

35518 .............................................................................................................................................................................. 21.20

35623 .............................................................................................................................................................................. 24.00

35521 .............................................................................................................................................................................. 22.20

35654 .............................................................................................................................................................................. 25.00

35533 .............................................................................................................................................................................. 28.00

Family 8 Arterial Bypass Grafts in Extremities

35666 .............................................................................................................................................................................. 22.19

35671 .............................................................................................................................................................................. 19.23

35571 .............................................................................................................................................................................. 24.06

35587 .............................................................................................................................................................................. 24.75

Family 9 Embolectomy/Thrombectomy by Extremity Incision

34490 .............................................................................................................................................................................. 9.86

34111 .............................................................................................................................................................................. 10.00

34201 .............................................................................................................................................................................. 10.03

34101 .............................................................................................................................................................................. 10.00

34421 .............................................................................................................................................................................. 12.00

34203 .............................................................................................................................................................................. 16.50

Family 10 Aneurysm Repairs in the Extremity

35045 .............................................................................................................................................................................. 17.57

35011 .............................................................................................................................................................................. 18.00

35141 .............................................................................................................................................................................. 20.00

35013 .............................................................................................................................................................................. 22.00

35151 .............................................................................................................................................................................. 22.64

35142 .............................................................................................................................................................................. 23.30

35152 .............................................................................................................................................................................. 25.62

Family 11 Endarterectomy of Extremity Arteries

35371 .............................................................................................................................................................................. 14.72

35321 .............................................................................................................................................................................. 16.00

35372 .............................................................................................................................................................................. 18.00

35355 .............................................................................................................................................................................. 18.50

Family 12 Arteriovenous Fistula Repairs in the Extremities

35190 .............................................................................................................................................................................. No change in work RVUs

35184 .............................................................................................................................................................................. 18.00

Family 13 Peripheral Artery and Vein Ligations

35721 .............................................................................................................................................................................. 7.18

37650 .............................................................................................................................................................................. 7.80

35741 .............................................................................................................................................................................. 8.00

37618 .............................................................................................................................................................................. No change in work RVUs

37565 .............................................................................................................................................................................. 10.88

37600 .............................................................................................................................................................................. 11.25

35701 .............................................................................................................................................................................. 8.50

37605 .............................................................................................................................................................................. 13.11

37615 .............................................................................................................................................................................. No change in work RVUs

Family 14 Vessel/Repairs in Extremities and Neck

35201 .............................................................................................................................................................................. 16.14

35206 .............................................................................................................................................................................. 13.25

35226 .............................................................................................................................................................................. 14.50

35266 .............................................................................................................................................................................. 14.91

35261 .............................................................................................................................................................................. 17.80

35286 .............................................................................................................................................................................. 16.16

35236 .............................................................................................................................................................................. 17.11

35231 .............................................................................................................................................................................. 20.00

35256 .............................................................................................................................................................................. 18.36

31048 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

CPT codes Work RVUs

Family 15 Reconstruction for Chronic Venous Disease

34501 .............................................................................................................................................................................. 16.00

34520 .............................................................................................................................................................................. 17.95

34510 .............................................................................................................................................................................. 18.95

34530 .............................................................................................................................................................................. 16.64 (decrease)

Family 16 Repairs, Bypass Grafts, Endarterectomies in the Chest

35276 .............................................................................................................................................................................. 24.25

35246 .............................................................................................................................................................................. 26.45

35626 .............................................................................................................................................................................. 27.75

35526 .............................................................................................................................................................................. 29.95

35311 .............................................................................................................................................................................. 27.00

Family 17 Ligation or Biopsy of Temporal Artery

37609 .............................................................................................................................................................................. 3.00

Family 18 Untitled

35081 .............................................................................................................................................................................. 28.01

35556 .............................................................................................................................................................................. 21.76

The RUC recommended the following

codes be submitted to the CPT Editorial

Panel for further consideration: 35381,

35541, 35546, 35551, 35582, 35641,

35646, 35840, 35860, 37615, 37618,

37700, 37730, 37735, 37760, 37785.

HCFA Proposal: 

We have reviewed and propose to

accept all of the RUC recommendations

for the vascular surgery codes. We

believe that relativity is maintained, and

the RVUs more appropriately reflect the

work involved.

2. General Surgery/Colon and Rectal

Surgery

Comment: The American Society of

General Surgeons (ASGS) submitted 55

codes it believed to be undervalued. The

ASGS recommended work RVUs for

each service. After submitting the codes,

the specialty society ultimately chose

not to pursue review of RVUs for the

following codes under the 5-year

review: 20605, 34001, and 29881.

The following codes 49505, 32440,

46320, 46924, 31622, 44140 (no change),

38500, 32480, 37609, 43239, 43638,

60220, 44050, 48150, and 38100 were

also submitted for review by other

specialty groups and are discussed in

other sections. (Note that codes 56305,

56341, 56300, 56340, and 56306 are

laparoscopic surgery codes also

submitted for review by the specialty

group; however, these services were

deleted or renumbered by CPT for

2000.)

RUC Recommendation: 

The RUC recommended that the work

RVUs for the following codes be

increased (the RUC-recommended work

RVUs are in parentheses):

Code 36489, Placement of central

venous catheter (subclavian, jugular, or

other vein (eg, for central venous

pressure, hyperalimentation,

hemodialysis, or chemotherapy));

percutaneous, age 2 years or under

(2.50) to correct a rank-order anomaly;

60100, Biopsy thyroid, percutaneous

core needle (1.56), to appropriately

reflect the work involved and fit in the

range of biopsy codes; and 31600,

Tracheostomy, planned (separate

procedure) (7.18), based on the

building-block approach and the

comparison to similar procedures.

For the following codes, the RUC

stated that there was no compelling

evidence provided to support increasing

the work RVUs. Therefore, it

recommended maintaining the current

work RVUs for the following codes:

19100, 88170, 57410, 76095, 88171,

32000, 21800, 46083, 19000, 19125,

45330, 19160, 13101, 11402, 12011,

11642, 27590, 45378, 36625, 45309,

45305, 35081, 19240, 58150, 43246,

19162, and 35556. The RUC also

recommended maintaining the current

work RVUs for codes 49321 and 49322

because these services had recently been

reviewed by the RUC.

The RUC recommended that the

following codes be referred to the CPT

Editorial Panel for review or

clarification: 37720 and 43215.

HCFA Proposal:

We have reviewed and propose to

accept all of the RUC recommendations

for these surgery codes.

Comment: 

The American College of Surgeons

(ACS) submitted general surgery codes

for review that account for

approximately 50 percent of general

surgery’s Medicare-allowed charges for

services categorized as surgery under

our ‘‘type of service’’ classification. The

procedures are predominantly

performed by general surgeons, and they

involve the gastrointestinal tract,

abdominal organs, thyroid, lymph

system, and endocrine system. Requests

for review of some of these codes were

also submitted by other specialty

groups.

In its comments, the ACS emphasized

that its analysis determined that the

work of codes in general surgery has

been systematically undervalued.

The ACS used a building-block

approach with panel-assigned

intraoperative work intensities for

procedures. Preoperative work RVUs

were determined based on an assigned

intensity multiplied by the number of

preservice minutes. The assigned

preservice work intensity was below

that of an evaluation and management

service. A panel of ASC members

assigned intraservice work intensity to

each code using a scale. The intensity of

an evaluation and management service

was the low end of the scale, and liver

resection services were on the high end

of the scale. The ends of the scale were

chosen to represent ‘‘average’’ work

intensity throughout a procedure. The

ACS maintains that the work intensity

of any surgical procedure is greater than

the work intensity of an evaluation and

management service. Postservice work

RVUs were calculated using current

work RVUs for hospital visits and

discounted work RVUs for office visits.

Pre, intra-, and postwork RVUs were

summed to equal the new work RVUs

that the ACS developed for each code.

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31049

The ACS assigned over 300 codes to

31 families of similar services (for

example, all codes related to hernia

repair were in one family). It conducted

a traditional RUC survey for 32 codes

(either high volume services or the

service most representative of the family

of codes). A minisurvey, which did not

include a respondent-recommended

work value, was conducted for the

remaining codes, with participation

from other specialty groups. The ACS

indicated that the survey respondents

tended to overvalue codes at the low

end of the scale and undervalue codes

at the high end of the scale. As a result,

ACS recommended using the 25th

percentile of survey results at the low

end and the 75th percentile for work

RVUs at the high end of the scale for

fully-surveyed codes. However, they

stated that acceptance of these survey

results without adjustments to other

codes in the family that were not fully

surveyed would distort the relativity

within and across families. They

recommended a regression methodology

to extrapolate the fully-surveyed code

results to the other codes.

RUC Recommendation: 

The RUC workgroup reviewed the

data collected for the 32 fully-surveyed

ACS codes. It also reviewed the families

of services proposed by ACS and

modified the families that were too

dissimilar to permit appropriate

comparison within the family. After the

anchor code was reviewed, each family

was reviewed to determine whether the

change to the anchor code should be

applied to the entire family of codes. In

some instances the RUC agreed that the

recommended change in the anchor

code should be extrapolated to the

entire family to ensure that rank-order

and relativity distortions were not

created by a change to the anchor code.

In other instances the RUC determined

that the recommendation for the anchor

code did not apply to the family of

codes. In these instances, either new

RVUs were recommended or the present

work RVUs were maintained. The

following are the code-specific RUC

recommendations:

CPT codes Work RVUs

Family 1A & B Thyroid/Endocrine

60220 .............................................................................................................................................................................. 11.90

60252 .............................................................................................................................................................................. 20.57

60254 .............................................................................................................................................................................. 26.99

60260 .............................................................................................................................................................................. 17.47

60270 .............................................................................................................................................................................. 20.27

60271 .............................................................................................................................................................................. 16.83

60540 .............................................................................................................................................................................. No change

60545 .............................................................................................................................................................................. No change

Family 2 Lymphadenectomy

38740 .............................................................................................................................................................................. 8.42

38745 .............................................................................................................................................................................. 11.00

38760 .............................................................................................................................................................................. 10.88

38765 .............................................................................................................................................................................. 19.98

Family 3 Lymph Nodes and Lymphatic Channels—Incision/Excision

38300 .............................................................................................................................................................................. 1.99

38305 .............................................................................................................................................................................. 6.00

38308 .............................................................................................................................................................................. 6.45

38500 .............................................................................................................................................................................. 3.75

38510 .............................................................................................................................................................................. 6.43

38520 .............................................................................................................................................................................. 6.67

38525 .............................................................................................................................................................................. 6.07

38530 .............................................................................................................................................................................. 7.98

Family 4 Intestines—Excision/Incision

44005 .............................................................................................................................................................................. 16.23

44010 .............................................................................................................................................................................. 12.52

44020 .............................................................................................................................................................................. 13.99

44021 .............................................................................................................................................................................. 14.08

44025 .............................................................................................................................................................................. 14.28

44050 .............................................................................................................................................................................. 14.03

44110 .............................................................................................................................................................................. 11.81

44111 .............................................................................................................................................................................. 14.29

44120 .............................................................................................................................................................................. 17.00

44125 .............................................................................................................................................................................. 17.54

44130 .............................................................................................................................................................................. 14.49

44160 .............................................................................................................................................................................. 18.62

44800 .............................................................................................................................................................................. 11.23

44820 .............................................................................................................................................................................. 12.09

Family 5 Intestines—External Fistulization

44300 .............................................................................................................................................................................. 12.11

44310 .............................................................................................................................................................................. 15.95

44312 .............................................................................................................................................................................. 8.02

44314 .............................................................................................................................................................................. 15.05

44316 .............................................................................................................................................................................. 21.09

31050 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

CPT codes Work RVUs

44320 .............................................................................................................................................................................. 17.64

44340 .............................................................................................................................................................................. 17.72

44345 .............................................................................................................................................................................. 15.43

44346 .............................................................................................................................................................................. 16.99

Family 6 Intestines—Colectomy

Codes 44140, 44143, 44144, 44145, 44146, 44150, 44151, 44152, 44153, 44155, and 44156. The RUC made no changes to any of these

codes based on the lack of compelling evidence.

Family 7 intestines—Repair

44602 .............................................................................................................................................................................. 11.91

44603 .............................................................................................................................................................................. 15.72

44604 .............................................................................................................................................................................. 16.03

44605 .............................................................................................................................................................................. 17.25

44615 .............................................................................................................................................................................. 15.93

44620 .............................................................................................................................................................................. 12.20

44625 .............................................................................................................................................................................. 15.05

44626 .............................................................................................................................................................................. 25.36

44640 .............................................................................................................................................................................. 16.65

44650 .............................................................................................................................................................................. 17.12

44660 .............................................................................................................................................................................. 16.42

44661 .............................................................................................................................................................................. 19.07

44680 .............................................................................................................................................................................. 15.40

44700 .............................................................................................................................................................................. 16.11

44850 .............................................................................................................................................................................. 10.74

Family 8 Anus/Rectum—Hemorrhoids/Fistula

45000 .............................................................................................................................................................................. 3.88

45020 .............................................................................................................................................................................. 4.05

45100 .............................................................................................................................................................................. 3.16

45108 .............................................................................................................................................................................. 4.09

46040 .............................................................................................................................................................................. 4.26

46045 .............................................................................................................................................................................. 3.71

46060 .............................................................................................................................................................................. 4.89

46250 .............................................................................................................................................................................. 3.89

46255 .............................................................................................................................................................................. 4.60

46257 .............................................................................................................................................................................. 5.40

46258 .............................................................................................................................................................................. 5.73

46260 .............................................................................................................................................................................. 6.37

46261 .............................................................................................................................................................................. 7.08

46262 .............................................................................................................................................................................. 7.50

46270 .............................................................................................................................................................................. 3.20

46275 .............................................................................................................................................................................. 3.92

46280 .............................................................................................................................................................................. 5.14

46288 .............................................................................................................................................................................. 6.13

46934 .............................................................................................................................................................................. 3.51

46936 .............................................................................................................................................................................. 3.69

46945 .............................................................................................................................................................................. 1.84

46946 .............................................................................................................................................................................. 2.58

Note: All of the work RVUs for Family 8 reflect a recommended decrease from the CY 2000 work RVUs.

Family 9 A B &C Anus/Rectum, Anus (destruction)—10-day global

45900 .............................................................................................................................................................................. 2.61

45905 .............................................................................................................................................................................. 2.30

45910 .............................................................................................................................................................................. 2.80

45915 .............................................................................................................................................................................. 3.14

46221 .............................................................................................................................................................................. 2.04

46754 .............................................................................................................................................................................. 2.20

Note: Based on the lack of compelling evidence, the RUC recommended that no changes be made to the following Family 9 codes: 46083,

46230, 46320, 46935, 46940, 46942, 46900, 46910, 46916, 46917, 46922, and 46924.

Family 10 Anus/Rectum Repair

45505 .............................................................................................................................................................................. 7.58

45540 .............................................................................................................................................................................. 16.27

45541 .............................................................................................................................................................................. 13.40

45550 .............................................................................................................................................................................. 23.00

45560 .............................................................................................................................................................................. 10.58

45562 .............................................................................................................................................................................. 15.38

45563 .............................................................................................................................................................................. 23.47

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31051

CPT codes Work RVUs

45800 .............................................................................................................................................................................. 17.77

45805 .............................................................................................................................................................................. 20.78

45820 .............................................................................................................................................................................. 18.48

45825 .............................................................................................................................................................................. 21.25

46700 .............................................................................................................................................................................. 9.13

46750 .............................................................................................................................................................................. 10.25

46753 .............................................................................................................................................................................. 8.29

46760 .............................................................................................................................................................................. 14.43

46761 .............................................................................................................................................................................. 13.84

46762 .............................................................................................................................................................................. 12.71

Family 11 Hernia

49500 .............................................................................................................................................................................. 5.48

49501 .............................................................................................................................................................................. 8.88

49505 .............................................................................................................................................................................. 7.60

49507 .............................................................................................................................................................................. 9.57

49520 .............................................................................................................................................................................. 9.63

49521 .............................................................................................................................................................................. 11.97

49525 .............................................................................................................................................................................. 8.57

49540 .............................................................................................................................................................................. 10.39

49550 .............................................................................................................................................................................. 8.63

49553 .............................................................................................................................................................................. 9.44

49555 .............................................................................................................................................................................. 9.03

49557 .............................................................................................................................................................................. 11.15

49560 .............................................................................................................................................................................. 11.57

49561 .............................................................................................................................................................................. 14.25

49565 .............................................................................................................................................................................. 11.57

49566 .............................................................................................................................................................................. 14.40

49570 .............................................................................................................................................................................. 5.69

49572 .............................................................................................................................................................................. 6.73

49580 .............................................................................................................................................................................. 4.11

49582 .............................................................................................................................................................................. 6.65

49585 .............................................................................................................................................................................. 6.23

49587 .............................................................................................................................................................................. 7.56

49590 .............................................................................................................................................................................. 8.54

Family 12 A & B Stomach—Gastrectomy and Gastrectomy/Vagotomy

43620 .............................................................................................................................................................................. 30.04

43621 .............................................................................................................................................................................. 30.73

43622 .............................................................................................................................................................................. 32.53

43638 .............................................................................................................................................................................. 29.00

43639 .............................................................................................................................................................................. 29.65

43631 .............................................................................................................................................................................. 22.59

43632 .............................................................................................................................................................................. 22.59

43633 .............................................................................................................................................................................. 23.10

43634 .............................................................................................................................................................................. 25.12

43640 .............................................................................................................................................................................. 17.02

43641 .............................................................................................................................................................................. 17.27

Family 13 A & B Stomach—Incision/Excision/Repair

43500 .............................................................................................................................................................................. 11.05

43501 .............................................................................................................................................................................. 20.04

43502 .............................................................................................................................................................................. 23.13

43510 .............................................................................................................................................................................. 13.08

43520 .............................................................................................................................................................................. 9.99

43605 .............................................................................................................................................................................. 11.98

43610 .............................................................................................................................................................................. 14.60

43611 .............................................................................................................................................................................. 17.84

43800 .............................................................................................................................................................................. 13.69

43810 .............................................................................................................................................................................. 14.65

43820 .............................................................................................................................................................................. 15.37

43825 .............................................................................................................................................................................. 19.22

43830 .............................................................................................................................................................................. 9.53

43832 .............................................................................................................................................................................. 15.60

43840 .............................................................................................................................................................................. 15.56

43870 .............................................................................................................................................................................. 9.69

43842 .............................................................................................................................................................................. 18.47

43843 .............................................................................................................................................................................. 18.65

43846 .............................................................................................................................................................................. 24.05

43847 .............................................................................................................................................................................. 26.92

43848 .............................................................................................................................................................................. 29.39

31052 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

CPT codes Work RVUs

43850 .............................................................................................................................................................................. 24.72

43855 .............................................................................................................................................................................. 26.16

43860 .............................................................................................................................................................................. 25.00

43865 .............................................................................................................................................................................. 26.52

43880 .............................................................................................................................................................................. 24.65

Family 14 A Abdomen, Peritoneum, Omentum

The RUC recommended no changes for codes 49000, 49002, 49010, 49200, 49201, 49220, 49255, 49900, 49421, 49422, 49425, 49426, and

49429.

Family 14 B Abdomen, Peritoneum, Omentum

49020 .............................................................................................................................................................................. 20.73

49040 .............................................................................................................................................................................. 12.27

49060 .............................................................................................................................................................................. 14.40

49085 .............................................................................................................................................................................. 11.03

Family 14 C Abdomen, Peritoneum, Omentum

49428 .............................................................................................................................................................................. 6.06

Family 15 Appendix

44900 .............................................................................................................................................................................. 10.14

44950 .............................................................................................................................................................................. 10.00

44960 .............................................................................................................................................................................. 12.34

Family 16 Rectum—Proctectomy/Excision

45110 .............................................................................................................................................................................. 28.00

45112 .............................................................................................................................................................................. 30.54

45113 .............................................................................................................................................................................. 30.58

45114 .............................................................................................................................................................................. 27.32

45116 .............................................................................................................................................................................. 24.58

45119 .............................................................................................................................................................................. 30.84

45123 .............................................................................................................................................................................. 16.71

45126 .............................................................................................................................................................................. 45.16

45130 .............................................................................................................................................................................. 16.44

45135 .............................................................................................................................................................................. 19.28

45160 .............................................................................................................................................................................. 15.32

45170 .............................................................................................................................................................................. 11.49

45190 .............................................................................................................................................................................. 9.74

Family 17 Biliary Tract

47420 .............................................................................................................................................................................. 19.88

47425 .............................................................................................................................................................................. 19.83

47460 .............................................................................................................................................................................. 18.04

47480 .............................................................................................................................................................................. 10.82

47600 .............................................................................................................................................................................. 13.58

47605 .............................................................................................................................................................................. 14.69

47610 .............................................................................................................................................................................. 18.82

47612 .............................................................................................................................................................................. 18.78

47620 .............................................................................................................................................................................. 20.64

47711 .............................................................................................................................................................................. 23.03

47712 .............................................................................................................................................................................. 30.24

47715 .............................................................................................................................................................................. 18.80

47716 .............................................................................................................................................................................. 16.44

47720 .............................................................................................................................................................................. 15.91

47721 .............................................................................................................................................................................. 19.12

47740 .............................................................................................................................................................................. 18.48

47741 .............................................................................................................................................................................. 21.34

47760 .............................................................................................................................................................................. 25.85

47765 .............................................................................................................................................................................. 24.88

47780 .............................................................................................................................................................................. 26.50

47785 .............................................................................................................................................................................. 31.18

47800 .............................................................................................................................................................................. 23.30

47801 .............................................................................................................................................................................. 15.17

47802 .............................................................................................................................................................................. 21.55

47900 .............................................................................................................................................................................. 19.90

Family 18 Esophagus—Repair/Reconstruction

43320 .............................................................................................................................................................................. 19.93

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31053

CPT codes Work RVUs

43324 .............................................................................................................................................................................. 20.57

43325 .............................................................................................................................................................................. 20.06

43326 .............................................................................................................................................................................. 19.74

43330 .............................................................................................................................................................................. 19.77

43331 .............................................................................................................................................................................. 20.13

43340 .............................................................................................................................................................................. 19.61

43341 .............................................................................................................................................................................. 20.85

43350 .............................................................................................................................................................................. 15.78

43351 .............................................................................................................................................................................. 18.35

43352 .............................................................................................................................................................................. 15.26

43360 .............................................................................................................................................................................. 35.70

43361 .............................................................................................................................................................................. 40.50

43400 .............................................................................................................................................................................. 21.20

43401 .............................................................................................................................................................................. 22.09

43405 .............................................................................................................................................................................. 20.01

43410 .............................................................................................................................................................................. 13.47

43415 .............................................................................................................................................................................. 25.00

43420 .............................................................................................................................................................................. 14.35

43425 .............................................................................................................................................................................. 21.03

Family 19 Liver

47010 .............................................................................................................................................................................. 16.01

47015 .............................................................................................................................................................................. 15.11

47100 .............................................................................................................................................................................. 11.67

47120 .............................................................................................................................................................................. 35.50

47122 .............................................................................................................................................................................. 55.13

47125 .............................................................................................................................................................................. 49.19

47130 .............................................................................................................................................................................. 53.35

47300 .............................................................................................................................................................................. 15.08

47350 .............................................................................................................................................................................. 19.56

47360 .............................................................................................................................................................................. 26.92

47361 .............................................................................................................................................................................. 47.12

47362 .............................................................................................................................................................................. 18.51

47400 .............................................................................................................................................................................. 32.49

Family 20 A & B Spleen—Incision/Excision/Repair and Pancreatitis Management

38100 .............................................................................................................................................................................. 14.50

38101 .............................................................................................................................................................................. 15.31

38115 .............................................................................................................................................................................. 15.82

48000 .............................................................................................................................................................................. 28.07

48001 .............................................................................................................................................................................. 35.45

48005 .............................................................................................................................................................................. 42.17

Family 21 Pancreatectomy

48020 .............................................................................................................................................................................. 15.70

48100 .............................................................................................................................................................................. 12.23

48120 .............................................................................................................................................................................. 15.85

48140 .............................................................................................................................................................................. 22.94

48145 .............................................................................................................................................................................. 24.02

48146 .............................................................................................................................................................................. 26.40

48148 .............................................................................................................................................................................. 17.34

48150 .............................................................................................................................................................................. 48.00

48152 .............................................................................................................................................................................. 43.75

48153 .............................................................................................................................................................................. 47.89

48154 .............................................................................................................................................................................. 44.10

48155 .............................................................................................................................................................................. 24.64

48180 .............................................................................................................................................................................. 24.72

48500 .............................................................................................................................................................................. 15.28

48510 .............................................................................................................................................................................. 14.31

48520 .............................................................................................................................................................................. 15.59

48540 .............................................................................................................................................................................. 19.72

48545 .............................................................................................................................................................................. 18.18

48547 .............................................................................................................................................................................. 25.83

Family 22 Laparoscopy

The RUC recommended no changes to the following codes based on lack of compelling evidence: 43651, 43652, 44200, 44970, 47562, 47563,

47564, 47570, 49320, 49650, and 49651.

31054 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

The RUC also recommended that the

following codes be referred to the CPT

Editorial Panel for review and

clarification: 36533, 36534, 36535,

49495, and 49496.

HCFA Proposal:

The ACS conducted full surveys of 32

codes, and we agreed with the RUC

analysis for most of the 32 codes. For

the other codes the ACS did

minisurveys that included pre-, intra-,

and postservice times as well as the

number and type of postservice visits.

These minisurveys did not include an

estimate of the relative work for the

procedure. For this reason, the RUC

used an extrapolation methodology to

arrive at its work RVU

recommendations for all codes that did

not have a full RUC survey. To make

appropriate extrapolations, the RUC

divided all of the general surgery codes

into families of related procedures. At

least one code in each family was fully

surveyed. After the RUC recommended

work RVUs for each surveyed code, it

applied the percent change for that code

to all of the other codes in the family.

When more than one code was fully

surveyed within a family of services, the

RUC extrapolated the percentage from

the fully surveyed code that would

produce the least increase in work

RVUs.

The validity of this extrapolation

methodology relies on at least two

things—first, that the relative work

values of all codes in the family were

correct before the extrapolation (or else

the extrapolation perpetuates and

magnifies any pre-existing anomalies),

and second, that the relative

misvaluation of each code in a family is

similar.

We did an analysis of all the families

of codes in the general surgery group to

determine whether the relative

valuations in the 2001 physician fee

schedule contained any anomalies. If

any anomalies existed, we reviewed the

RUC recommendations to determine

whether the anomalies were addressed

by the RUC recommendations. If the

anomalies were not corrected, we took

steps to correct them.

We also analyzed all of the

recommended values for general surgery

to ensure that the percentage changes

for each family were appropriate. To

determine if the extrapolation for each

family was correct, we compared each

extrapolated code to codes in other

families, and to codes in other

specialties. We compared extrapolated

codes to codes whose current or RUC

recommended work RVUs (from the 5-

year-review) were similar to the

extrapolated code. We then compared

the preservice, intraservice, and

postservice physician times as well as

the number of postoperative visits. In

addition, we generally determined

whether the survey vignette was typical

for the procedure. The following is an

example of our review of the general

surgery codes. Code 35132 (Direct repair

of aneurysm, false aneurysm, or

excision (partial or total) and graft

insertion, with or without patch graft;

for ruptured aneurysm, iliac artery

(common, internal, external) (30.00

work RVUs) with a preservice time of 67

minutes, intraservice time of 180

minutes, seven hospital visits, and three

office visits is similar to codes 47712

(Excision of bile duct tumor, with or

without primary repair of bile duct;

intrahepatic) (30.24 work RVUs) with a

preservice time of 75 minutes,

intraservice time of 210 minutes, one

intensive care unit visit, nine hospital

visits, and three office visits and 43638

(Gastrectomy, partial, proximal,

thoracic or abdominal approach and

esophagogastrostomy with vagotomy)

(29.00 work RVUs ) with a preservice

time of 75 minutes, intraservice time of

210 minutes, 10 hospital visits, and 4

office visits. A review of these codes

demonstrates the similarity in

preservice and intraservice time and the

proposed RVUs maintain relativity

across surgical specialties.

Upon completion of this analysis, we

propose to accept the RUC

recommendations for the following

families of services:

Family 1A and 1B Thyroid and

Endocrine.

Family 3 Lymph Nodes and Lymphatic

Channels—Incision/Excision.

Family 4 Intestines—Excision/

Incision.

Family 5 Intestines—External

Fistulization.

Family 9 Anus/Rectum—10-day global

period.

Family 10 Anus/Rectum—Repair.

Family 11 Hernia.

Family 12 Stomach—Gastrectomy/

Vagotomy.

Family 13 Stomach—Incision/

Excision/Repair.

Family 14A and C Abdomen,

Peritoneum, Omentum.

Family 15 Appendectomy.

Family 16 Rectum-Proctectomy/

Excision.

Family 17 Biliary Tract.

Family 18 Esophagus—Repair/

Reconstruction.

Family 19 Liver.

Family 20 Pancreas/Spleen—Incision/

Excision/Repair. 

Family 21 Pancreatectomy.

Family 22 Laparoscopy.

For the above families, adopting the

RUC-recommended RVUs maintains

relativity of the codes based upon a

comparison of the codes to procedures

in other families and within the family.

For other families of services, the

extrapolation methodology

inappropriately values codes or does not

address current rank-order anomalies.

Application of the percentage increases

derived from the RUC’s extrapolation

methodology would only exacerbate any

current rank-order anomalies within

families. Below, we have outlined, for

each family of services, our proposed

work RVUs to rectify these problems.

Family 2 Lymphadenectomy

The RUC recommended an increase in

work RVUs for the fully surveyed code

38745 (Axillary lymphadenectomy;

complete) from 8.84 to 11.0 RVUs based

on comparisons with codes 60210

(Partial thyroid lobectomy, unilateral,

with or without isthmusectomy), and

32100 (Thoracotomy, major with

exploration and biopsy). We disagree.

Although codes 38745 and 60210 are

performed in the outpatient setting and

32100 is not, code 38745 requires more

postoperative wound care. Additionally,

the RUC compared 38745 to the pre-5-

year review value of 32100.

Subsequently the RUC reviewed code

32100 for the 5-year review and is

recommending an RVU increase to

15.24 RVUs. Because the intraservice

times for codes 38745 and 32100 are

identical and 38745 requires more

postoperative wound care, a clear rank

order anomaly would exist if 38745 was

valued at 11.00 work RVUs and 32100

was valued at 15.24 work RVUs.

Therefore, we are assigning the median

survey RVUs of 13.00 to code 38745. We

would also note that the survey RVU

spread from the 25th percentile to the

75th percentile ranged from 12.15 to

14.29 RVUs, which is relatively small.

An RVU of 13.00 places code 38745 in

the correct rank order to the comparison

codes. To maintain relativity within this

family, we are extrapolating the 47

percent increase in work RVUs of code

38745 to codes 38740 (Axillary

lymphadenectomy; superficial) and

38760 (Inguinofemoral

lymphadenectomy, superficial,

including Cloquets node (separate

procedure)) for proposed work RVUs of

10.02 and 12.94, respectively. However,

code 38765 (Inguinofemoral

lymphadenectomy, superficial, in

continuity with pelvic

lymphadenectomy, including external

iliac, hypogastric, and obturator nodes

(separate procedure)) represents a rankorder anomaly as it is currently valued

too high relative to the other codes in

the family. Therefore, we are accepting

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31055

the RUC recommendation for code

38765 of 19.98 work RVUs.

Family 6 Colectomy

The RUC recommended no change in

the work RVUs for this family of codes

based on lack of compelling evidence

for changing the RVUs of the fully

surveyed code 44140 (Partial

colectomy). Moreover, the intraservice

time for code 44140 had not changed

since the last 5-year review.

Additionally, the RUC compared code

44140 to code 32480 (Removal of lung,

other than total pneumonectomy; single

lobe (lobectomy)) and code 50230

(Nephrectomy, including partial

ureterectomy, any approach including

rib resection; radical, with regional

lymphadenectomy and/or vena caval

thrombectomy) that have similar work

RVUs to 44140 and were believed to be

longer, more intense procedures with

more postoperative care. We disagree

with this recommendation. If the RVUs

for procedures in this family are not

changed, the procedures will be

significantly undervalued compared to

other general surgery codes (Family 5

and Family 7) and vascular surgery

codes. As an example, we note that the

RUC-recommended work RVU for code

44153 Colectomy, total, abdominal,

without proctectomy; with rectal

mucosectomy, ileoanal anastomosis,

creation of ileal reservoir (S or J), with

or without loop, will significantly

undervalue this code compared to code

45113, Proctectomy, partial, with rectal

mucosectomy, ileoanal anastomosis,

creation of ileal reservoir (S or J), with

our without loop ileostomy, thus

creating a rank-order anomaly.

We compared code 44140 to code

32480 for which the RUC is

recommending a work RVU increase to

23.75. These procedures have similar

intraservice times, and the postoperative

visits show that although the initial care

required for code 32480 is more intense,

the length of stay for code 44140 is

frequently longer. We also compared

code 44140 to codes 37617, Ligation,

major artery (eg post-traumatic,

rupture); abdomen, and 35221, Repair

blood vessel, direct; intra-abdominal.

Code 37617, for which the RUC

recommended work RVUs of 22.06, is

an emergency operation with a slightly

shorter intraservice time and shorter

hospital stay. Code 35221, which has

RUC-recommended work RVUs of

24.39, is also an emergency operation

with an intraservice time and length of

stay identical to code 44140. Based on

these comparisons, we believe that the

survey’s 25th percentile work RVUs of

21.00 are appropriate and correctly rank

code 44140 to the comparison

procedures. This increase is 14 percent

greater than the current work RVUs and,

with the exception of the two codes

discussed below, applying this 14

percent increase to the other codes in

this family will place them in proper

relationship to other comparable

procedures.

Family 6 contains two current rankorder anomalies: code 44151,

Colectomy, total, abdominal, without

proctectomy; with continent ileostomy,

has lower work RVUs than code 44150,

Colectomy, total, abdominal, without

proctectomy; with ileostomy or

ileoproctostomy, and 44156, Colectomy,

total, abdominal, with proctectomy;

with continent ileostomy, has lower

work RVUs than code 44155,

Colectomy, total, abdominal, with

proctectomy; with ileostomy. Code

44151 is identical to code 44150, and

code 44156 is identical to code 44155,

except that codes 44151 and 44156

involve the creation of a ‘‘continent

ileostomy’’ instead of an ‘‘ileostomy or

ileoproctostomy.’’ The work of creating

a ‘‘continent ileostomy’’ is greater than

the work of creating an ‘‘ileostomy or

ileoproctostomy.’’ To correct this rankorder anomaly, we applied the 14

percent increase discussed above to

codes 44150 and 44155. Next, we

determined the proper incremental

increase in work for creation of a

‘‘continent ileostomy’’ by looking to

codes 44310, Ileostomy or jejunostomy,

non-tube (separate procedure), and

44316, Continent Ileostomy (Kock

procedure) (separate procedure),

because the work RVUs of 44316 are the

same as the work RVUs of 44310 with

the addition of creating a continent

ileostomy. We subtracted the RUCrecommended work RVUs of 15.95 for

code 44310 from the RUC-recommended

work RVUs of 21.09 for code 44316 and

divided by 50 percent (50 percent

approximates the intraservice portion of

the extra work). This resulted in work

RVUs of 2.57 that we increased by 14

percent to yield work RVUs of 2.93. We

then added 2.93 work RVUs to the RVUs

for codes 44150 and 44155 to yield

proposed work RVUs of 26.88 for code

44151 and 30.79 for code 44156.

In summary, we propose the

following work RVUs for the codes in

this family:

Code Work RVUs

44140 ........................................ 21.00

44143 ........................................ 22.99

44144 ........................................ 21.53

44145 ........................................ 26.42

44146 ........................................ 27.54

44150 ........................................ 23.95

44151 ........................................ 26.88

44152 ........................................ 27.83

Code Work RVUs

44153 ........................................ 30.59

44155 ........................................ 27.86

44156 ........................................ 30.79

With these assigned work RVUs, we

believe that Family 6 is ranked

appropriately in relation to other

general and vascular surgery codes.

Family 7 Intestines—Repair

The RUC recommended an increase of

14 percent for all work RVUs in this

family based on a recommended

increase in a fully surveyed code 44604

(Suture of large intestine (colorrhaphy)

for perforated ulcer, diverticulum,

wound, injury or rupture (single or

multiple perforations); without

colostomy) from 14.28 work RVUs to

16.03 work RVUs.

We agree with the increase in work

RVUs for code 44604 but note that there

are several rank-order anomalies

currently in this family of codes that

would be exacerbated by an across-theboard increase in work RVUs. Therefore,

we propose to correct the rank-order

anomalies as follows:

We propose 16.03 work RVUs for

44602 (Suture of small intestine

(enterorrhaphy) for perforated ulcer,

diverticulum, wound, injury or rupture;

single perforation). The work RVUs for

code 44602 are identical to the work

RVUs for code 44604 because they

describe the same procedure except

code 44604 is for the large intestine.

We propose work RVUs of 19.53 for

code 44605 (Suture of large intestine

(colorrhaphy) for perforated ulcer,

diverticulum, wound, injury or rupture

(single or multiple perforations); with

colostomy). The work RVUs for code

44605 are identical to the work RVUs

for code 44604 except that code 44605

includes creating a colostomy with the

attendant increase in postoperative

wound care. The intraservice work of

creating a colostomy is captured by

subtracting the work RVUs for code

44140 from code 44143, which leaves

1.99 RVUs. In addition, there is one

extra postoperative visit required for

code 44605 that we believe is equivalent

to code 99233 that has 1.51. work RVUs.

Therefore, we added 1.99 and 1.51 work

RVUs to the work RVUs for code 44604

to arrive at 19.53 work RVUs for code

44605.

We propose 18.66 work RVUs for

code 44603 (Suture of small intestine

(enterorrhaphy) for perforated ulcer,

diverticulum, wound, injury or rupture;

multiple perforations). The additional

work required for code 44603 as

compared to code 44602 is similar to the

additional work required for code 44605

31056 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

as compared to code 44604 except, since

there is no actual colostomy, the

additional postoperative visit is

comparable to code 99231 with 0.64

work RVUs. Therefore, we added work

RVUs of 1.99 and 0.64 to the work RVUs

of code 44602 to arrive at 18.66 work

RVUs for code 44603.

The current work RVUs for codes

44640 (Closure of intestinal cutaneous

fistula); 44650 (Closure of enteroenteric

or enterocolic fistula); 44660 (Closure of

enterovesical fistula; without intestinal

or bladder resection); and 44661

(Closure of enterovesical fistula; with

bowel and/or bladder resection) are

rank-order anomalies as they are

undervalued compared to code 44604.

However, relativity among codes 44640,

44650, 44660, and 44661 is appropriate.

To correct the anomalies, we compared

codes 44650 to 50525 (Closure of

nephrovisceral fistula (eg renocolic)

including visceral repair; abdominal

approach), which involves similar

intraoperative and postoperative work.

The intraoperative work for code 50525

is greater than that of code 44650

because code 50525 involves visceral

repair but the postoperative work for

code 44650 is greater than the

postoperative work for code 50525

because the fistula is enteroenteric or

enterocolic as opposed to renovisceral

(that is, renocolic). Therefore, we

propose to assign 22.27 work RVUs to

code 44650 and, to keep the current

relativity with the other codes, we

propose 21.65 work RVUs for code

44640, 21.36 work RVUs for code 44660,

and 24.81 work RVUs for code 44661.

We propose to accept the RUC

recommendations for the remaining

codes (44615, 44620, 44625, 44626,

44680, 44700, and 44850).

Family 8 Anus/Rectum—Hemorrhoids/

Fistula

The RUC extrapolated a 14 percent

decrease in work RVUs to all codes in

this family based upon a decrease in

work RVUs for the fully surveyed code

46262, Hemorrhoidectomy, internal and

external, complex or extensive; with

fistulectomy, with or without

fissurectomy. We agree with the RUC

recommendation for the surveyed code,

but disagree with the extrapolation to

the anal fistula repair codes and the anal

abscess treatment codes. The surveyed

intraoperative time for code 46262 is not

consistent with the surveyed

intraoperative times for many of the

other codes in the family. Moreover, the

work RVUs for many of the codes

subject to the minisurveys are

significantly less than for code 46262

and are not comparable. Therefore, we

propose to maintain the current RVUs

for codes 46270, 46275, 46280, 46288,

45000, 45020, 45100, 45108, 46040,

46045, and 46060. We agree with the

RUC recommendations and propose to

decrease the work RVUs for other codes

in this family of codes (46250, 46255,

46257, 46258, 46260, 46261, 46262,

46934, 46936, 46945, and 46946).

Family 14B Abdomen, Peritoneum,

Omentum

The RUC recommended an increase

for the fully-surveyed code 49020,

(Drainage of peritoneal abscess or

localized peritonitis, exclusive of

appendiceal abscess; open,) from 16.79

work RVUs to 20.73 work RVUs, the

25th percentile of surveyed work RVUs,

based on a comparison to code 61312

(Craniectomy or craniotomy for

evacuation of hematoma,

supratentorial; extradural or subdural).

We disagree and propose the surveyed

median work RVUs of 22.84. We

compared code 49020 to code 35151

(Direct repair of aneurysm, false

aneurysm, or excision (partial or total)

and graft insertion, with or without

patch graft; for aneurysm, false

aneurysm and associated occlusive

disease, popliteal artery), 48000

(Placement of drains, peripancreatic, for

acute pancreatitis), and code 48140

(Pancreatectomy, distal subtotal, with

our without splenectomy; without

pancreaticojejunostomy). Code 48000

involves sicker patients but the

intraoperative time (120 minutes) and

postoperative visits (10-day length of

stay for code 48000 with two critical

care visits versus an 11-day length of

stay for code 49020 with one critical

care visit) are similar, and code 48000

has RUC-recommended work RVUs of

28.07. Code 48140, with RUCrecommended work RVUs of 22.94, has

a longer intraoperative time (150

minutes) with a shorter length of stay (9

days with one critical care visit) and

involves less sick patients. Code 35151,

with RUC-recommended work RVUs of

22.64, involves patients not nearly as ill

as patients for whom code 49020 is

reported, has a surveyed intraoperative

time of 150 minutes, and a 5-day length

of stay with no critical care visits.

Therefore, we propose the median

surveyed work RVUs of 22.84 for code

49020. Since the current relativity

within this family is correct, we propose

to extrapolate this increase of 36 percent

to the other codes in this family and

value the work as follows: 49040

(13.52), 49060 (15.86), and 49085

(12.14).

Comment: The American Society of

Colon and Rectal Surgeons collaborated

with the ACS and submitted 12 codes

for review that they believe to be

undervalued. They also expressed

support for the methodology proposed

by ACS to value services. The specific

codes referenced were: 44130, 44144,

44147, 44151, 44156, 44394, 45111,

45113, 45337, 45339, 45910, and 46258.

RUC Recommendation:

The RUC recommended increasing

the work RVUs for the following codes:

44130 (14.49), 45113 (30.58), and 45910

(2.80) to retain current rank-order and

relativity within the grouping of

services. However, for code 46258, the

RUC recommended decreasing the work

RVUs to 5.73 to retain the current rankorder and relativity within these

services.

For codes 44147, 44394, 45111,

45337, 45339, 44144, 44151, and 44156,

the RUC did not receive compelling

evidence to suggest an increase was

needed in the work RVUs; therefore, the

RUC recommended that the current

work RVUs for these codes be

maintained.

HCFA Proposal: We propose to accept

all but one of the RUC recommendations

for the surgical codes submitted by the

American Society of Colon and Rectal

Surgeons. For code 44147, Colectomy,

partial; abdominal and transanal

approach, we are proposing to increase

the work RVUs by 14 percent to 20.71.

This is similar to the increase applied to

ACS family 6 and will prevent a rankorder anomaly.

Comment: The American Academy of

Otolaryngology-Head and Neck Surgery

submitted codes, on behalf of the

American Otological Society and the

American Academy of Facial Plastic and

Reconstructive Surgery, that they

believe to be undervalued, along with

suggested new work RVUs for each

service. However, subsequent to the

submission of their comments, the

specialty society chose not to pursue

revaluing of the following codes:

(69450, 69436, 69440, 69631, 69205,

69801, 69633, 69501, 69632, 69905,

69666, 69650, 69806, 69667, 69720,

69641, 69550, 69636, 69637, 69643,

69140, 69505, 69635, 69502, 69645,

69511, 69601, 69602, 69642, 69603,

69644, 69910, 69660, 69604, 69646,

69662, 69661, 69930, 69145, 69676,

69310, 69620, 69805, 69670, 69700,

69802, 69320, 69530, 69820, 68711,

69840, 69540, 69421, 69552, 69150,

69915, 69605, 69300, 69000, 69005,

69020, 69711, 69100, 69105, 69110,

69120, 69140, 69145, 691500, 69155,

69200, 69205, 69210, 69220, 69222,

69300, 69310, 69320, 69400, 69401,

69405, 69410, 69420, 69421, 69424,

69433, 69436, 69535, 69554, 69610,

69725, 69740, 69745, 69950, 69955,

69960, 69970).

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31057

RUC Recommendation: For codes

69990, 11642, 13131, and 13132, the

RUC recommends no change to the

current RVUs for these services, as

compelling evidence was not provided

to demonstrate the need for an increase.

HCFA Proposal: We have reviewed

and propose to accept all of the RUC

recommendations for the surgical codes

submitted by the American Academy of

Otolaryngology-Head and Neck Surgery.

3. Thoracic Surgery

Comment: In their comments, the

Society of Thoracic Surgeons (STS)

indicated that there have been major

changes in the practice of thoracic

surgery since the initial development of

the physician fee schedule. These major

changes in surgical techniques, along

with changes in the typical patient, have

had an impact on physician work. Time

and intensity of a number of procedures,

including the reference procedures used

by STS, have been affected.

The STS grouped codes into three

categories: general thoracic surgery,

adult cardiac surgery, and congenital

thoracic surgery. These three categories

were grouped into 23 families of codes.

Each family had an anchor code that

received a full RUC survey. Each of the

remaining codes in a family received a

minisurvey. The minisurvey collected

information on time and the number of

postoperative visits. The minisurvey

also asked respondents to estimate work

RVUs for the procedure based on the

reference service for the family of codes.

The RUC had a number of concerns

with the STS approach. They are as

follows: (1) The RUC concluded that

STS inappropriately had the same

survey respondents review and estimate

both misvalued services and reference

services. (2) In many instances, the

respondents valued the code under

review relative to their perception of

what the reference code value should

be, not the current value of the reference

code. (3) The STS also used too many

minisurveys and too few full surveys.

(4) Within a family of codes, the STS

inappropriately mixed codes with

different global periods.

To overcome these methodological

problems, the RUC first reviewed the

reference service that was used for each

family, and the resulting value was

compared to the codes in each family.

For the adult cardiac surgery codes, the

RUC developed a building-block

methodology to validate the survey

results. For the congenital thoracic

codes, previous RUC reviews of the

codes were used to determine how the

work has changed since the last 5-year

review. In addition, for the pediatric

thoracic codes, the specialty’s society’s

presenter offered additional information

demonstrating that the patient

population has changed, (for example,

more neonates) leading to a higher

intensity of work.

Additionally, The STS subsequently

chose not to pursue review of code

33207 under the 5-year review.

RUC Recommendations: The RUC

reviewed 89 thoracic surgery codes. Of

this total, the RUC recommended

increases for 44 codes, no changes for 43

codes, and decreases for 2 codes. The

recommendations by family are as

follows:

Family 1: The RUC generally found

that the STS had not furnished

compelling evidence or that the STS

inappropriately compared codes with a

zero global period to codes with a 90-

day global period. The RUC

recommended no increase in work

RVUs for codes 32000, 32005, 32020,

32035, 32225, 32602, 32651, and 32652.

The RUC recommended increases in

work RVUs for code 32220 (24.00) and

code 32320 (24.00), based on the

median surveyed work RVUs which

would place these codes in proper rank

order.

Family 2: The RUC recommended

increases for code 32440 (25.00) based

on the median survey value, and code

32480 (23.75) based on the value of

43415. The RUC also recommended

increases in work RVUs for codes 32100

(15.24) and 32110 (23.00) based on a

comparison to code 58150. These values

place all these codes in proper rank

order.

Family 3: The RUC recommended

increases in codes 32482 (25.00) and

32500 (22.00), based on the STS

surveyed median work RVUs for each

code, which would create the proper

rank order within the family of codes.

Family 4: The RUC recommended no

increase for code 32655 because the STS

had not furnished compelling evidence

for an increase in work. The RUC

recommended increases for codes 31600

(7.18) and 32500 (22.00) based on

survey data, a sicker patient population,

and, in the case of 31600, comparison to

35474.

Family 5: The RUC recommended

increases for codes 38746 (4.89) based

on the work RVU for 38747, but

recommended no increases for codes

39010, 39220 or 39400 due to lack of

compelling evidence or inappropriate

comparisons to codes with 90-day

global periods.

Family 6: The RUC agreed with the

STS analysis of work for codes 43107

(40.00) and 43112 (43.50) and stated

that using the survey median for each

code correctly rank ordered these codes

in the family of esophagectomy codes.

Family 7: The RUC recommended an

increase for code 43117 (40.00) after

comparing it to the reference service

code 43361 which had similar data. The

RUC also recommended an increase for

code 43122 (40.00) based on the survey

median of 40.00 work RVUs which

correctly rank ordered this code in the

family of esophagectomy codes.

Family 8: The RUC recommended no

increase for codes 31625 or 31645

because the STS did not furnish

compelling evidence for an increase in

work.

Family 9: The RUC recommended

increases for the following codes: 33400

(28.50), 33405 (35.00), 33406 (37.50),

33411 (36.25), 33412 (42.00), and 33413

(43.50), based on a building-block

approach that used code 33405 as the

anchor code for this family.

Family 10: The RUC recommended

increases for the following codes: 33426

(33.00), 33427 (40.00), 33430 (33.50),

and 33475 (33.00), based on a buildingblock approach that used code 33427 as

the anchor code for this family. The

RUC recommended no increases for

codes 33425 or 33468 because the

building-block approach did not

support the STS’s requested increase.

Family 11: The RUC recommended

increases for the following codes: 33510

(29.00), 33511 (30.00), 33512 (31.80),

and 33513 (32.00), based on a buildingblock approach that used code 33512 as

the anchor code for the family. The RUC

recommended decreases for codes

33514 (32.75) and 33516 (35.00). These

were the values recommended by the

STS and validated through the buildingblock approach.

Family 12: The RUC recommended no

increases for the following add-on

codes: 33517, 33518, 33519, 33521,

33522, 33523, and 33530, because it

believes that they were inappropriately

surveyed as 90-day global procedure

codes and the results were not reliable.

Family 13: The RUC recommended

increases in work RVUs for the

following codes: 33533 (30.00), 33534

(32.20), 33535 (34.50), and 33536

(37.50), based on a building-block

approach that used code 33533 as the

anchor code for the family of codes. The

RUC recommended no increase for code

33530 because it is an add-on code and

was inappropriately surveyed as a 90-

day global surgical procedure.

Family 14: The RUC recommended

increases in work RVUs in the following

codes: 33860 (38.00), 33861 (42.00),

33863 (45.00), and 33870 (44.00) based

on a building-block approach that used

code 33860 as the anchor code for the

family. The RUC recommended no

increase for code 33945 because the

building-block approach did not

31058 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

support the higher value requested by

the STS.

Family 15: The RUC recommended no

increases in work RVUs for the

following codes: 33750, 33820, and

33840, due to lack of compelling

evidence to support an increase.

Family 16: The RUC recommended an

increase in code 33660 (30.00) based on

intraservice work RVUs for 33401 and

pre- and postservice work RVUs for

33641. The RUC recommended no

increase in code 33641 as it did not find

any compelling evidence to warrant a

change in the work RVUs.

Family 17: The RUC recommended no

increase in work RVUs for code 33415,

because it did not believe that the

typical patient for this procedure has

changed, and the minisurvey did not

provide compelling evidence to justify a

change in the work RVUs. However, the

RUC recommended an increase in work

RVUs in code 33681 (30.61), because the

intraservice intensity of 33681 is more

complex than it was 5 years ago.

Family 18: The RUC recommended

increases in the following codes: 33615

(34.00), 33670 (35.00), and 33730

(34.25) based on a comparison to code

33412.

Family 19: The RUC recommended

increases in work RVUs for the

following codes: 33611 (34.00), 33612

(35.00), 33694 (34.00) and 33697

(36.00). The RUC compared the

intraservice time of code 33611 to the

family anchor code of 33694 and

recommended 34.00 work RVUs to

maintain proper rank order in the

family. The RUC compared code 33612

to code 33611 and agreed code 33612

was equivalent to 33611 plus 1

additional work RVU. The RUC

compared code 33694 to 33412 and

concluded that all measures of

physician work were greater for 33694.

The RUC compared code 33697 to

33694 and recommended 36.00 work

RVUs to maintain rank order. The RUC

recommended no increase for 33767

because there was no compelling

evidence for a change in the work RVUs.

Family 20: The RUC recommended an

increase in code 33617 (37.00), after

comparing it to code 33412 and noting

that 33617 has greater intraservice time

and higher intensity ranking than code

33412.

Family 21: The RUC recommended an

increase in code 33619 (45.00) after

comparing it to codes 48150 and 62530.

Family 22: The RUC recommended an

increase in code 33506 (35.50) to

preserve proper rank order within this

family. The RUC recommended an

increase in code 33770 (37.00) after

finding that the work of this code is

more than that of the comparison code

33697. The RUC recommended an

increase in code 33778 (40.00), after

comparing it to 33870, and 33412 which

are less intense procedures. The RUC

recommended an increase in code

33780 (41.75), based on a comparison to

33778. 33780 involves more work and

warrants an additional 1.75 RVUs due to

the additional 35 minutes of intraservice

time.

Family 23: The RUC recommended an

increase in code 33786 (39.00) after

comparing it to 33412, which has less

time and intensity. Given the limited

specialty survey data, the RUC believed

that the recommended increase in code

33919 to 40.00 work RVUs was

warranted, but that the survey did not

support a value higher than the median

survey value.

Based on information supplied to the

RUC, the RUC did not recommend a

change in RVUs for codes 32520, 33917,

31622, and 32657. For codes 32095,

33410 and 32491, the RUC indicated

that it had recently reviewed these

codes, and thus it recommended no

change. The RUC recommended that

codes 33875, 33877, 43107, and 43112

be referred to the CPT Editorial Panel.

HCFA Proposal:

We validated the RUC

recommendations by comparing the

thoracic surgery codes to vascular

surgery and general surgery codes and

propose to use the RUC-recommended

work RVUs for the thoracic codes based

on our own analysis. The following is

an example of our review of the thoracic

surgery codes. We compared code 32440

(Removal of lung, total

pneumonectomy) (25.00 work RVUs)

with a preservice time of 90 minutes,

intraservice time of 160 minutes, one

intensive care unit visit, six hospital

visits, and three office visits with the

following surgical codes in other

surgical specialties: code 34151

(Embolectomy or thrombectomy, with or

without catheter; renal, celiac,

mesentery, aortoiliac artery, by

abdominal incision) (25.00 work RVUs)

with a preservice time of 75 minutes,

intraservice time of 150 minutes, seven

hospital visits, and three office visits

and code 44150 (Colectomy, total,

abdominal, without proctectomy; with

ileostomy or ileoproctostomy) (23.95

work RVUs) with a preservice time of 63

minutes, intraservice time of 200

minutes, eight hospital visits, and three

office visits. A review of these codes

demonstrates the similarity in

preservice time and intraservice time

and the proposed RVUs maintains

relativity across surgical specialties.

4. Orthopedic Surgery

Comment: The American Academy of

Orthopaedic Surgeons forwarded 42

codes for review. It indicated that these

codes were undervalued when

compared to their respective reference

codes.

RUC Recommendation:

The RUC recommended increasing

the work RVUs for the following codes:

29883 (11.05) because this service

consists of two procedures; 29889

(16.00) based on increase in post and

intraservice work; 29450 (2.08) based on

the increased intraservice time for

manipulating the foot of the patient;

code 28299 (9.18) which is of value

equal to the reference code, with the

understanding that the code be sent to

CPT Editorial Panel to better define the

code; code 28705 (18.80), which more

accurately reflects the work of the two

distinct services of this procedure (ankle

fusion and triple arthrodesis); code

23472 (21.10) to correct a rank-order

anomaly; code 26562 (15.00) to correct

a rank-order anomaly; code 20245 (8.50)

to correct a rank-order anomaly; code

27075 (35.00) noting that this is a major

operation and there is increased

intraservice time with respect to the

reference code; code 27077 (40.00)

noting that this a major operation and

there is increased intraservice time with

respect to the reference code; 27284

(23.45) because this is the value for code

27227 that has identical pre-, intra-, and

postservice times; code 27286 (23.45) to

avoid creating a rank-order anomaly due

to the recommended work RVUs

increase of code 27284; code 27822

(11.00) to correct an existing rank-order

anomaly; code 27823 (13.00) to avoid

creating a rank-order anomaly caused by

increasing code 27822; code 28445

(15.62) to correct a rank-order anomaly

and appropriately reflect the work

involved; code 27724 (18.20) to reflect

the work for obtaining a graft that was

not included in the last 5-year review.

The RUC believed that the commenter

provided no compelling evidence to

revise the work RVUs for codes 27280,

27282, 23585, 23615, 23630, 23680,

24545, 27216, 27217, 27218, 27226,

27236, 27513, 27536, 27828, 23485,

24435, 27472, 28322, and 28420.

Therefore, the RUC recommended the

current work RVUs be maintained for

these codes.

The RUC referred the following codes

to the CPT Editorial Panel for

clarification: 23076, 24076, 25076,

27048, 27328, 27619, and 20205,

because these codes are being reported

incorrectly.

HCFA Proposal:

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31059

We propose to accept all but one of

the of the RUC recommendations for the

orthopedic surgery codes. For code

20245, (Biopsy, bone, excisional; deep

(eg, humerus, ischium, femur), the RUC

recommended an increase from 3.95

work RVUs to 8.5 work RVUs and

compared code 20245 to codes 27635

(Excision or curettage of bone cyst or

benign tumor, tibia or fibula), and 27607

(Incision (eg, osteomyelitis or bone

abscess), leg or ankle) (work RVUs of

7.78 and 7.97, respectively), because it

believed the work required for code

20245 was similar to the work required

for these codes. The survey for code

20245 compared the code to code

27635. The intraservice times were

similar (90 versus 85 minutes) and the

amount of postservice was similar (169

versus 163 minutes). However, the

survey median work RVUs were 13 and

the 25th percentile RVUs were 8.5. The

RUC recommended the 25th percentile

RVUs because the RVUs were

reasonably close to the RVUs for code

27635. We agree that the current work

RVUs are a rank-order anomaly with

code 20240 (Biopsy, bone, excisional;

superficial (eg, ilium, sternum, spinous

process, ribs, trochanter or femur));

however, we disagree with the RUC

recommendation. The intraservice work

of a deep excisional bone biopsy is

similar to the work of excising a bone

cyst or benign tumor from the tibia and

fibula (code 27635). This is reflected in

the similarity in their pre-, intra-, and

postservice times. Moreover, the

vignette used for code 20245 was

atypical in that it involved an ischial

lesion, whereas the code is also to be

reported for lesions of the humerus and

femur. Lesions of the humerus and

femur require less dissection and would

be more comparable to lesions of the

tibia and fibula. Moreover, code 27635

requires complete removal of a known

lesion, whereas code 20245 is only an

excisional biopsy. Additionally, we are

concerned about the spread of work

RVUs in the work survey (25th

percentile was 8.5 RVUs and 50th

percentile was 13.0 work RVUs) and

lack of consistency with the time data

from the survey. We do not believe there

is compelling evidence that the work of

code 20245 is greater than the work of

code 27635 and are therefore proposing

to assign 7.78 work RVUs to code 20245,

which is identical to work RVUs for the

reference service code 27635.

5. Ophthalmology

Comment: The American Academy of

Ophthalmology submitted comments

requesting nine codes be reviewed,

including one code for evaluation of the

global period and not the work RVU.

The specialty society subsequently

chose not to pursue review of codes

66170, 66172, and 67108.

RUC Recommendation:

The RUC agreed with the request from

the specialty society to change the

global period from 90 days to 10 days

for code 65855 (Laser surgery of eye)

and also reduced the work RVUs to 3.85

to account for this reduction in the

global period. The RUC noted that code

67218 includes two procedures, and the

specialty society indicated that this was

not reflected in the original valuation.

To correct this error, a building-block

approach was used to arrive at new

RVUs more reflective of the work of

both procedures. The RUC

recommended work RVUs of 18.53 for

this service. For code 92018, the RUC

acknowledged that the preservice work

of this service was greater than the

standard office procedure because of the

need for anesthesia. While concerned

about the reliability of the data

provided, the RUC recommended that

the work RVUs be increased to 2.50, as

it suggested during the first 5-year

review, with the understanding that the

code would be sent to the CPT Editorial

Panel for clarification.

For codes 66180, 66986, 67028, and

67904, the RUC believed that the

commenters provided no compelling

evidence to justify an increase in the

work RVUs; therefore, the RUC

recommended maintaining the current

value for this code.

HCFA Proposal:

We have reviewed and propose to

accept all of the RUC recommendations

for the ophthalmology codes.

6. Urology

Comment: The American Urological

Association presented four codes for

review: 50230, 51595, 51596, and

38780. They believed that the work

RVUs for these codes do not account for

all the in-hospital and office-based

postoperative care.

RUC Recommendation:

The RUC questioned the arguments

for an increase in RVUs, noting that

there was no compelling evidence

presented for recommending an increase

for three of these codes (51595, 51596

and 38780). However, the RUC noted

that the code descriptor for code 50230

includes the term ‘‘and/or vena caval

thrombectomy’’ which impacts the work

RVU. The RUC agreed to refer this code

back to the CPT Editorial Panel to

separate these two distinct services so

each may be reported and valued

appropriately.

HCFA Proposal:

We have reviewed and propose to

accept all of the RUC recommendations

for the urology codes.

7. Obstetrics/Gynecology

a. Specialty Comments

Comment: The American College of

Obstetrics and Gynecology (ACOG)

referenced 35 codes in their written

comments submitted to us. The

specialty society chose not to pursue the

review of work RVUs for code 57555, as

well as the work RVUs for codes 59150

and 59151.

RUC recommendation:

The RUC recommended increases in

the RVUs for the following codes: 38572

(16.59) that would align the code

relative to the work of other

laparoscopic codes; 56515 (2.76), which

was not the value requested by the

specialty group but was the value

assigned to code 46924, which has

comparable work and intraservice time;

56740 (4.57) based on a modified

building-block approach, which was

similar to ACOG’s approach; 57100

(1.20) as presented by the specialty

society; 58152 (20.60) in recognition

that the current work RVUs are less than

the RVUs for code 58150 performed

alone even though 58152 combines the

work of codes 58150 and 58840; 58260

(12.98) to reflect work of additional

office visits included in the procedure;

58262 (14.77) to accurately reflect the

work of its component procedures;

58263 (16.06), 58275 (15.76), 58270

(14.26) and 58280 (17.01) to maintain

relativity within family of hysterectomy

codes; 58267 (17.04) because the

procedure is currently undervalued

since it encompasses three separate

components; 58285 (22.26), which was

lower than requested by the specialty

group, but which the RUC believed was

more reflective of the work for the

procedure; 58600 (5.60) based on

similarity of this procedure to code

58670; 58605 (5.00) to reflect the

slightly lower pre-, intra-, and posttimes for this code as compared to

58670; 58611 (1.45) to appropriately

reflect the increase in preservice work;

58700 (12.05) reflecting the higher

technical skill associated with this

procedure (removing only fallopian tube

versus ovary and fallopian tube); 58740

(14.00) to reflect increase in intraservice time and postoperative work;

58825 (10.98) which aligns the work

value with other codes with similar

work; 58920 (11.36) to correct a rankorder anomaly; 58950 (16.93) which

combines both codes 58720 and 49255

and applies the multiple procedure rule;

58951 (22.38) based on the similarity of

work to 58285 which has the same

31060 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

recommended value; 59812 (4.01) based

on the similarity of work to code 59820;

59870 (6.01) based on increased

physician work and postoperative time.

The RUC indicated that the

commenter provided no compelling

evidence to support an increase in the

work RVUs for codes 38571, 57130,

57292, 57307, 57505, 58323, 58400, and

58805.

For code 58820, the RUC indicated

that this service had recently been

reviewed by the RUC and, therefore, the

current work RVUs should be

maintained.

HCFA Proposal:

We have reviewed and propose to

accept all of the RUC recommendations

for the obstetrics/gynecology codes.

b. Other Concerns

We have been alerted to concerns that

certain female-specific procedures may

be undervalued. Our staff has reviewed

the work RVUs associated with a

number of female-specific procedures,

including major and minor surgical

procedures as well as several

laparoscopic procedures and has

determined that, for the most part, the

RVUs assigned seem reasonable and

consistent with the time, intensity, and

postoperative care involved with the

procedures. However, there were several

codes that seemed to be inappropriately

valued as compared to other similar

procedures. These procedures are: code

56515 (Destruction of vulvar lesions,

extensive); code 57100 (Biopsy of

vagina); code 56605 (Biopsy of vulva);

code 58100 (Biopsy of endometrium);

and code 56810 (Perineoplasty).

We forwarded two of these codes

(codes 56515 and 57100) to the RUC for

review under the 5-year refinement

process, and the RUC has recommended

an increase in work RVUs for both of

these codes.

We have referred the remaining three

codes that appear to be misvalued to the

RUC for review, and we anticipate

receiving a response from the RUC that

we can consider in the November 1,

2001 final rule.

8. Gastroenterology

Comment: The American Society for

Gastrointestinal Endoscopy (ASGE),

American College of Gastroenterology

(ACG), and the American

Gastrointestinal Association (AGA)

provided comments describing

gastrointestinal services that they

believed to be misvalued. Their

comments focused on the identification

of specific services whose work RVUs

they believe are too low in comparison

to other gastroenterology services when

comparing time and intensity of the

procedures. They also expressed

concern that the work RVUs for all

gastroenterology procedures involving

conscious sedation are substantially

undervalued and need to be increased

because of the added requirements

associated with conscious sedation.

RUC Recommendation:

With regard to conscious sedation, the

RUC was concerned about—(1) The

need to break out different levels of

physician work for conscious sedation,

and (2) many gastroenterology codes

have been previously valued with

conscious sedation included and some

codes were not valued with conscious

sedation included. Therefore, the RUC

agreed to create a joint RUC and CPT

workgroup to review and define the

issues related to conscious sedation.

Based upon information presented by

the specialty at the February 2001 RUC

meeting, the RUC agreed that elements

of conscious sedation have changed

over the past 5 years; however, the RUC

was not able to quantify the change in

physician work. While the RUC did not

recommend a specific increase, it did

recommend and urge us to allow

separate reporting and payment of

conscious sedation codes 99141 and

99142 when conscious sedation is not

inherently included as a component of

the physician work of the procedure.

Based on technological advances,

increased complexity in procedure, and

changes in patient population the RUC

recommended an increase in work

RVUs for the following codes: 43219

(3.18); 43239 (2.87); 43244 (5.05); 43247

(3.59): 43249 (3.35); 43255 (4.82); 43259

(8.59); 43263 (7.29); 43265 (10.02);

43269 (8.21); 44388 (3.70); 44389 (4.26);

44390 (4.81); 44391 (5.18); 44392 (4.81);

44393 (5.00); and 45380 (4.44).

Based on the lack of compelling

evidence to increase the work RVUs, the

RUC recommended that the current

work RVUs be maintained for the

following codes: 43217, 43228, 43246,

43251, 43258, 44394, 45383, 45384, and

45385.

HCFA Proposal:

The RUC reviewed a selected series of

gastrointestinal endoscopy codes for the

5-year review. These codes included

endoscopy of the esophagus, stomach,

duodenum, small intestine, large

intestine, stoma, and biliary tree. The

RUC recommended increases in work

RVUs for some of the codes and no

change in work for other codes.

Unfortunately, the RUC could not

review all of the endoscopy codes in

each family and, therefore, was in the

position of having to make

recommendations that would likely

cause new rank-order anomalies or

exacerbate existing rank-order

anomalies within and among these

families. Furthermore, creation of rankorder anomalies across specialties was

also likely. For example, a

bronchoscopic biopsy would be valued

significantly less than a gastrointestinal

endoscopic biopsy if the gastrointestinal

endoscopic biopsy was increased in

value.

Although we are concerned that some

of these endoscopy codes may be

misvalued, we are proposing to keep all

work RVUs for gastrointestinal

endoscopy codes unchanged. However,

we believe that a comprehensive review

of the work RVUs for all gastrointestinal

endoscopy codes is warranted.

Therefore, we are asking the RUC to

perform a comprehensive review of all

gastrointestinal endoscopy codes to

ensure that all codes are properly

valued, and that no rank-order

anomalies within and across specialties

are created or exacerbated. We hope to

receive recommendations from the RUC

for these codes in time for the proposed

physician fee schedule regulation in

2002.

Below we discuss our reasons for

proposing to reject the recommended

work increases for each code. However,

we note that many new gastrointestinal

endoscopy CPT codes were created for

use in 2002 and reviewed by the RUC

concurrent with the 5-year review.

Recommendations for these new codes

were made by comparing them to the

current work RVUs of existing

gastrointestinal endoscopy codes, some

of which were reviewed as part of the

5-year review. Therefore, any increases

in work RVUs for codes in the 5-year

review will likely invalidate the work

RVUs for many of the new codes

reviewed by the RUC. Furthermore,

proposals have been made for even

more gastrointestinal endoscopy CPT

codes for CYs 2002 and 2003. We want

to ensure that these new codes are

properly reviewed and appropriate work

RVUs assigned. Until a comprehensive

review of all gastrointestinal endoscopy

codes is performed we do not believe

this is possible.

Code 43219, Esophagoscopy, rigid or

flexible; with insertion of plastic tube or

stent:

The RUC recommended an increase in

work RVUs from 2.8 to 3.18 based upon

the increased complexity of the

condition of patients receiving these

stents. The current work increment

between this code and 43200 (1.21

RVUs) has been used extensively by the

RUC to make recommendations for

other endoscopic stent placement

procedures. Therefore, in spite of this

recommendation, it appears that the

RUC and the specialists who perform

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31061

this procedure agree that the correct

increment for stent placement is 1.21

work RVUs. If the work RVUs for code

43219 were accepted, many other

recommendations from the RUC would

need to be reevaluated. Furthermore, it

is unclear from the vignette used to

value this procedure whether or not

predilation of the esophagus was

included in the work of this code.

Currently, code 43226 describes the

work of predilation and may be billed

in addition to code 43219. The

incremental work for placing a tracheal

stent with predilation (the difference in

work between codes 31622 and 31631)

is 1.59 work RVUs. This is significantly

less than the current work increment for

esophageal stent placement with

predilation, 1.96 (1.21 + .75).

Additionally, the vignette describes

placement of an expandable wire mesh

stent but the code is also used for plastic

stents, placement of which may require

less work. We propose maintaining the

current RVU for this code in view of

these concerns and the rank-order

anomalies that would be created by

accepting the RUC recommendation.

Code 43239 (Upper gastrointestinal

endoscopy including esophagus,

stomach, and either the duodenum and/

or jejunum as appropriate; with biopsy,

single or multiple):

The RUC recommended an increase in

work RVUs from 2.69 to 2.87 based on

a larger number of biopsies obtained

during a procedure. The RUC also stated

that technological advances allowing for

greater precision and detail in finding

abnormalities have increased the need

for this service. The RUC also stated that

technological advances have allowed for

more immediacy of results which

increases the post service work in

conveying the biopsy information and

treatment guidance to the patient. We

would note that the current work

increments for all endoscopic

gastrointestinal biopsy codes (described

as the base procedure with ‘‘biopsy,

single or multiple’’) are 0.3 RVUs.

Accepting the RUC recommendation

would increase this increment to 0.48

work RVUs while keeping all the other

biopsy increments at 0.3 work RVUs,

creating a clear rank-order anomaly.

Furthermore, this code is used for

‘‘single’’ biopsies, and, with the increase

in work, these biopsies would be

overvalued. We also do not understand

how technological advances in locating

lesions and getting more immediate

results increases the work of the

procedure itself. Therefore, we propose

maintaining the current work RVU for

this procedure.

Code 43244 (Upper gastrointestinal

endoscopy including esophagus,

stomach, and either the duodenum and/

or jejunum as appropriate; with band

ligation of esophageal and/or gastric

varices) and 43255 (Upper

gastrointestinal endoscopy including

esophagus, stomach, and either the

duodenum and/or jejunum as

appropriate; with control of bleeding,

any method):

The RUC recommended an increase in

work RVUs for code 43255 from 4.4 to

4.82 work RVUs based on new

technology, such as lasers, to control

bleeding. The RUC also states that this

new technology increases the intensity

of the procedure. However, the vignette

used to survey code 43255 describes use

of cautery to control bleeding. The work

for this code must be appropriate for all

methods of controlling bleeding and the

vignette must represent the typical case.

The current work increment for ‘‘control

of bleeding, any method’’ for

gastrointestinal endoscopic procedures

is 2.01 work RVUs. Acceptance of the

RUC recommendation for code 43255

would make this work increment 2.43

RVUs, for upper gastrointestinal

endoscopy only, creating a clear rankorder anomaly.

The RUC recommended an increase in

work RVUs for code 43244 from 4.59 to

5.05 RVUs, based on the increased

number of bands used to treat

esophageal varices. However, the RUC

agreed that the work RVUs for code

43244 were similar to the work RVUs

for code 43255. Therefore, accepting the

RUC recommendation for code 43244

and not code 43255 would create a clear

rank-order anomaly. We believe that

these two codes should have similar

work RVUs. Therefore, we propose to

maintain the current work RVUs for

these procedures.

Code 43247 (Upper gastrointestinal

endoscopy including esophagus,

stomach, and either the duodenum and/

or jejunum as appropriate; with removal

of foreign body):

The RUC recommended an increase in

work RVUs for this code from 3.39 to

3.59 work RVUs based on increased

complexity of the condition of patients

undergoing this procedure with a

concomitant increase in risk of

morbidity. The RUC used a buildingblock approach to validate its

acceptance of the median work RVUs

from the survey. We do not fully

understand the building-block analysis

the RUC used but believe it was invalid.

Moreover, the current work increment

for ‘‘removal of foreign body’’ for

gastrointestinal endoscopy procedures

is 1.0 work RVUs. Acceptance of the

RUC recommendation would create a

clear rank-order anomaly. Therefore, we

propose to maintain the current work

RVUs for this procedure.

Code 43249 (Upper gastrointestinal

endoscopy including esophagus,

stomach, and either the duodenum and/

or jejunum as appropriate; with balloon

dilation of esophagus (less than 30mm

diameter)):

The RUC recommended an increase

from 2.9 to 3.35 work RVUs for this

code based on increased complexity of

the condition of patients undergoing

this procedure. The current work

increment for ‘‘balloon dilation of

esophagus (less than 30 mm diameter)’’

is 0.51 RVUs for both the esophagus and

upper gastrointestinal endoscopy

families. Since this is the same

procedure in both families, it is unclear

why the work should be increased to

0.96 work RVUs for the upper

gastrointestinal family only. Accepting

the RUC recommendation would create

a clear rank-order anomaly. Therefore,

we are proposing to maintain the

current work RVUs for this code.

Code 43259 (Upper gastrointestinal

endoscopy including esophagus,

stomach, and either the duodenum and/

or jejunum as appropriate; with

endoscopic ultrasound examination):

The RUC recommended an increase in

work RVUs from 4.59 to 8.59 based on

the complexity of the equipment and

the skill and judgement required. The

RUC also noted that the survey results

supported this procedure as more

difficult than an endoscopic retrograde

cholangio-pancreatography (ERCP). The

RUC then used the following buildingblock methodology: (1) The RUC added

1.5 work RVUs, which was

approximately 75 percent of the

difference between the RUC

recommendation from the last 5-year

review (6.11 work RVUs) and the work

RVUs that we assigned (4.0 work RVUs).

(2) The RUC then added 2.2 work RVUs,

which are the work RVUs of code

93312. Not only do we disagree with the

RUC methodology for this

recommendation, but we also note that

the RUC has used the current work

RVUs for code 43259 to value not only

other gastrointestinal transendoscopic

ultrasound procedures but also many

transendoscopic ultrasound guided

biopsy codes. We would also note that

the RUC has recently re-evaluated code

43231, Esophagoscopy, rigid or flexible;

with endoscopic ultrasound

examination, and will be sending a new

recommendation to us regarding the

work valuation of this procedure.

Accepting the RUC recommendation for

this code would be inconsistent with

the RUC’s reevaluation of code 43231,

would invalidate the work valuation of

many other gastrointestinal endoscopy

31062 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

codes, and would create numerous rankorder anomalies. Therefore, we propose

to maintain this code at its current work

RVUs.

Codes 43263 (Endoscopic retrograde

cholangio-pancreatography (ERCP);

with pressure measurement of sphincter

of Oddi (pancreatic duct or common

bile duct)), 43265 (ERCP; with

endoscopic retrograde destruction,

lithotripsy of stone(s), any method), and

43269 (ERCP; with endoscopic

retrograde removal of foreign body and/

or change of tube or stent):

The RUC recommended an increase in

work RVUs from 6.19 to 7.29 for code

43263 based on the need to measure

pressures in both the biliary and

pancreatic sphincters as well as the

need for prolonged postoperative

monitoring. The RUC arrived at its

recommendation by adding 1.1 work

RVUs (the value of code 99214) to the

current work RVUs. We disagree with

valuing a post procedure observation

period as equal to an evaluation and

management service. Furthermore,

increasing the value of this code while

not adjusting the values of codes 43262,

43267, and 43268 creates clear rankorder anomalies.

The RUC recommended an increase in

work RVUs from 8.9 to 10.02 for code

43265 based on a rank-order anomaly

with code 43264. The RUC compared

survey times to the Harvard study times

for this code and used a building-block

method to arrive at its recommendation.

We do not fully understand the RUC

methodology and disagree with the

conclusion. The Harvard study time

data show less time for code 43265 than

for code 43264, which would indicate

that the current valuations of these

codes are correct. Moreover, increasing

the value of 43265 while not adjusting

codes 43264, 43267, and 43268 would

create clear rank-order anomalies.

The RUC recommended an increase in

work RVUs from 6.04 to 8.21 for code

43269 based on a rank-order anomaly

between this code and code 43268. The

RUC used a building-block methodology

adding 0.82 work RVUs to the work

RVUs of code 43268 (7.39) to arrive at

its recommendation. We disagree with

the RUC methodology of using an

evaluation and management service to

arrive at its recommendation since this

is an invasive procedure. Furthermore,

we believe increasing the value of this

code creates a rank-order anomaly with

codes 43271 and 43272. Therefore, we

are proposing maintaining the current

work RVUs of all three of these codes.

Codes 44388 (Colonoscopy through

stoma; diagnostic with or without

collection of specimen(s) by brushing or

washing (separate procedure)), 44389

(Colonoscopy through stoma; with

biopsy, single or multiple), 44390

(Colonoscopy through stoma; with

removal of foreign body), 44391

(Colonoscopy through stoma; with

control of bleeding, any method) 44392

(Colonoscopy through stoma; with

removal of tumor(s), polyp(s), or other

lesion(s) by hot biopsy forceps or bipolar

cautery), and 44393 (Colonoscopy

through stoma; with ablation of

tumor(s), polyp(s), or other lesion(s) not

amenable to removal by hot biopsy

forceps, bipolar cautery or snare

technique). 

These codes are in the same family of

codes, and the RUC recommended

increases in work RVUs for all these

codes based on a misvaluation of the

base code in this family of codes, code

44388. The RUC valued it similarly to

code 45378. We disagree. We think this

creates a clear rank-order anomaly

between the value of this family and the

value of the colonoscopy family of

codes beginning with code 45378.

Colonoscopy through a stoma is clearly

less work than colonoscopy of the

complete colon and it has been valued

as such since the inception of the

physician fee schedule. We question the

accuracy of the surveyed intraservice

time for this service. Because of our

nonacceptance of the increase in work

RVUs for the base code in this family,

we must also not accept the

recommendations for all other increases

in work RVUs for other codes in this

family. Moreover, the recommendations

create increments of work for ‘‘biopsy,

single or multiple,’’ ‘‘removal of foreign

body,’’ ‘‘control of bleeding, any

method,’’ ‘‘removal of tumors,’’ and

‘‘ablation of tumors,’’ which are

inconsistent with the same increments

for the colonoscopy family of codes

beginning with code 45378. Accepting

these RUC recommendations would

create clear rank-order anomalies that

do not currently exist. Therefore, we are

proposing to maintain the current work

RVUs for these procedures.

Code 45380 (Colonoscopy, flexible,

proximal to splenic flexure; with biopsy,

single or multiple).

The RUC recommended an increase in

work RVUs from 3.98 to 4.44 for this

code based on the increased number of

biopsies generally taken during this

procedure and the increased difficulty

in removing these polyps. The current

work increment for ‘‘biopsy, single or

multiple’’ for gastrointestinal

endoscopic procedures is 0.3 work

RVUs. Accepting the RUC

recommendation would create a clear

rank-order anomaly. Moreover, we note

that this code is also used for single

biopsies that would become

significantly overvalued if we accepted

the RUC recommendation. Therefore,

we are proposing to maintain the

current work RVUs for this code.

In summary, we believe the only way

to accurately value gastrointestinal

endoscopy procedures is to evaluate the

entire series of codes, including all

families of codes (esophagus, upper

gastrointestinal, ERCP, and colonoscopy

etc.) at the same time. Only then can

appropriate incremental work RVUs be

determined without creating rank-order

anomalies. We would also suggest that

the RUC consider reorganization of all

these codes to facilitate more accurate

coding (for example, to determine

whether every family of codes needs a

code for ‘‘removal of foreign body’’ or

whether the base code be revalued to

include more procedures than it

currently does).

We suggest that while the RUC is

reevaluating these codes that it delay

making recommendations on any new

codes for this series so that conflicting

recommendations are not made and the

chance of creating rank-order anomalies

is minimized.

With respect to the RUC

recommendation concerning reporting

and payment of conscious sedation

codes 90141 and 90142, we will be

reviewing data concerning this issue.

Any proposals we would have

concerning payment and reporting of

conscious sedation codes would be the

subject of future rulemaking.

9. Pulmonary Medicine/Critical Care

Comment: Several specialty groups,

including the societies for pulmonary

medicine and critical care, indicated

that codes 36620 and 36489 were

undervalued. Commenters indicated

that the work RVUs for code 36489

should be greater than the work RVUs

for the reference service code, 36010,

because there is more work involved.

Commenters also stated that code 36620

is undervalued as compared to the

reference code 36140, because there are

more variables affecting the work

involved with this procedure.

These specialty groups also requested

that codes 99291 and 99292 be

evaluated because the groups claimed

they were undervalued.

RUC Recommendation:

For code 36489, the RUC noted that

there is additional work and

postoperative time involved in this

procedure as compared to that of the

reference service code 36010, and

recommended work RVUs of 2.50 which

are higher than the reference service

code 36010 (2.43), which corrects the

rank-order anomaly. With respect to

36620, the RUC compared this

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31063

procedure to the reference service (code

36140) and agreed that this service

appeared to be undervalued. However,

the RUC was concerned that

anesthesiologists who perform this

procedure over 80 percent of the time

did not comment or participate in the

survey conducted by the specialty

groups. The RUC concluded that code

36620 should be referred to the CPT

Editorial Panel to clarify the appropriate

use of this code.

The RUC recommended maintaining

the work RVUs for critical care services

(codes 99291 and 99292) due to the lack

of compelling evidence to recommend

an increase in the work RVUs above the

2001 work RVUs of 4.00 and 2.00,

respectively.

HCFA Proposal:

We have reviewed and propose to

accept all of the RUC recommendations

for the pulmonary medicine and critical

care codes.

10. Cardiology

Comment: The American College of

Cardiology (ACC) recommended review

of three procedure codes under the 5-

year refinement. They are code 93350,

which was not reviewed during the first

5-year review but which the ACC

believes is undervalued; and codes

33234 and 33235, which ACC argues are

undervalued because it does not believe

the codes reflect the level of difficulty

associated with the procedures.

RUC Recommendation:

The RUC supported an increase in the

work RVUs for code 93350 to account

for the increased work and more

complex conditions of the patient

population as supported by survey

information submitted. The RUC

recommendation was to increase the

work RVUs to 1.48. For codes 33234 and

33235, they recommended that no

change be made in the work RVUs

because both procedures had been

recently reviewed by the RUC.

HCFA Proposal:

We have reviewed and propose to

accept all of the RUC recommendations

for the cardiology codes.

11. Pediatrics

Comment: The American Academy of

Pediatrics (AAP) submitted

approximately 40 codes involving

several specialty areas and indicated

that they believed these services are

undervalued, particularly when they are

provided to the pediatric population. A

few of these codes were also submitted

by other specialty groups and are

discussed under those areas (codes

29450, 99291, and 99292). The AAP

subsequently indicated to the RUC that

they were not interested in pursuing the

review of the work RVUs for the

following codes for this 5-year review:

11100, 11730, 17000, 17003, 17004,

20600, 36600, 52300, 52327, and 52340.

RUC Recommendation:

For codes 36400 and 36405, the RUC

agreed that an increase in the work

RVUs appeared to be warranted and

recommended work RVUs of 0.38 and

0.32, respectively. However, for codes

94640, 99440, 99233, 99273, and 99274,

the RUC indicated that compelling

evidence was not provided to suggest a

recommendation to increase the work

RVUs and thus the current RVUs should

be maintained for these services.

The RUC recommended that the

following codes be submitted to the CPT

Editorial panel for further consideration:

12001, 12002, 36406, 36520, 50200,

90935, 90937, 90945, 90947, 90989,

90993, 90997, 94664, and 94665.

For codes 99295, 99296, 99297,

99298, and 99436, the RUC

recommended no change in the work

RVUs for these services because these

services had recently been reviewed by

the RUC.

HCFA Proposal:

We have reviewed and propose to

accept all but two of the RUC

recommendations for the pediatric

codes.

For code 36400 (Venipuncture, under

age 3 years; femoral, jugular or sagittal

sinus), the RUC recommended an

increase in work RVUs from 0.18 to

0.38. The RUC survey compared this

code to code 36410 (Drawing blood,

child over 3 or adult, necessitating

physician’s skill (separate procedure),

for diagnostic or therapeutic purposes)

(work RVUs of 0.18). The survey times

indicated that the pre-, intra-, and

postservice times for code 36400 were

less than the times for code 36410. The

median work RVUs from the survey

were 0.71, and the 25th percentile work

RVUs were 0.30. The specialty society

recommended work RVUs of 0.71, citing

the change in population of patients

requiring this procedure (being younger

and smaller). The RUC also compared

code 36400 to code 99212 (Office/

outpatient visit, established patient)

with work RVUs of 0.45 and believed

the work RVUs of code 36400 were

comparable to the work RVUs of code

99212). The RUC then recommended

work RVUs between the 25th percentile

of the survey and the work RVUs of

code 99212. We do not believe it is

appropriate to compare the work RVUs

of a venipuncture to the work of an

evaluation and management service.

Furthermore, we are concerned about

the spread in the survey work RVUs

from 0.30 at the 25th percentile to 0.71

at the median. In view of the survey

times being less than the reference code

(with work RVUs of 0.18), the

inconsistency of the survey times with

the survey RVUs, and the inappropriate

comparison to an evaluation and

management service, we are proposing

to continue the work RVUs of code

36400 as 0.18 work RVUs.

For code 36405 (Venipuncture, under

age 3 years; scalp vein), the RUC

recommended an increase in work

RVUs from 0.18 to 0.32. The survey

compared code 36405 to code 36410.

The pre-, intra-, and postservice times

for code 36405 were less than the times

for the reference code. The survey RVUs

were widely spread with the 25th

percentile work RVUs being 0.2 and the

median work RVUs being 0.4. The RUC

also compared code 36405 to code

99212 (0.45) and recommended a value

between the survey 25th percentile

work RVUs and the work RVUs for code

99212. Our concerns about this

recommendation are similar to the

concerns about the recommendation for

code 36400. In view of the survey times,

the wide range of survey work RVUs,

and the inappropriate comparison to an

evaluation and management service, we

are proposing to continue the work

RVUs of code 36405 at 0.18.

12. Pediatric Surgery

Comment: The American Pediatric

Surgical Association (APSA) stated that

the pediatric surgery procedure codes

are misvalued and included

recommended work RVUs. While they

suggested reductions in the work RVUs

of codes 46705 and 46715 to retain

relativity in the family of services, they

believed that the majority of the codes

they provide are significantly

undervalued. The association justifies

the need to increase the work RVUs for

these services based on one or more of

the following rationales:

• A change in practice and

technology.

• A change in the patient population

for which the code is most frequently

applied.

• An undervaluation of the

postservice work in the global period.

• Rank-order anomalies.

• Extended postoperative critical

care. It is the provision of very

intensive, prolonged services with long

episodes of critical care and long

hospital stays that account for the very

high work RVUs recommended for some

procedures. APSA subsequently

indicated that they did not want to

pursue review of two codes under the 5-

year review: 43305 and 60280.

RUC Recommendation:

The RUC recommended that the

suggested decreases in the work RVUs

31064 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

for codes 46705 and 46715 be

implemented. The recommended work

RVUs are 6.90 for code 46705 and 7.20

for code 46715.

Based on the information provided by

the specialty society, the RUC

recommended increasing work RVUs for

the following codes to address the

undervalued physician work in the

intra- and postservice periods, the

extended critical care services, and a

change in patient population: 39503

(95.00); 44055 (22.00); 46716 (15.07);

46730 (26.75); 46735 (32.17); 46740

(30.00); 46742 (35.80); 46744 (52.63);

46746 (58.22); 46748 (64.21); 49215

(33.50); and 49605 (76.00).

The RUC did not receive compelling

evidence to suggest that an increase is

needed in the work RVUs for these

codes: 36822, 45120, 45121, 47701, and

49606.

The RUC recommended that the

following codes be referred to the CPT

Editorial Panel for clarification and

review: 21740, 43310, 43312, 49495,

and 49496. In some instances, new

codes may need to be created to

accurately value services performed on

the pediatric and adult population.

HCFA Proposal:

We propose to accept all but two of

the RUC recommendations for the

pediatric surgery codes. The RUC

recommended large increases in work

RVUs for codes 39503 (Repair, neonatal

hernia, with or without chest tube

insertion and with or without creation of

ventral hernia) and 49605 (Repair of

large omphalocele or gastrochsis; with

or without prosthesis) for both of these

procedures (an increase from 37.54 to

95.0 work RVUs for code 39503 and

from 24.94 to 76.0 work RVUs for code

49605). These increases were based

entirely on the increase of postoperative

work required for these procedures,

resulting in an increase of

approximately 50 work units for each

code. Both procedures are performed on

neonates who require prolonged stays in

the intensive care unit postoperatively.

We understand that the postoperative

care may be performed by the surgeon,

the intensivist, or both physicians. In

situations where the postoperative care

is provided by both physicians, we

could make duplicate payments for

postoperative care if we continue to

value these as 90-day global procedures.

To permit the physician who is

performing the postoperative care to be

appropriately paid, but prevent

duplicate payment for the same

services, we are considering a reduction

in the global period (for example,

making the global period 10 or 0 days).

If we shortened the global period for

these services, appropriate work RVUs

consistent with this change would need

to be developed. If the surgeon provides

postoperative care outside of the 10-day

global period (that is, 10 days after the

date of surgery)or outside of the 0-day

global period (that is, the day after

surgery) he or she would bill separately

for those services. Moreover, if the

intensivist provides the postoperative

care, then the intensivist would bill for

the service, and there would be no

duplicate payment to the surgeon.

Based on the above discussion, we are

proposing to maintain the current RVUs

for these two CPT codes (39503 and

49605) as an interim for 2002 and would

ask the RUC to submit work RVU

recommendations for these codes

valued with reduced global periods (a 0-

day or 10-day period). We would

consider the RUC recommendations and

make a proposal to initiate a change to

the global period as well as associated

RVUs in next year’s proposed rule. We

invite comments on the issue of

reducing the global period for these

services and welcome any alternative

suggestions that we could consider that

address our concerns of eliminating

duplicate payment.

13. Radiology

Comment: The American College of

Radiology (ACR) identified three codes

that they believe are undervalued. The

code 76065, radiologic examination of

an infant, is most commonly performed

in the situation of alleged child abuse

and requires a significant amount of

physician work. Additionally,

radiologists indicated that the work

RVUs for two mammography procedure

codes (codes 76090 and 76091) are not

reflective of the amount of physician

work necessary to perform all the

requirements for the government

regulated procedures and ACR

standards. The level of quality control

and quality assurance requirements

instituted by the Food and Drug

Administration (FDA) and

Mammography Quality Standards Act of

1992 (MQSA) have increased the level

of physician time outside of the direct

patient care time. The current work

RVUs assigned to these codes are not

adequate to perform this procedure in

accordance with Federal regulations or

ACR standards. ACR contended the

combination of increased mental effort

and judgement, psychological stress,

time, and intensity mandate that the

work RVUs for these codes should be

increased.

RUC Recommendation:

The RUC noted that the intensity for

code 76065 is higher than the reference

service code 76062 and that for

intraservice work the physician

typically reviews more films. The RUC

recommended work RVUs of 0.70 for

code 76065. For the mammography

procedure codes, the RUC was in

agreement that as a result of the

revisions of the MQSA requirements,

which require the physician to code

radiologic results using BIRADs

terminology and require that separate

reports be sent to the patient and

referring physician, the codes result in

increased physician time, mental effort,

and judgement. In addition, code 76091

is a bilateral mammography requiring

two studies to be performed. Based on

survey information, the RUC

determined the 25th percentile of the

survey was the appropriate value and

recommended work RVUs of 0.70 for

code 76090 and 0.87 for code 76091.

HCFA Proposal: 

We have reviewed and propose to

accept all of the RUC recommendations

for the radiology codes discussed above.

We would also note that section 104

of the Medicare, Medicaid, and SCHIP

Benefits Improvement and Protection

Act of 2000 (Public Law 106–554) puts

screening mammography under the

physician fee schedule for services

furnished beginning January 1, 2002.

We will include our recommendation of

the work RVUs for this service for CY

2002 as part of the physician fee

schedule proposed rule for CY 2002.

Because this will be a new code in the

physician fee schedule, we have asked

the RUC to recommend work RVUs for

screening mammography.

14. Plastic Surgery

Comment: The American Society of

Plastic Surgery (ASPS) requested that

codes 42205 and 49905 be reviewed

under the 5-year review. ASPS

indicated that there currently is a rankorder anomaly for code 42205 that was

created when other codes in the family

of codes were reviewed and increased

during the first 5-year review. They

recommended an increase to the work

RVUs (9.59 to 12.0) for this code that

would reestablish rank-order in the cleft

palate family of codes. With respect to

code 49905, ASPS stated that this code

is currently designated as an add-on

code, which was not the intent of the

specialty group when they submitted

the proposal to the AMA CPT Editorial

Panel in 1991 for creation of this code.

They also disagree with our assumption

that pre- and postoperative work was

included in the RUC-recommended

work RVUs that we reduced. ASPA

recommended that code 49905 be

changed from an add-on to a primary

procedure code with a 90-day global

period and be assigned work RVUs

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31065

comparable to those of code 15374

(17.79).

RUC Recommendation: 

The RUC reviewed code 42205 and

recommended an increase in the work

RVUs (for work RVUs of 13.29), which

will correct the existing rank-order

anomaly in this family of codes. The

RUC recommended that code 49905 be

referred to the CPT Editorial Panel for

review.

HCFA Proposal: 

We have reviewed and proposed to

accept the RUC recommendations for

the plastic surgery codes.

C. Other Comments

1. Anesthesia Services

The American Society of

Anesthesiologists (ASA) contended that

the work of anesthesia services is

undervalued by almost 31 percent. (This

initial request was subsequently

adjusted based on additional

discussions with the RUC.)

As required by law, we base Medicare

payments for anesthesia services on

allowable base and time units. We have

developed a uniform relative value

guide in which the base unit per

anesthesia code is largely based on the

American Society of Anesthesiologists’

1988 relative value guide.

Anesthesiologists report the actual

anesthesia time for each procedure on

the claim, and the carrier converts the

time to time units. The carriers then

multiply the sum of the base units and

time units by the anesthesia conversion

factor.

We used the results of the original

Harvard Study on work to determine the

adjustment to the anesthesia CF under

the physician fee schedule in 1992.

(Anesthesia services do not have work

RVUs. Therefore, if work RVUs of other

physician services are increased an

adjustment has to be made to the

anesthesia CF so that the work of

anesthesia services remains on the same

scale as other physician work.)

In the first 5-year review of work, we

accepted the RUC’s recommendation

that the work of anesthesia services was

undervalued by 22.76 percent, which

resulted in a 16 percent increase in the

anesthesia CF.

The approach to this 5-year review

used by the ASA involves a physician

survey and a consensus panel review.

The survey was sent to 262 members of

the ASA in a geographically

representative sample. Eighty-five

surveys were returned from respondents

who were geographically representative

of the specialty as a whole. The findings

of the survey were presented to an

expert consensus panel of 16 practicing

anesthesiologists from the ASA’s

Relative Value System (RVS)

Committee. The work of the anesthesia

service was uniformly divided into five

components. These components are—

preoperative evaluation, equipment and

supply preparation, induction period,

postinduction anesthesia period, and

postoperative care and visits. The

survey median times were assigned to

each of the five components. The

consensus panel assigned the work

RVUs of an evaluation and management

code, usually codes 99202 or 99201, to

the preoperative evaluation. The

consensus panel developed a codespecific survey time estimate and

intensity value for equipment and

supply preparation. For postoperative

care and visits, the consensus panel

assigned work RVUs equivalent to those

of an evaluation and management code,

usually code 99211 or 99231. The

survey median time for the

postinduction anesthesia period was

divided in quintiles and each quintile

was assigned intensity work RVUs

ranging from 0.026 to 0.085. The

consensus panel identified the typical

anesthetic by procedure code and

generally used the intensity of code

31500, Intubation, endotracheal,

emergency procedure, a similar CPT

code, to value the work. This

methodology was used for 19 highvolume surgical codes requiring

anesthesia and representing a

reasonable variety of surgical services.

The following illustrates this

approach for anesthesia code 00404 and

the underlying surgical code 19240

(Modified radical mastectomy):

Work RVUs

Preanesthesia Median Time ........................................................................................................... 15 min.

• Preanesthesia reference code 99202 ......................................................................................... 0.88

Equipment and Supply Preparation Median Time .......................................................................... 10 min. 0.14

Induction Period Procedure Time ................................................................................................... 10 min. 0.93

Post Induction Anesthesia Period:

Level 1 Time ............................................................................................................................ 87 min.

Level 2 Time ............................................................................................................................ 10 min.

Level 3 Time ............................................................................................................................ 10 min.

Level 4 Time ............................................................................................................................ 0 min.

Level 5 Time ............................................................................................................................ 0 min. 3.09

Postanesthesia Time ....................................................................................................................... 14 min.

• Postanesthesia Reference Code 99231 ..................................................................................... 0.64

Total Work RVUs ..................................................................................................................... 5.68

For each code, the total work RVUs

were compared to a Medicare fee

schedule imputed work value. The

Medicare imputed work value is

computed by multiplying the average

allowed anesthesia charge per code by

the anesthesia work share and dividing

by the national CF. The average

anesthesia allowed charge is determined

by surgical code from HCFA’s 5 percent

Beneficiary File.

Based on this analysis, the ASA

requested a 24 percent increase in

anesthesia work.

RUC Recommendation:

The RUC furnished no

recommendation on anesthesia services;

instead it assigned to a newly created

workgroup the responsibility for

reviewing anesthesia services in the

context of the physician fee schedule.

The ASA will be working with this

workgroup on clinical issues, such as

induction and postinduction intensity

RVUs.

HCFA Proposal:

We propose to make no changes to the

anesthesia CF at this time to reflect the

5-year review of physician work for

anesthesia services. However, we may

make changes in response to

recommendations the RUC may provide.

2. Spine Injection Procedures

Comment: The American Society of

Anesthesiologists submitted a request

for re-evaluation of seven spinal

injection codes that they, along with

several other medical associations, had

expressed concern about when the

codes were revalued for CY 2000. They

continue to believe the work RVUs

31066 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

assigned by the RUC in 1999 and

forwarded to HCFA were appropriate.

RUC recommendation:

In 1999, when the RUC forwarded

revised work RVUs, we agreed with the

relativity of the four injection codes

(62310, 62311, 62318, and 62319), but

applied a budget-neutrality factor that

the specialties believe is inappropriate.

In 1999, we also decreased the RUCrecommended work RVUs for codes

72275, 62263, and 76005 based on our

belief that the values were too high. The

RUC has now reviewed the original

surveys and subsequent

recommendations and continues to

believe that its 1999 recommendations

for work RVUs for these codes are

appropriate. They recommended the

following work RVUs for these services:

62310 (2.20); 62311 (1.78); 62318 (2.35);

62319 (2.15); 62263 (7.20); 72275 (0.83)

and 76005 (0.60). (Note: for code 76005,

the work RVUs were 0.60 for this

service on the CY 2000 fee schedule)

HCFA Proposal:

We propose to reject the RUC

recommendations for these codes for the

following reasons:

Codes 62310 (Single injection (not via

indwelling catheter), not including

neurolytic substances, with or without

contrast (for either localization or

epidurography), of diagnostic or

therapeutic substance(s) (including

anesthetic, antispasmodic, opioid,

steroid, other solution), epidural or

subarachnoid; cervical or thoracic)),

62311 (Single injection (not via

indwelling catheter), not including

neurolytic substances, with or without

contrast (for either localization or

epidurography), of diagnostic or

therapeutic substance(s) (including

anesthetic, antispasmodoic, opioid,

steroid, other solution), epidural or

subarachnoid, lumbar, sacral(caudal)),

62318 (Injection, including catheter

placement, continuous infusion or

intermittent bolus, not including

neurolytic substances, with or without

contrast(for either localization or

epidurography), of diagnostic or

therapeutic substance(s) (including

anesthetic, antispasmodic, opioid,

steroid, other solution), epidural or

subarachnoid; cervical or thoracic), and

62319 (Injection, including catheter

placement, continuous infusion or

intermittent bolus, not including

neurolytic substances, with or without

contrast (for either localization or

epidurography), of diagnostic or

therapeutic substance(s) (including

anesthetic, antispasmodoic, opioid,

steroid, other solution), epidural or

subarachnoid; lumbar, sacral (caudal)).

These were new codes for CY 2000.

The RUC submitted recommendations

for these codes in CY 1999. We accepted

the RUC recommendations and made a

work-neutrality adjustment because

these new codes replaced codes under

which these services were billed before

2000. The RUC and several specialty

societies disagreed with the data we

used in making our work-neutrality

adjustment. (Work-neutrality

adjustments ensure that the

recommendations for work RVUs for

new and revised services are adjusted so

that the sum of the new or revised work

RVUs (weighted by projected frequency

of use).) for a family of codes will be the

same as the sum of the current work

RVUs (weighted by frequency of use).

We have reviewed the data used to

make our work-neutrality adjustment

and have determined that the

adjustment made was accurate. The

RUC work recommendations for the 5-

year review are identical to the

recommendations we received and

evaluated in CY 1999. In view of this,

we are proposing to maintain the

current work RVUs for these services.

Code 62263 (Percutaneous lysis of

epidural adhesions using solution

injection (eg, hypertonic saline, enzyme)

or mechanical means (eg, spring-wound

catheter) including radiologic

localization (includes contrast when

administered).

This was a new code for CY 2000. We

received RUC recommendations in CY

1999 for this code and disagreed with

them. The RUC recommendation was

7.20 work RVUs, and we made the

interim work RVUs 6.02 for CY 2000. In

the summer of 2000, we convened a

multispecialty review panel that

reviewed this code in detail and

recommended work RVUs of 6.14. We

finalized the multispecialty review

panel recommendation of 6.14 work

RVUs for CY 2001. The current RUC

recommendation is identical to the RUC

recommendation from CY 1999. We find

no compelling reason to change the

RVUs for this procedure, especially

since this procedure was reviewed by a

multispecialty panel less than 1 year

ago. We propose to continue the current

work RVUs for this procedure.

Code 72275 (Epidurography,

radiological supervision and

interpretation).

This code was new for CY 2000. The

RUC submitted a recommendation for

0.83 RVUs. We disagreed with this

recommendation and made the interim

work RVUs 0.54 for CY 2000. We

submitted this code to a multispecialty

review panel that recommended an

increase to 0.76 work RVUs that we

implemented for CY 2001. The RUC

now submits a recommendation of 0.83

work RVUs for this procedure, identical

to its prior recommendation. In the

absence of compelling reasons to change

the current work RVUs, and because

this code was reviewed by an objective

multispecialty panel less than 1 year

ago, we are proposing to continue the

current work RVUs.

Additionally, codes 62310, 62311,

62318, 62319, 62263, and 72275 were

reviewed and finalized in the July 2000

Multispecialty Refinement Panels for

new and/or revised services. Since the

RUC recommendations have offered no

evidence in addition to that which was

presented at the July 2000

Multispecialty Refinement Panel

Meeting, we propose to retain the

existing work RVUs.

3. Biofeedback

Comment: One organization, Medcare,

requested review of the work and

practice expense RVUs for biofeedback

codes 90911 and 90901, as it believes

that these codes currently are

undervalued.

RUC Recommendation:

The RUC reviewed the original survey

data for code 90911 and noted that

while we had decreased the original

RUC-recommended work RVUs, we

received no further information to

indicate that our rationale for reducing

the work RVUs was inappropriate, and

the specialty societies that perform the

service did not present new information

in response to the decrease. The RUC

recommended that the current RVUs be

maintained since it received no

compelling evidence to recommend an

increase in work RVUs.

HCPAC Recommendation:

The HCPAC recommended that the

current work RVUs be maintained for

code 90901 because we received no

additional information from the

specialists who perform this service to

warrant an increase in work RVUs.

HCFA Proposal:

We reviewed and propose to accept

the RUC and HCPAC recommendations

for biofeedback services.

4. Surgical Management of Burn

Wounds

Comment: The American Burn

Association (ABA) submitted codes

commonly used for the surgical

management of burn wounds (codes

15000 through 15641). The ABA

requested assignment of RVUs for these

codes that more appropriately reflect the

work involved. ABA also requested the

creation of more specific codes that

would obviate the need for ‘‘G’’ codes.

The ABA indicated that these codes

should be exempt from CPT payment

policies with respect to the 90-day

global period, multiple procedures and

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31067

staged procedures due to the unique

clinical case management of burns.

RUC Recommendation:

The RUC recommended that the

following codes be reviewed by the CPT

Editorial Panel: 15000, 15001, 15100,

15101, 15120, 15121, 15350, 15351,

15400, and 15401.

HCFA Proposal:

We have reviewed and proposed to

accept the RUC recommendation for

these codes.

5. Transplantation

Comment: The American Society for

Transplant Surgeons requested

reassessment of the work RVUs for code

47134 because the current work RVUs

do not accurately reflect the work

involved (it contended that over 50

percent of these procedures involve

right lobectomies that are more labor

intensive than left lobectomies, on

which the current work RVUs are

based). As an alternative, the American

Society for Transplant Surgeons also

suggested referral to the CPT Editorial

Panel for consideration of creation of an

additional code.

RUC Recommendation:

The RUC recommended that code

47134 be forwarded to the CPT Editorial

Panel for further consideration.

HCFA Proposal:

We have reviewed and propose to

accept the RUC recommendation for this

code.

6. Arthroscopy Services

Comment: The Arthroscopy

Association of North America (AANA)

requested that work for other

arthroscopy services be reconsidered in

light of the increase in work RVUs for

code 29848 in the last 5-year review.

The AANA also requested a specific

increase in the work RVUs for code

29889. Subsequently, the specialty

society chose not to pursue its request

for consideration for code 29881.

RUC Recommendations:

For code 29883, the RUC noted that

this service consisted of two procedures,

medial and lateral meniscus repair.

Because this service encompassed the

work involved in code 29882 plus

additional work for the lateral meniscus

repair, and using the building-block

approach, the RUC recommended work

RVUs of 11.05 for this service. For code

29889, the RUC indicated that, due to

the increase in post-and intraservice

time, the work RVUs should be

increased to 16.00.

HCFA Proposal:

We have reviewed and propose to

accept the RUC recommendation for this

code.

7. Wheelchair Management

Comment: The American Physical

Therapy Association requested review

of code 97542.

HCPAC Proposal: We had revised the

recommended work RVUs for this code

when it was previously reviewed by the

HCPAC in 1995, based on a comparison

of code 97542 to code 97032 rather than

to code 97110. The HCPAC concluded

that our comparison was incorrect

because code 97032 is the application of

a modality, while code 97542 requires

additional skills because the patients

requiring this service have cognitive,

sensory, and physical disabilities. In

addition, HCPAC indicated that we may

not have understood that this procedure

is reported very infrequently. The

HCPAC supports its original

recommendation of 0.45 work RVUs for

this service.

HCFA Proposal:

We have reviewed and propose to

accept the HCPAC recommendation for

this code.

8. Psychological Testing

Comment: The American

Psychological Association

recommended that we review five

psychological testing codes (96100,

96105, 96110, 96115, and 96117).

HCPAC Recommendation:

The HCPAC did not have any

recommendations for these codes at this

time. However, it indicated that the

American Psychological Association

may request HCPAC to review these

services at a future date once additional

information is collected.

HCFA Proposal:

We propose to make no changes at

this time. We believe more precise

definitions of these services may be

necessary to value them properly and to

ensure proper coding and billing of

these services.

9. Podiatric Services

Comment: The American Podiatric

Medical Association submitted five

codes (trim skin lesions/trim nails) for

review (11719, 11055, 11056, 11057,

and G0127) indicating that they are

undervalued and do not accurately

reflect the level of physician work

involved.

HCPAC Recommendation:

The HCPAC reviewed these codes and

had no information to support an

increase in work RVUs. However, the

HCPAC requested that we review our

current utilization data to ensure that

the original utilization assumptions

were correct. The HCPAC recommended

that the current review of data should be

based on actual 1999 utilization data

since these codes were not fully

implemented until April 1, 1998.

HCFA Proposal:

Taking into account the

recommendation of the HCPAC, we

propose to review utilization data

associated with the aforementioned

codes to ensure the original

assumptions are still correct. We will

publish our final decision in the

November 2001 final rule.

D. Other Issues

1. Critical Care Services in a Global

Period

Validation of RUC recommendations

for the work of many surgical

procedures included the use of a

‘‘building-block’’ methodology as

previously described. Before this 5-year

review, the RUC compared the work of

a postoperative intensive care unit visit

by the surgeon to a level three

subsequent hospital visit (code 99233)

which is valued at 1.51 work RVUs.

Now, for the first time since the

inception of the physician fee schedule,

one of the ‘‘building blocks’’ the RUC

used to validate postoperative work by

the surgeon in the intensive care unit is

code 99291 (Critical care, evaluation

and management of the critically ill or

critically injured patient, first 30–74

minutes), which is valued at 4.00 work

RVUs. Specifically, the RUC validated

the postoperative work of several

thoracic, vascular, and general surgical

procedures by comparing the surgeon’s

intensive care unit visits to code 99291.

Current Medicare policy allows

separate payment to the surgeon for

postoperative critical care services

during the surgical global period only

when the patient has suffered trauma or

burns. If the surgeon provides critical

care services during the global period,

for reasons unrelated to the surgery, that

is separately payable as well.

The RUC recommendations have

raised several issues for which we are

considering future action. In view of our

desire to ensure that Medicare

beneficiaries have appropriate access to

critical care services, and to ensure that

we make appropriate payments to

physicians furnishing postoperative

critical care services to Medicare

beneficiaries, we are soliciting

information and comments on the

following questions and issues:

1. If critical care (as described in CPT

2001) is provided postoperative, who

typically provides this care? The

surgeon, an intensivist, other

physicians?

2. Do surgeons typically meet the CPT

requirements for billing critical care

services (as described in CPT 2001)

31068 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

when making intensive care unit visits

on their postoperative patients?

3. Are surgeons currently performing

more, or less, critical care on their

postoperative patients than they were at

the time of the last 5-year review?

4. What is, or will be, the effect of

‘‘closed’’ intensive care units (a unit

staffed by dedicated intensivists who

manage the care for all patients in the

intensive care unit) on who performs

postoperative critical care services?

5. What is the likelihood of making

duplicate payment for critical care

services if the surgical global period is

valued with the inclusion of critical care

in the postoperative work (for example,

if we also pay an intensivist for

postoperative critical care services)?

6. If valuation of the surgical global

period includes postoperative critical

care, are there concerns about additional

carrier scrutiny being applied to claims

from intensivists for postoperative

critical care services?

7. Does valuation of the surgical

global period with the inclusion of

postoperative critical care create an

incentive for the surgeon to either (a)

not perform postoperative critical care

services if there is an intensivist

available or (b) to not consult an

intensivist if one is available?

Below are some of the options we are

considering:

• Removing work RVUs for critical

care services from the surgical global

period, valuing these services as

subsequent hospital visits and allowing

surgeons to bill separately for critical

care (for an identified subset of surgical

procedures where there is a high

likelihood that the surgeon is typically

providing critical care services).

• Removing the work RVUs for

critical care services from the surgical

global period, valuing these services as

subsequent hospital visits and not

allowing surgeons to bill separately for

critical care services.

• Leaving the work RVUs for critical

care services in the surgical global

period, not allowing surgeons to bill

separately for critical care services,

requiring surgeons to follow

documentation rules for critical care

services and instructing carriers to make

payment for medically necessary critical

care services furnished by other

physicians. (This option would facilitate

tracking of critical care services, permit

appropriate medical record review, and

provide a basis to re-evaluate the work

of the procedure.)

Valuing the surgeon’s postoperative

intensive care unit visits as critical care

services has raised a number of issues.

We believe these issues will require a

change in payment policy to ensure that

postoperative critical care is

appropriately paid. Therefore, we are

proposing to make the work RVUs for

those surgical codes where any

postoperative intensive care unit visits

were valued as critical care, interim,

until we address the issues discussed

above.

2. Codes Referred to CPT

As discussed in sections B and C

above, there were some codes that

commenters had submitted for review

that the RUC recommended be referred

to the CPT Editorial Panel for

clarification or consideration of

definitional changes. These codes are

listed in Table 2, which follows.

TABLE 2.—CODES REFERRED TO CPT

EDITORIAL PANEL FROM FIVE-YEAR

REVIEW OF WORK RELATIVE VALUE

UNITS

CPT/

HCPCS

code 1

Mod Descriptor

12001 ....... ......... Repair superficial

wound(s)

12002 ....... ......... Repair superficial

wound(s)

15000 ....... ......... Skin graft

15001 ....... ......... Skin graft add-on

15100 ....... ......... Skin split graft

15101 ....... ......... Skin split graft add-on

15120 ....... ......... Skin split graft

15121 ....... ......... Skin split graft add-on

15350 ....... ......... Skin homograft

15351 ....... ......... Skin homograft add-on

15400 ....... ......... Skin heterograft

15401 ....... ......... Skin heterograft add-on

20205 ....... ......... Deep muscle biopsy

21740 ....... ......... Reconstruction of sternum

23076 ....... ......... Removal of shoulder lesion

24076 ....... ......... Remove arm/elbow lesion

25076 ....... ......... Removal of forearm lesion

27048 ....... ......... Remove hip/pelvis lesion

27328 ....... ......... Removal of thigh lesion

27619 ....... ......... Remove lower leg lesion

33875 ....... ......... Thoracic aortic graft

33877 ....... ......... Thoracoabdominal graft

35381 ....... ......... Rechanneling of artery

35541 ....... ......... Artery bypass graft

35546 ....... ......... Artery bypass graft

35551 ....... ......... Artery bypass graft

35582 ....... ......... Vein bypass graft

35641 ....... ......... Artery bypass graft

35646 ....... ......... Artery bypass graft

35840 ....... ......... Explore abdominal vessels

35860 ....... ......... Explore limb vessels

36406 ....... ......... Drawing blood

36520 ....... ......... Plasma and/or cell exchange

36533 ....... ......... Insertion of access device

36534 ....... ......... Revision of access device

TABLE 2.—CODES REFERRED TO CPT

EDITORIAL PANEL FROM FIVE-YEAR

REVIEW OF WORK RELATIVE VALUE

UNITS—Continued

CPT/

HCPCS

code 1

Mod Descriptor

36535 ....... ......... Removal of access device

36620 ....... ......... Insertion catheter, artery

37615 ....... ......... Ligation of neck artery

37618 ....... ......... Ligation of extremity artery

37700 ....... ......... Revise leg vein

37720 ....... ......... Removal of leg vein

37730 ....... ......... Removal of leg veins

37735 ....... ......... Removal of leg veins/lesion

37760 ....... ......... Revision of leg veins

37785 ....... ......... Revision secondary varicosity

43215 ....... ......... Esophagus endoscopy

43310 ....... ......... Repair of esophagus

43312 ....... ......... Repair esophagus and

fistula

47134 ....... ......... Partial removal, donor

liver

49495 ....... ......... Repair inguinal hernia,

init

49496 ....... ......... Repair inguinal hernia,

init

49905 ....... ......... Omental flap

50200 ....... ......... Biopsy of kidney

50230 ....... ......... Removal of kidney

90935 ....... ......... Hemodialysis, one evaluation

90937 ....... ......... Hemodialysis, repeated

eval

90945 ....... ......... Dialysis, one evaluation

90947 ....... ......... Dialysis, repeated eval

90989 ....... ......... Dialysis training, complete

90993 ....... ......... Dialysis training, incompl

90997 ....... ......... Hemoperfusion

94664 ....... ......... Aerosol or vapor

inhalations

94665 ....... ......... Aerosol or vapor

inhalations

3. Budget Neutrality

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

requires that increases or decreases in

relative value units may not cause the

amount of expenditures for the year to

differ by more than $20 million from

what expenditures would have been in

the absence of these changes. If this

threshold is exceeded, we make

adjustments to preserve budget

neutrality. This year, budget-neutrality

adjustments will be required for changes

in work relative value units resulting

from the 5-year refinement. Revisions in

payment policies, including the

establishment of interim and final

relative value units for coding changes

that will be announced later this year,

may result in additional budgetneutrality adjustments.

We considered making the statutorily

required budget-neutrality adjustments

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices 31069

to account for the 5-year review of

physician work by reducing all work

RVUs. We estimate that all work RVUs

would have to be reduced by 0.7 percent

under this option. Alternatively, we

considered making an adjustment to the

physician fee schedule CF to meet the

provisions of section 1848(c)(2)(B). This

option would require an estimated 0.3

percent reduction in the conversion

factor. For the 5-year review, we are

proposing to reduce the conversion

factor by 0.3 percent to meet the

provisions of section 1848(c)(2)(B).

HCFA Proposal:

We propose to make the budgetneutrality adjustment by reducing the

CF.

4. Calculation of Practice Expense and

Malpractice Expense RVUs

As we noted in the November 2, 1999

final rule (64 FR 59427), practice

expense and malpractice expense RVUs

were not subject to comment and will

not be recalculated (other than the

change to practice expense RVUs that

result from changes in work) as part of

the 5-year review of work RVUs. Section

4505 of the BBA also provides for the

gradual 4-year transition for resourcebased practice expenses, with resourcebased practice expenses becoming fully

effective in CY 2002. We are currently

in the process of developing our annual

physician fee schedule proposed rule

that will continue the 4-year refinement

process for resource-based practice

expense RVUs.

Section 4505(f) of the Balanced

Budget Act of 1997 (BBA) amended

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

requires us to implement resource-based

malpractice RVUs for services furnished

beginning in CY 2000. A methodology

for establishing resource-based

malpractice RVUs was included in the

November 1999 final rule and

implemented January 1, 2000. In

addition, based on concerns expressed

by commenters, updated premium data

used under this methodology were

obtained and used to calculate

malpractice RVUs for CY 2001.

Since resource-based malpractice

RVUs were recently implemented, and

resource-based practice expenses are in

the final phase of transition to a fully

resource-based system, these

components are not being included in

this 5-year review. However, as stated

above we expect to publish our annual

physician fee schedule proposed rule

that will propose continuing

refinements to resource-based practice

expense RVUs.

5. Nature and Format of Comments on

Work RVUs

We will accept comments on the

proposed work RVUs for the codes

identified in the Addendum of this

notice. We will also accept comments

on the anesthesia codes. Comments

should discuss how the work associated

with a given CPT or HCPCS code is

analogous to the work in other services

or discuss the rationale for disagreeing

with the proposed work RVU. We are

especially interested in information or

arguments that were not presented in

earlier comments.

III. Collection of Information

Requirements

This document does not impose

information collection and

recordkeeping requirements.

Consequently it need not be reviewed

by the Office of Management and

Budget under the authority of the

Paperwork Reduction Act of 1995 (44

U.S.C. 3501 et seq.)

IV. Response to Comments

Because of the large number of items

of correspondence we normally receive

on Federal Register documents

published for comment, we are not able

to acknowledge or respond to them

individually. We will consider all

comment received by the date and time

specified in the DATES section of this

preamble, and we will respond to the

comments in the physician fee schedule

final rule.

V. Regulatory Impact Analysis

A. Overall Impact

We have examined the impacts of this

proposed notice as required by

Executive Order 12866 (September

1993, Regulatory Planning and Review)

and the Regulatory Flexibility Act (RFA)

(September 9, 1980 Public Law 96–354).

Executive Order 12866 directs agencies

to assess all costs and benefits of

available regulatory alternatives and, if

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 major rules with

economically significant effects ($100

million or more annually). While the

changes in the Medicare physician fee

schedule due to the 5-year review are

budget neutral, they do involve a

redistribution of Medicare spending

among procedures that will exceed $100

million. For this reason, we are

considering this to be a major rule. We

estimate that the aggregate amount of

payments being redistributed among

specialties as a result of the 5-year

review will be over $200 million.

The RFA requires agencies to analyze

options for regulatory relief of small

businesses. For purposes of the RFA,

small entities include small businesses,

nonprofit organizations and government

agencies. Most hospitals and most other

providers and suppliers are small

entities, either by nonprofit status or by

having revenues of $7.5 million or less

annually for physicians and $5 million

or less for other practitioners. For

purposes of the RFA and based on small

business administration data for 1997

we estimate that there are 162,000

physician organizations that meet the

definition of a small entity. There are

about 700,000 physicians and other

practitioners who receive Medicare

payment under the physician fee

schedule. Individuals and States are not

included in the definition of a small

entity.

In addition, section 1102(b) of the Act

requires us to prepare a regulatory

impact analysis if a rule 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 of

a Metropolitan Statistical Area and has

fewer than 100 beds.

Section 202 of the Unfunded

Mandates Reform Act of 1995 also

requires that agencies assess anticipated

costs and benefits before issuing any

rule that may result in expenditure in

any one year by State, local, or tribal

governments, in the aggregate, or by the

private sector, of $110 million. We have

determined that this rule has no

consequential effect on State, local or

tribal governments. We believe the

private sector costs of this rule will fall

below this threshold as well.

For purposes of Executive Order

12866 and the RFA, we have prepared

the following analysis, which, together

with the rest of this preamble, meets all

four assessment requirements. It

explains the rationale for and purpose of

the proposed notice, details the costs

and benefits of the proposed notice,

analyzes alternatives, and presents the

measures we considered to minimize

burden on small entities. Section

1848(c)(2)(B) of the Act requires that

increases or decreases in RVUs may not

cause the amount of expenditures for

the year to differ by more than $20

million from what expenditures would

have been in the absence of these

changes. If this threshold is exceeded,

31070 Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

we make adjustments to preserve budget

neutrality. This year, budget-neutrality

adjustments will be required for changes

in work relative value units resulting

from the 5-year refinement. Revisions in

payment policies, including the

establishment of interim and final

relative value units for coding changes

that will be announced later this year,

may result in additional budgetneutrality adjustments.

We considered making the statutorily

required budget-neutrality adjustments

to account for the 5-year review of

physician work by reducing all work

RVUs. We estimate that all work RVUs

would have to be reduced by 0.7 percent

under this option. Alternatively, we

considered making an adjustment to the

physician fee schedule CF to meet the

provisions of section 1848(c)(2)(B) of the

Act. This option would require an

estimated 0.3 percent reduction in the

CF. For the 5-year review, we are

proposing to reduce the CF by 0.3

percent to meet the provisions of section

1848(c)(2)(B) of the Act.

TABLE 3.—PERCENT CHANGE IN TOTAL PAYMENTS BY SPECIALTY RESULTING FROM THE 5 YEAR REVIEW OF WORK

Specialty

Allowed

charges

(billions)

Percent

change in

total payments from

increase in

work

Percent

change in

total payments from

change in

PE

Total percent change

in payments

from 5 year

review

Anesthesiology ................................................................................................................. 1.5 1 0 1

Cardiac Surgery ............................................................................................................... 0.3 5 1 6

Cardiology ........................................................................................................................ 4.2 0 ¥1 ¥1

Chiropractor ..................................................................................................................... 0.4 0 0 0

Clinics .............................................................................................................................. 1.6 0 0 0

Dermatology ..................................................................................................................... 1.4 0 0 0

Emergency Medicine ....................................................................................................... 1.0 0 0 0

Family Practice ................................................................................................................ 3.3 0 0 0

Gastroenterology ............................................................................................................. 1.2000

General Practice .............................................................................................................. 1.0 0 0 0

General Surgery .............................................................................................................. 2.0314

Hematology Oncology ..................................................................................................... 0.6 0 ¥1 ¥1

Internal Medicine ............................................................................................................. 7.1 0 0 0

Nephrology ....................................................................................................................... 1.0 0 0 0

Neurology ......................................................................................................................... 0.9 0 0 0

Neurosurgery ................................................................................................................... 0.4 0 0 0

Nonphysician Practitioner ................................................................................................ 1.2 0 0 0

Obstetrics/Gynecology ..................................................................................................... 0.4 0 0 0

Ophthalmology ................................................................................................................. 3.9 0 0 0

Optometrist ...................................................................................................................... 0.5 0 0 0

Orthopedic Surgery .......................................................................................................... 2.3 000

Other Physician ............................................................................................................... 1.6 0 0 0

Otolaryngology ................................................................................................................. 0.6 0 0 0

Pathology ......................................................................................................................... 0.6 0 0 0

Plastic Surgery ................................................................................................................. 0.2 0 0 0

Podiatry ............................................................................................................................ 1.1 0 0 0

Psychiatry ........................................................................................................................ 1.1 0 0 0

Pulmonary ........................................................................................................................ 1.1 0 0 0

Radiation Oncology ......................................................................................................... 0.7 0 ¥1 ¥1

Radiology ......................................................................................................................... 3.3 0 ¥1 ¥1

Rheumatology .................................................................................................................. 0.3 0 0 0

Suppliers .......................................................................................................................... 0.5 0 0 ¥1

Thoracic Surgery ............................................................................................................. 0.5415

Urology ............................................................................................................................. 1.3 0 0 0

Vascular Surgery ............................................................................................................. 0.3202

Note: This table incorporates two separate budget neutrality adjustments. The increase in practice expense relative value units is incorporated

through a rescaling of all practice expense RVUs. In addition, all physician fee schedule payments (not the work RVUs) are reduced to make the

increase in physician work RVUs budget neutral.

The table above shows the specialty

level payment impact of changes in

work and practice expense relative

values resulting from the 5-year review.

The table includes the effect of budgetneutrality adjustments applied to the

physician fee schedule CF. Since the

practice expense RVUs are based, in

part, on physician work, the table also

reflects changes in practice expense

RVUs that will result from the 5-year

review of physician work. The changes

in practice expense RVUs resulting from

the changes in physician work RVUs

were made budget neutral by rescaling

all practice expense RVUs. This table

shows the impact on payments per

service at the specialty level that would

result only from the 5-year review of

physician work RVUs.

We are in the process of developing

our annual physician fee schedule

proposed rule that will make

refinements in practice expense RVUs

and other policies that will affect

payment for physician fee schedule

services in CY 2002. As part of the

physician fee schedule proposed rule,

we expect to use revised physician

times submitted to us by the RUC in the

methodology for determining practice

expense RVUs. The RUC is

recommending that we use new time

data for codes in which they

recommended a change in work RVUs.

In addition, the RUC is recommending

a revision of the time data for many

other codes. For some specialties, we

expect that use of the revised times will

change the impacts shown here.

In particular, it appears that the

revised times submitted to us by the

31071

RUC are less than the times included in

our database for many heart and chest

procedures. Our expectation is that use

of the RUC recommended times will

result in a reduction in the practice

expense RVUs for these services that are

predominantly performed by cardiac

and thoracic surgeons. This means that

our expectation is that the total payment

increase shown here for these

specialties will be less when the revised

times are used to determine the practice

expense RVUs. In addition, there may

be other refinements to the practice

expense RVUs or other changes in

policies that may result in a specialty

level payment impact for 2002 that we

will announce in our proposed rule. We

will show the combined payment

impact by specialty, as a result of the

revised times and other proposed policy

changes, in our notice of proposed

rulemaking that we expect to be

published shortly.

We will show the combined impact of

all policy changes affecting physician

fee schedule payments in 2002 in one

final rule that we expect to be published

no later than November 1, 2001.

Federalism: Executive Order 13132

establishes certain requirements that an

agency must meet when it promulgates

a proposed rule (and subsequent final

rule) that imposes substantial direct

requirement costs on State and local

governments, preempts State law, or

otherwise has Federalism implications.

We have determined that this rule will

not impose substantial direct

requirement costs on State and local

governments, preempt State law, or

otherwise have Federalism implications.

In accordance with the provisions of

Executive Order 12866, this regulation

was reviewed by the Office of

Management and Budget.

(42 U.S.C. 1395k(a)(2)(F) and 1395l(i)(1) and

(2)); 42 CFR 416.120, 416.125, and 416.130)

(Catalog of Federal Domestic Assistance

Programs No. 93.774, Medicare—

Supplementary Medical Insurance Program)

Dated: April 17, 2001.

Michael McMullan,

Acting Deputy Administrator, Health Care

Financing Administration.

Dated: April 23, 2001.

Tommy G. Thompson,

Secretary.

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

G0127 ...... ......... Trim nail(s) ............................................................................................................................................................. 0.11

11055 ....... ......... Trim skin lesion ...................................................................................................................................................... 0.27

11056 ....... ......... Trim skin lesion, 2 to 4 ........................................................................................................................................... 0.39

11057 ....... ......... Trim skin lesions, over 4 ........................................................................................................................................ 0.50

11402 ....... ......... Removal of skin lesion ........................................................................................................................................... 1.61

11642 ....... ......... Removal of skin lesion ........................................................................................................................................... 2.93

11642 ....... ......... Removal of skin lesion ........................................................................................................................................... 2.93

11719 ....... ......... Trim nail(s) ............................................................................................................................................................. 0.11

12001 ....... ......... Repair superficial wound(s) .................................................................................................................................... 1.70

12002 ....... ......... Repair superficial wound(s) .................................................................................................................................... 1.86

12011 ....... ......... Repair superficial wound(s) .................................................................................................................................... 1.76

13101 ....... ......... Repair of wound or lesion ...................................................................................................................................... 3.92

13131 ....... ......... Repair of wound or lesion ...................................................................................................................................... 3.79

13132 ....... ......... Repair of wound or lesion ...................................................................................................................................... 5.95

15000 ....... ......... Skin graft ................................................................................................................................................................ 4.00

15001 ....... ......... Skin graft add-on .................................................................................................................................................... 1.00

15100 ....... ......... Skin split graft ......................................................................................................................................................... 9.05

15101 ....... ......... Skin split graft add-on ............................................................................................................................................ 1.72

15120 ....... ......... Skin split graft ......................................................................................................................................................... 9.83

15121 ....... ......... Skin split graft add-on ............................................................................................................................................ 2.67

15350 ....... ......... Skin homograft ....................................................................................................................................................... 4.00

15351 ....... ......... Skin homograft add-on ........................................................................................................................................... 1.00

15400 ....... ......... Skin heterograft ...................................................................................................................................................... 4.00

15401 ....... ......... Skin heterograft add-on .......................................................................................................................................... 1.00

19000 ....... ......... Drainage of breast lesion ....................................................................................................................................... 0.84

19100 ....... ......... Biopsy of breast ..................................................................................................................................................... 1.27

19125 ....... ......... Excision, breast lesion ........................................................................................................................................... 6.06

19160 ....... ......... Removal of breast tissue ........................................................................................................................................ 5.99

19162 ....... ......... Remove breast tissue, nodes ................................................................................................................................ 13.53

19240 ....... ......... Removal of breast .................................................................................................................................................. 16.00

20205 ....... ......... Deep muscle biopsy ............................................................................................................................................... 2.35

20245 ....... ......... Bone biopsy, excisional .......................................................................................................................................... 7.78

21740 ....... ......... Reconstruction of sternum ..................................................................................................................................... 16.50

21800 ....... ......... Treatment of rib fracture ........................................................................................................................................ 0.96

23076 ....... ......... Removal of shoulder lesion .................................................................................................................................... 7.63

23472 ....... ......... Reconstruct shoulder joint ...................................................................................................................................... 21.10

23485 ....... ......... Revision of collar bone ........................................................................................................................................... 13.43

23585 ....... ......... Treat scapula fracture ............................................................................................................................................ 8.96

23615 ....... ......... Treat humerus fracture ........................................................................................................................................... 9.35

23630 ....... ......... Treat humerus fracture ........................................................................................................................................... 7.35

23680 ....... ......... Treat dislocation/fracture ........................................................................................................................................ 10.06

24076 ....... ......... Remove arm/elbow lesion ...................................................................................................................................... 6.30

24435 ....... ......... Repair humerus with graft ...................................................................................................................................... 13.17

31072

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

24545 ....... ......... Treat humerus fracture ........................................................................................................................................... 10.46

25076 ....... ......... Removal of forearm lesion ..................................................................................................................................... 4.92

26562 ....... ......... Repair of web finger ............................................................................................................................................... 15.00

27048 ....... ......... Remove hip/pelvis lesion ........................................................................................................................................ 6.25

27075 ....... ......... Extensive hip surgery ............................................................................................................................................. 35.00

27077 ....... ......... Extensive hip surgery ............................................................................................................................................. 40.00

27216 ....... ......... Treat pelvic ring fracture ........................................................................................................................................ 15.19

27217 ....... ......... Treat pelvic ring fracture ........................................................................................................................................ 14.11

27218 ....... ......... Treat pelvic ring fracture ........................................................................................................................................ 20.15

27226 ....... ......... Treat hip wall fracture ............................................................................................................................................. 14.91

27236 ....... ......... Treat thigh fracture ................................................................................................................................................. 15.60

27280 ....... ......... Fusion of sacroiliac joint ......................................................................................................................................... 13.39

27282 ....... ......... Fusion of pubic bones ............................................................................................................................................ 11.34

27284 ....... ......... Fusion of hip joint ................................................................................................................................................... 23.45

27328 ....... ......... Removal of thigh lesion .......................................................................................................................................... 5.57

27472 ....... ......... Repair/graft of thigh ................................................................................................................................................ 17.72

27513 ....... ......... Treatment of thigh fracture ..................................................................................................................................... 17.92

27536 ....... ......... Treat knee fracture ................................................................................................................................................. 15.65

27590 ....... ......... Amputate leg at thigh ............................................................................................................................................. 12.03

27619 ....... ......... Remove lower leg lesion ........................................................................................................................................ 8.40

27724 ....... ......... Repair/graft of tibia ................................................................................................................................................. 18.20

27822 ....... ......... Treatment of ankle fracture .................................................................................................................................... 11.00

27823 ....... ......... Treatment of ankle fracture .................................................................................................................................... 13.00

27828 ....... ......... Treat lower leg fracture .......................................................................................................................................... 16.23

28299 ....... ......... Correction of bunion ............................................................................................................................................... 9.18

28322 ....... ......... Repair of metatarsals ............................................................................................................................................. 8.34

28420 ....... ......... Treat/graft heel fracture .......................................................................................................................................... 16.64

28445 ....... ......... Treat ankle fracture ................................................................................................................................................ 15.62

28705 ....... ......... Fusion of foot bones .............................................................................................................................................. 18.80

29450 ....... ......... Application of leg cast ............................................................................................................................................ 2.08

29450 ....... ......... Application of leg cast ............................................................................................................................................ 2.08

29883 ....... ......... Knee arthroscopy/surgery ...................................................................................................................................... 11.05

29889 ....... ......... Knee arthroscopy/surgery ...................................................................................................................................... 16.00

29889 ....... ......... Knee arthroscopy/surgery ...................................................................................................................................... 16.00

31600 ....... ......... Incision of windpipe ................................................................................................................................................ 7.18

31622 ....... ......... Dx bronchoscope/wash .......................................................................................................................................... 2.78

31622 ....... ......... Dx bronchoscope/wash .......................................................................................................................................... 2.78

31625 ....... ......... Bronchoscopy with biopsy ...................................................................................................................................... 3.37

31645 ....... ......... Bronchoscopy, clear airways .................................................................................................................................. 3.16

32000 ....... ......... Drainage of chest ................................................................................................................................................... 1.54

32000 ....... ......... Drainage of chest ................................................................................................................................................... 1.54

32005 ....... ......... Treat lung lining chemically .................................................................................................................................... 2.19

32020 ....... ......... Insertion of chest tube ............................................................................................................................................ 3.98

32035 ....... ......... Exploration of chest ................................................................................................................................................ 8.67

32095 ....... ......... Biopsy through chest wall ...................................................................................................................................... 8.36

32100 ....... ......... Exploration/biopsy of chest .................................................................................................................................... 15.24

32110 ....... ......... Explore/repair chest ............................................................................................................................................... 23.00

32220 ....... ......... Release of lung ...................................................................................................................................................... 24.00

32225 ....... ......... Partial release of lung ............................................................................................................................................ 13.96

32320 ....... ......... Free/remove chest lining ........................................................................................................................................ 24.00

32440 ....... ......... Removal of lung ..................................................................................................................................................... 25.00

32440 ....... ......... Removal of lung ..................................................................................................................................................... 25.00

32480 ....... ......... Partial removal of lung ........................................................................................................................................... 23.75

32480 ....... ......... Partial removal of lung ........................................................................................................................................... 23.75

32482 ....... ......... Bilobectomy ............................................................................................................................................................ 25.00

32491 ....... ......... Lung volume reduction ........................................................................................................................................... 21.25

32500 ....... ......... Partial removal of lung ........................................................................................................................................... 22.00

32520 ....... ......... Remove lung & revise chest .................................................................................................................................. 21.68

32602 ....... ......... Thoracoscopy, diagnostic ....................................................................................................................................... 5.96

32651 ....... ......... Thoracoscopy, surgical .......................................................................................................................................... 12.91

32652 ....... ......... Thoracoscopy, surgical .......................................................................................................................................... 18.66

32655 ....... ......... Thoracoscopy, surgical .......................................................................................................................................... 13.10

32657 ....... ......... Thoracoscopy, surgical .......................................................................................................................................... 13.65

33234 ....... ......... Removal of pacemaker system .............................................................................................................................. 7.82

33235 ....... ......... Removal of pacemaker electrode .......................................................................................................................... 9.40

33400 ....... ......... Repair of aortic valve ............................................................................................................................................. 28.50

31073

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

33405 ....... ......... Replacement of aortic valve ................................................................................................................................... 35.00

33406 ....... ......... Replacement of aortic valve ................................................................................................................................... 37.50

33410 ....... ......... Replacement of aortic valve ................................................................................................................................... 32.46

33411 ....... ......... Replacement of aortic valve ................................................................................................................................... 36.25

33412 ....... ......... Replacement of aortic valve ................................................................................................................................... 42.00

33413 ....... ......... Replacement of aortic valve ................................................................................................................................... 43.50

33415 ....... ......... Revision, subvalvular tissue ................................................................................................................................... 27.15

33425 ....... ......... Repair of mitral valve ............................................................................................................................................. 27.00

33426 ....... ......... Repair of mitral valve ............................................................................................................................................. 33.00

33427 ....... ......... Repair of mitral valve ............................................................................................................................................. 40.00

33430 ....... ......... Replacement of mitral valve ................................................................................................................................... 33.50

33468 ....... ......... Revision of tricuspid valve ...................................................................................................................................... 30.12

33475 ....... ......... Replacement, pulmonary valve .............................................................................................................................. 33.00

33506 ....... ......... Repair artery, translocation .................................................................................................................................... 35.50

33510 ....... ......... CABG, vein, single ................................................................................................................................................. 29.00

33511 ....... ......... CABG, vein, two ..................................................................................................................................................... 30.00

33512 ....... ......... CABG, vein, three .................................................................................................................................................. 31.80

33513 ....... ......... CABG, vein, four .................................................................................................................................................... 32.00

33514 ....... ......... CABG, vein, five ..................................................................................................................................................... 32.75

33516 ....... ......... Cabg, vein, six or more .......................................................................................................................................... 35.00

33517 ....... ......... CABG, artery-vein, single ....................................................................................................................................... 2.57

33518 ....... ......... CABG, artery-vein, two .......................................................................................................................................... 4.85

33519 ....... ......... CABG, artery-vein, three ........................................................................................................................................ 7.12

33521 ....... ......... CABG, artery-vein, four .......................................................................................................................................... 9.40

33522 ....... ......... CABG, artery-vein, five .......................................................................................................................................... 11.67

33523 ....... ......... Cabg, art-vein, six or more ..................................................................................................................................... 13.95

33530 ....... ......... Coronary artery, bypass/reop ................................................................................................................................. 5.86

33533 ....... ......... CABG, arterial, single ............................................................................................................................................. 30.00

33534 ....... ......... CABG, arterial, two ................................................................................................................................................ 32.20

33535 ....... ......... CABG, arterial, three .............................................................................................................................................. 34.50

33536 ....... ......... Cabg, arterial, four or more .................................................................................................................................... 37.50

33611 ....... ......... Repair double ventricle .......................................................................................................................................... 34.00

33612 ....... ......... Repair double ventricle .......................................................................................................................................... 35.00

33615 ....... ......... Repair, simple fontan ............................................................................................................................................. 34.00

33617 ....... ......... Repair, modified fontan .......................................................................................................................................... 37.00

33619 ....... ......... Repair single ventricle ............................................................................................................................................ 45.00

33641 ....... ......... Repair heart septum defect .................................................................................................................................... 21.39

33660 ....... ......... Repair of heart defects ........................................................................................................................................... 30.00

33670 ....... ......... Repair of heart chambers ....................................................................................................................................... 35.00

33681 ....... ......... Repair heart septum defect .................................................................................................................................... 30.61

33694 ....... ......... Repair of heart defects ........................................................................................................................................... 34.00

33697 ....... ......... Repair of heart defects ........................................................................................................................................... 36.00

33730 ....... ......... Repair heart-vein defect(s) ..................................................................................................................................... 34.25

33750 ....... ......... Major vessel shunt ................................................................................................................................................. 21.41

33767 ....... ......... Major vessel shunt ................................................................................................................................................. 24.50

33770 ....... ......... Repair great vessels defect ................................................................................................................................... 37.00

33778 ....... ......... Repair great vessels defect ................................................................................................................................... 40.00

33780 ....... ......... Repair great vessels defect ................................................................................................................................... 41.75

33786 ....... ......... Repair arterial trunk ................................................................................................................................................ 39.00

33820 ....... ......... Revise major vessel ............................................................................................................................................... 16.29

33840 ....... ......... Remove aorta constriction ..................................................................................................................................... 20.63

33860 ....... ......... Ascending aortic graft ............................................................................................................................................ 38.00

33861 ....... ......... Ascending aortic graft ............................................................................................................................................ 42.00

33863 ....... ......... Ascending aortic graft ............................................................................................................................................ 45.00

33870 ....... ......... Transverse aortic arch graft ................................................................................................................................... 44.00

33875 ....... ......... Thoracic aortic graft ............................................................................................................................................... 33.06

33877 ....... ......... Thoracoabdominal graft ......................................................................................................................................... 42.60

33917 ....... ......... Repair pulmonary artery ......................................................................................................................................... 24.50

33919 ....... ......... Repair pulmonary atresia ....................................................................................................................................... 40.00

33945 ....... ......... Transplantation of heart ......................................................................................................................................... 42.10

34101 ....... ......... Removal of artery clot ............................................................................................................................................ 10.00

34111 ....... ......... Removal of arm artery clot ..................................................................................................................................... 10.00

34151 ....... ......... Removal of artery clot ............................................................................................................................................ 25.00

34151 ....... ......... Removal of artery clot ............................................................................................................................................ 25.00

34201 ....... ......... Removal of artery clot ............................................................................................................................................ 10.03

34201 ....... ......... Removal of artery clot ............................................................................................................................................ 10.03

31074

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

34203 ....... ......... Removal of leg artery clot ...................................................................................................................................... 16.50

34203 ....... ......... Removal of leg artery clot ...................................................................................................................................... 16.50

34401 ....... ......... Removal of vein clot ............................................................................................................................................... 25.00

34401 ....... ......... Removal of vein clot ............................................................................................................................................... 25.00

34421 ....... ......... Removal of vein clot ............................................................................................................................................... 12.00

34421 ....... ......... Removal of vein clot ............................................................................................................................................... 12.00

34451 ....... ......... Removal of vein clot ............................................................................................................................................... 27.00

34451 ....... ......... Removal of vein clot ............................................................................................................................................... 27.00

34490 ....... ......... Removal of vein clot ............................................................................................................................................... 9.86

34501 ....... ......... Repair valve, femoral vein ...................................................................................................................................... 16.00

34510 ....... ......... Transposition of vein valve .................................................................................................................................... 18.95

34520 ....... ......... Cross-over vein graft .............................................................................................................................................. 17.95

34530 ....... ......... Leg vein fusion ....................................................................................................................................................... 16.64

35011 ....... ......... Repair defect of artery ........................................................................................................................................... 18.00

35011 ....... ......... Repair defect of artery ........................................................................................................................................... 18.00

35013 ....... ......... Repair artery rupture, arm ...................................................................................................................................... 22.00

35013 ....... ......... Repair artery rupture, arm ...................................................................................................................................... 22.00

35045 ....... ......... Repair defect of arm artery .................................................................................................................................... 17.57

35045 ....... ......... Repair defect of arm artery .................................................................................................................................... 17.57

35081 ....... ......... Repair defect of artery ........................................................................................................................................... 28.01

35082 ....... ......... Repair artery rupture, aorta .................................................................................................................................... 38.50

35082 ....... ......... Repair artery rupture, aorta .................................................................................................................................... 38.50

35092 ....... ......... Repair artery rupture, aorta .................................................................................................................................... 45.00

35092 ....... ......... Repair artery rupture, aorta .................................................................................................................................... 45.00

35103 ....... ......... Repair artery rupture, groin .................................................................................................................................... 40.50

35103 ....... ......... Repair artery rupture, groin .................................................................................................................................... 40.50

35111 ....... ......... Repair defect of artery ........................................................................................................................................... 25.00

35111 ....... ......... Repair defect of artery ........................................................................................................................................... 25.00

35112 ....... ......... Repair artery rupture, spleen ................................................................................................................................. 30.00

35112 ....... ......... Repair artery rupture, spleen ................................................................................................................................. 30.00

35121 ....... ......... Repair defect of artery ........................................................................................................................................... 30.00

35121 ....... ......... Repair defect of artery ........................................................................................................................................... 30.00

35122 ....... ......... Repair artery rupture, belly ..................................................................................................................................... 35.00

35122 ....... ......... Repair artery rupture, belly ..................................................................................................................................... 35.00

35131 ....... ......... Repair defect of artery ........................................................................................................................................... 25.00

35131 ....... ......... Repair defect of artery ........................................................................................................................................... 25.00

35132 ....... ......... Repair artery rupture, groin .................................................................................................................................... 30.00

35132 ....... ......... Repair artery rupture, groin .................................................................................................................................... 30.00

35141 ....... ......... Repair defect of artery ........................................................................................................................................... 20.00

35141 ....... ......... Repair defect of artery ........................................................................................................................................... 20.00

35142 ....... ......... Repair artery rupture, thigh .................................................................................................................................... 23.30

35142 ....... ......... Repair artery rupture, thigh .................................................................................................................................... 23.30

35151 ....... ......... Repair defect of artery ........................................................................................................................................... 22.64

35151 ....... ......... Repair defect of artery ........................................................................................................................................... 22.64

35152 ....... ......... Repair artery rupture, knee .................................................................................................................................... 25.62

35152 ....... ......... Repair artery rupture, knee .................................................................................................................................... 25.62

35182 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 30.00

35184 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 18.00

35189 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 28.00

35190 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 12.75

35201 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 16.14

35201 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 16.14

35206 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 13.25

35221 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 24.39

35221 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 24.39

35226 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 14.50

35226 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 14.50

35231 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 20.00

35231 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 20.00

35236 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 17.11

35236 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 17.11

35246 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 26.45

35246 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 26.45

35251 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 30.20

35251 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 30.20

35256 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 18.36

31075

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

35261 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 17.80

35261 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 17.80

35266 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 14.91

35266 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 14.91

35276 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 24.25

35276 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 24.25

35281 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 28.00

35281 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 28.00

35286 ....... ......... Repair blood vessel lesion ..................................................................................................................................... 16.16

35311 ....... ......... Rechanneling of artery ........................................................................................................................................... 27.00

35311 ....... ......... Rechanneling of artery ........................................................................................................................................... 27.00

35321 ....... ......... Rechanneling of artery ........................................................................................................................................... 16.00

35321 ....... ......... Rechanneling of artery ........................................................................................................................................... 16.00

35331 ....... ......... Rechanneling of artery ........................................................................................................................................... 26.20

35331 ....... ......... Rechanneling of artery ........................................................................................................................................... 26.20

35351 ....... ......... Rechanneling of artery ........................................................................................................................................... 23.00

35351 ....... ......... Rechanneling of artery ........................................................................................................................................... 23.00

35355 ....... ......... Rechanneling of artery ........................................................................................................................................... 18.50

35355 ....... ......... Rechanneling of artery ........................................................................................................................................... 18.50

35361 ....... ......... Rechanneling of artery ........................................................................................................................................... 28.20

35361 ....... ......... Rechanneling of artery ........................................................................................................................................... 28.20

35363 ....... ......... Rechanneling of artery ........................................................................................................................................... 30.20

35363 ....... ......... Rechanneling of artery ........................................................................................................................................... 30.20

35371 ....... ......... Rechanneling of artery ........................................................................................................................................... 14.72

35371 ....... ......... Rechanneling of artery ........................................................................................................................................... 14.72

35372 ....... ......... Rechanneling of artery ........................................................................................................................................... 18.00

35372 ....... ......... Rechanneling of artery ........................................................................................................................................... 18.00

35381 ....... ......... Rechanneling of artery ........................................................................................................................................... 15.81

35511 ....... ......... Artery bypass graft ................................................................................................................................................. 21.20

35511 ....... ......... Artery bypass graft ................................................................................................................................................. 21.20

35518 ....... ......... Artery bypass graft ................................................................................................................................................. 21.20

35518 ....... ......... Artery bypass graft ................................................................................................................................................. 21.20

35521 ....... ......... Artery bypass graft ................................................................................................................................................. 22.20

35521 ....... ......... Artery bypass graft ................................................................................................................................................. 22.20

35526 ....... ......... Artery bypass graft ................................................................................................................................................. 29.95

35526 ....... ......... Artery bypass graft ................................................................................................................................................. 29.95

35531 ....... ......... Artery bypass graft ................................................................................................................................................. 36.20

35531 ....... ......... Artery bypass graft ................................................................................................................................................. 36.20

35533 ....... ......... Artery bypass graft ................................................................................................................................................. 28.00

35533 ....... ......... Artery bypass graft ................................................................................................................................................. 28.00

35536 ....... ......... Artery bypass graft ................................................................................................................................................. 31.70

35536 ....... ......... Artery bypass graft ................................................................................................................................................. 31.70

35541 ....... ......... Artery bypass graft ................................................................................................................................................. 25.80

35546 ....... ......... Artery bypass graft ................................................................................................................................................. 25.54

35551 ....... ......... Artery bypass graft ................................................................................................................................................. 26.67

35556 ....... ......... Artery bypass graft ................................................................................................................................................. 21.76

35556 ....... ......... Artery bypass graft ................................................................................................................................................. 21.76

35558 ....... ......... Artery bypass graft ................................................................................................................................................. 21.20

35558 ....... ......... Artery bypass graft ................................................................................................................................................. 21.20

35560 ....... ......... Artery bypass graft ................................................................................................................................................. 32.00

35560 ....... ......... Artery bypass graft ................................................................................................................................................. 32.00

35563 ....... ......... Artery bypass graft ................................................................................................................................................. 24.20

35563 ....... ......... Artery bypass graft ................................................................................................................................................. 24.20

35565 ....... ......... Artery bypass graft ................................................................................................................................................. 23.20

35565 ....... ......... Artery bypass graft ................................................................................................................................................. 23.20

35571 ....... ......... Artery bypass graft ................................................................................................................................................. 24.06

35571 ....... ......... Artery bypass graft ................................................................................................................................................. 24.06

35582 ....... ......... Vein bypass graft ................................................................................................................................................... 27.13

35587 ....... ......... Vein bypass graft ................................................................................................................................................... 24.75

35587 ....... ......... Vein bypass graft ................................................................................................................................................... 24.75

35621 ....... ......... Artery bypass graft ................................................................................................................................................. 20.00

35621 ....... ......... Artery bypass graft ................................................................................................................................................. 20.00

35623 ....... ......... Bypass graft, not vein ............................................................................................................................................ 24.00

35623 ....... ......... Bypass graft, not vein ............................................................................................................................................ 24.00

35626 ....... ......... Artery bypass graft ................................................................................................................................................. 27.75

35626 ....... ......... Artery bypass graft ................................................................................................................................................. 27.75

31076

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

35631 ....... ......... Artery bypass graft ................................................................................................................................................. 34.00

35631 ....... ......... Artery bypass graft ................................................................................................................................................. 34.00

35636 ....... ......... Artery bypass graft ................................................................................................................................................. 29.50

35636 ....... ......... Artery bypass graft ................................................................................................................................................. 29.50

35641 ....... ......... Artery bypass graft ................................................................................................................................................. 24.57

35646 ....... ......... Artery bypass graft ................................................................................................................................................. 25.81

35650 ....... ......... Artery bypass graft ................................................................................................................................................. 19.00

35650 ....... ......... Artery bypass graft ................................................................................................................................................. 19.00

35654 ....... ......... Artery bypass graft ................................................................................................................................................. 25.00

35654 ....... ......... Artery bypass graft ................................................................................................................................................. 25.00

35661 ....... ......... Artery bypass graft ................................................................................................................................................. 19.00

35661 ....... ......... Artery bypass graft ................................................................................................................................................. 19.00

35663 ....... ......... Artery bypass graft ................................................................................................................................................. 22.00

35663 ....... ......... Artery bypass graft ................................................................................................................................................. 22.00

35665 ....... ......... Artery bypass graft ................................................................................................................................................. 21.00

35665 ....... ......... Artery bypass graft ................................................................................................................................................. 21.00

35666 ....... ......... Artery bypass graft ................................................................................................................................................. 22.19

35666 ....... ......... Artery bypass graft ................................................................................................................................................. 22.19

35671 ....... ......... Artery bypass graft ................................................................................................................................................. 19.33

35671 ....... ......... Artery bypass graft ................................................................................................................................................. 19.33

35701 ....... ......... Exploration, carotid artery ...................................................................................................................................... 8.50

35701 ....... ......... Exploration, carotid artery ...................................................................................................................................... 8.50

35721 ....... ......... Exploration, femoral artery ..................................................................................................................................... 7.18

35741 ....... ......... Exploration popliteal artery ..................................................................................................................................... 8.00

35840 ....... ......... Explore abdominal vessels .................................................................................................................................... 9.77

35860 ....... ......... Explore limb vessels .............................................................................................................................................. 5.55

35905 ....... ......... Excision, graft, thorax ............................................................................................................................................. 31.25

35905 ....... ......... Excision, graft, thorax ............................................................................................................................................. 31.25

35907 ....... ......... Excision, graft, abdomen ........................................................................................................................................ 35.00

35907 ....... ......... Excision, graft, abdomen ........................................................................................................................................ 35.00

36400 ....... ......... Drawing blood ........................................................................................................................................................ 0.18

36405 ....... ......... Drawing blood ........................................................................................................................................................ 0.18

36406 ....... ......... Drawing blood ........................................................................................................................................................ 0.18

36489 ....... ......... Insertion of catheter, vein ....................................................................................................................................... 2.50

36489 ....... ......... Insertion of catheter, vein ....................................................................................................................................... 2.50

36520 ....... ......... Plasma and/or cell exchange ................................................................................................................................. 1.74

36533 ....... ......... Insertion of access device ...................................................................................................................................... 5.32

36534 ....... ......... Revision of access device ...................................................................................................................................... 2.80

36535 ....... ......... Removal of access device ..................................................................................................................................... 2.27

36620 ....... ......... Insertion catheter, artery ........................................................................................................................................ 1.15

36625 ....... ......... Insertion catheter, artery ........................................................................................................................................ 2.11

36822 ....... ......... Insertion of cannula(s) ............................................................................................................................................ 5.42

37565 ....... ......... Ligation of neck vein .............................................................................................................................................. 10.88

37565 ....... ......... Ligation of neck vein .............................................................................................................................................. 10.88

37600 ....... ......... Ligation of neck artery ............................................................................................................................................ 11.25

37600 ....... ......... Ligation of neck artery ............................................................................................................................................ 11.25

37605 ....... ......... Ligation of neck artery ............................................................................................................................................ 13.11

37605 ....... ......... Ligation of neck artery ............................................................................................................................................ 13.11

37609 ....... ......... Temporal artery procedure ..................................................................................................................................... 3.00

37609 ....... ......... Temporal artery procedure ..................................................................................................................................... 3.00

37615 ....... ......... Ligation of neck artery ............................................................................................................................................ 5.73

37615 ....... ......... Ligation of neck artery ............................................................................................................................................ 5.73

37617 ....... ......... Ligation of abdomen artery .................................................................................................................................... 22.06

37618 ....... ......... Ligation of extremity artery ..................................................................................................................................... 4.84

37650 ....... ......... Revision of major vein ............................................................................................................................................ 7.80

37660 ....... ......... Revision of major vein ............................................................................................................................................ 21.00

37700 ....... ......... Revise leg vein ....................................................................................................................................................... 3.73

37720 ....... ......... Removal of leg vein ............................................................................................................................................... 5.66

37730 ....... ......... Removal of leg veins .............................................................................................................................................. 7.33

37735 ....... ......... Removal of leg veins/lesion ................................................................................................................................... 10.53

37760 ....... ......... Revision of leg veins .............................................................................................................................................. 10.47

37785 ....... ......... Revision secondary varicosity ................................................................................................................................ 3.84

38100 ....... ......... Removal of spleen, total ........................................................................................................................................ 14.50

38100 ....... ......... Removal of spleen, total ........................................................................................................................................ 14.50

38101 ....... ......... Removal of spleen, partial ..................................................................................................................................... 15.31

38115 ....... ......... Repair of ruptured spleen ...................................................................................................................................... 15.82

31077

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

38300 ....... ......... Drainage, lymph node lesion .................................................................................................................................. 1.99

38305 ....... ......... Drainage, lymph node lesion .................................................................................................................................. 6.00

38308 ....... ......... Incision of lymph channels ..................................................................................................................................... 6.45

38500 ....... ......... Biopsy/removal, lymph nodes ................................................................................................................................ 3.75

38500 ....... ......... Biopsy/removal, lymph nodes ................................................................................................................................ 3.75

38510 ....... ......... Biopsy/removal, lymph nodes ................................................................................................................................ 6.43

38520 ....... ......... Biopsy/removal, lymph nodes ................................................................................................................................ 6.67

38525 ....... ......... Biopsy/removal, lymph nodes ................................................................................................................................ 6.07

38530 ....... ......... Biopsy/removal, lymph nodes ................................................................................................................................ 7.98

38571 ....... ......... Laparoscopy, lymphadenectomy ............................................................................................................................ 12.38

38572 ....... ......... Laparoscopy, lymphadenectomy ............................................................................................................................ 16.59

38740 ....... ......... Remove armpit lymph nodes ................................................................................................................................. 10.02

38745 ....... ......... Remove armpit lymph nodes ................................................................................................................................. 13.00

38746 ....... ......... Remove thoracic lymph nodes ............................................................................................................................... 4.89

38760 ....... ......... Remove groin lymph nodes ................................................................................................................................... 12.94

38765 ....... ......... Remove groin lymph nodes ................................................................................................................................... 19.98

38780 ....... ......... Remove abdomen lymph nodes ............................................................................................................................ 16.59

39010 ....... ......... Exploration of chest ................................................................................................................................................ 11.79

39220 ....... ......... Removal chest lesion ............................................................................................................................................. 17.42

39400 ....... ......... Visualization of chest ............................................................................................................................................. 5.61

39503 ....... ......... Repair of diaphragm hernia ................................................................................................................................... 34.85

42205 ....... ......... Reconstruct cleft palate .......................................................................................................................................... 13.29

43107 ....... ......... Removal of esophagus .......................................................................................................................................... 40.00

43112 ....... ......... Removal of esophagus .......................................................................................................................................... 43.50

43117 ....... ......... Partial removal of esophagus ................................................................................................................................ 40.00

43122 ....... ......... Parital removal of esophagus ................................................................................................................................ 40.00

43215 ....... ......... Esophagus endoscopy ........................................................................................................................................... 2.60

43217 ....... ......... Esophagus endoscopy ........................................................................................................................................... 2.90

43219 ....... ......... Esophagus endoscopy ........................................................................................................................................... 2.80

43228 ....... ......... Esoph endoscopy, ablation .................................................................................................................................... 3.77

43239 ....... ......... Upper GI endoscopy, biopsy .................................................................................................................................. 2.69

43239 ....... ......... Upper GI endoscopy, biopsy .................................................................................................................................. 2.87

43244 ....... ......... Upper GI endoscopy/ligation .................................................................................................................................. 4.59

43246 ....... ......... Place gastrostomy tube .......................................................................................................................................... 4.33

43246 ....... ......... Place gastrostomy tube .......................................................................................................................................... 4.33

43247 ....... ......... Operative upper GI endoscopy .............................................................................................................................. 3.39

43249 ....... ......... Esoph endoscopy, dilation ..................................................................................................................................... 2.90

43251 ....... ......... Operative upper GI endoscopy .............................................................................................................................. 3.70

43255 ....... ......... Operative upper GI endoscopy .............................................................................................................................. 4.40

43258 ....... ......... Operative upper GI endoscopy .............................................................................................................................. 4.55

43259 ....... ......... Endoscopic ultrasound exam ................................................................................................................................. 4.89

43263 ....... ......... Endo cholangiopancreatograph ............................................................................................................................. 6.19

43265 ....... ......... Endo cholangiopancreatograph ............................................................................................................................. 8.90

43269 ....... ......... Endo cholangiopancreatograph ............................................................................................................................. 6.04

43310 ....... ......... Repair of esophagus .............................................................................................................................................. 25.39

43312 ....... ......... Repair esophagus and fistula ................................................................................................................................ 28.42

43320 ....... ......... Fuse esophagus & stomach .................................................................................................................................. 19.93

43324 ....... ......... Revise esophagus & stomach ............................................................................................................................... 20.57

43325 ....... ......... Revise esophagus & stomach ............................................................................................................................... 20.06

43326 ....... ......... Revise esophagus & stomach ............................................................................................................................... 19.74

43330 ....... ......... Repair of esophagus .............................................................................................................................................. 19.77

43331 ....... ......... Repair of esophagus .............................................................................................................................................. 20.13

43340 ....... ......... Fuse esophagus & intestine ................................................................................................................................... 19.61

43341 ....... ......... Fuse esophagus & intestine ................................................................................................................................... 20.85

43350 ....... ......... Surgical opening, esophagus ................................................................................................................................. 15.78

43351 ....... ......... Surgical opening, esophagus ................................................................................................................................. 18.35

43352 ....... ......... Surgical opening, esophagus ................................................................................................................................. 15.26

43360 ....... ......... Gastrointestinal repair ............................................................................................................................................ 35.70

43361 ....... ......... Gastrointestinal repair ............................................................................................................................................ 40.50

43400 ....... ......... Ligate esophagus veins ......................................................................................................................................... 21.20

43401 ....... ......... Esophagus surgery for veins .................................................................................................................................. 22.09

43405 ....... ......... Ligate/staple esophagus ........................................................................................................................................ 20.01

43410 ....... ......... Repair esophagus wound ...................................................................................................................................... 13.47

43415 ....... ......... Repair esophagus wound ...................................................................................................................................... 25.00

43420 ....... ......... Repair esophagus opening .................................................................................................................................... 14.35

43425 ....... ......... Repair esophagus opening .................................................................................................................................... 21.03

31078

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

43500 ....... ......... Surgical opening of stomach .................................................................................................................................. 11.05

43501 ....... ......... Surgical repair of stomach ..................................................................................................................................... 20.04

43502 ....... ......... Surgical repair of stomach ..................................................................................................................................... 23.13

43510 ....... ......... Surgical opening of stomach .................................................................................................................................. 13.08

43520 ....... ......... Incision of pyloric muscle ....................................................................................................................................... 9.99

43605 ....... ......... Biopsy of stomach .................................................................................................................................................. 11.98

43610 ....... ......... Excision of stomach lesion ..................................................................................................................................... 14.60

43611 ....... ......... Excision of stomach lesion ..................................................................................................................................... 17.84

43620 ....... ......... Removal of stomach .............................................................................................................................................. 30.04

43621 ....... ......... Removal of stomach .............................................................................................................................................. 30.73

43622 ....... ......... Removal of stomach .............................................................................................................................................. 32.53

43631 ....... ......... Removal of stomach, partial ................................................................................................................................... 22.59

43632 ....... ......... Removal of stomach, partial ................................................................................................................................... 22.59

43633 ....... ......... Removal of stomach, partial ................................................................................................................................... 23.10

43634 ....... ......... Removal of stomach, partial ................................................................................................................................... 25.12

43638 ....... ......... Removal of stomach, partial ................................................................................................................................... 29.00

43638 ....... ......... Removal of stomach, partial ................................................................................................................................... 29.00

43639 ....... ......... Removal of stomach, partial ................................................................................................................................... 29.65

43640 ....... ......... Vagotomy & pylorus repair ..................................................................................................................................... 17.02

43641 ....... ......... Vagotomy & pylorus repair ..................................................................................................................................... 17.27

43651 ....... ......... Laparoscopy, vagus nerve ..................................................................................................................................... 10.15

43652 ....... ......... Laparoscopy, vagus nerve ..................................................................................................................................... 12.15

43800 ....... ......... Reconstruction of pylorus ....................................................................................................................................... 13.69

43810 ....... ......... Fusion of stomach and bowel ................................................................................................................................ 14.65

43820 ....... ......... Fusion of stomach and bowel ................................................................................................................................ 15.37

43825 ....... ......... Fusion of stomach and bowel ................................................................................................................................ 19.22

43830 ....... ......... Place gastrostomy tube .......................................................................................................................................... 9.53

43832 ....... ......... Place gastrostomy tube .......................................................................................................................................... 15.60

43840 ....... ......... Repair of stomach lesion ........................................................................................................................................ 15.56

43842 ....... ......... Gastroplasty for obesity ......................................................................................................................................... 18.47

43843 ....... ......... Gastroplasty for obesity ......................................................................................................................................... 18.65

43846 ....... ......... Gastric bypass for obesity ...................................................................................................................................... 24.05

43847 ....... ......... Gastric bypass for obesity ...................................................................................................................................... 26.92

43848 ....... ......... Revision gastroplasty ............................................................................................................................................. 29.39

43850 ....... ......... Revise stomach-bowel fusion ................................................................................................................................. 24.72

43855 ....... ......... Revise stomach-bowel fusion ................................................................................................................................. 26.16

43860 ....... ......... Revise stomach-bowel fusion ................................................................................................................................. 25.00

43865 ....... ......... Revise stomach-bowel fusion ................................................................................................................................. 26.52

43870 ....... ......... Repair stomach opening ........................................................................................................................................ 9.69

43880 ....... ......... Repair stomach-bowel fistula ................................................................................................................................. 24.65

44005 ....... ......... Freeing of bowel adhesion ..................................................................................................................................... 16.23

44010 ....... ......... Incision of small bowel ........................................................................................................................................... 12.52

44020 ....... ......... Exploration of small bowel ..................................................................................................................................... 13.99

44021 ....... ......... Decompress small bowel ....................................................................................................................................... 14.08

44025 ....... ......... Incision of large bowel ........................................................................................................................................... 14.28

44050 ....... ......... Reduce bowel obstruction ...................................................................................................................................... 14.03

44050 ....... ......... Reduce bowel obstruction ...................................................................................................................................... 14.03

44055 ....... ......... Correct malrotation of bowel .................................................................................................................................. 22.00

44110 ....... ......... Excision of bowel lesion(s) ..................................................................................................................................... 11.81

44111 ....... ......... Excision of bowel lesion(s) ..................................................................................................................................... 14.29

44120 ....... ......... Removal of small intestine ..................................................................................................................................... 17.00

44125 ....... ......... Removal of small intestine ..................................................................................................................................... 17.54

44130 ....... ......... Bowel to bowel fusion ............................................................................................................................................ 14.49

44130 ....... ......... Bowel to bowel fusion ............................................................................................................................................ 14.49

44140 ....... ......... Partial removal of colon ......................................................................................................................................... 21.00

44140 ....... ......... Partial removal of colon ......................................................................................................................................... 21.00

44143 ....... ......... Partial removal of colon ......................................................................................................................................... 22.99

44144 ....... ......... Partial removal of colon ......................................................................................................................................... 21.53

44144 ....... ......... Partial removal of colon ......................................................................................................................................... 21.53

44145 ....... ......... Partial removal of colon ......................................................................................................................................... 26.42

44146 ....... ......... Partial removal of colon ......................................................................................................................................... 27.54

44147 ....... ......... Partial removal of colon ......................................................................................................................................... 20.71

44150 ....... ......... Removal of colon ................................................................................................................................................... 23.95

44151 ....... ......... Removal of colon/ileostomy ................................................................................................................................... 26.88

44151 ....... ......... Removal of colon/ileostomy ................................................................................................................................... 26.88

44152 ....... ......... Removal of colon/ileostomy ................................................................................................................................... 27.83

31079

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

44153 ....... ......... Removal of colon/ileostomy ................................................................................................................................... 30.59

44155 ....... ......... Removal of colon/ileostomy ................................................................................................................................... 27.86

44156 ....... ......... Removal of colon/ileostomy ................................................................................................................................... 30.79

44156 ....... ......... Removal of colon/ileostomy ................................................................................................................................... 30.79

44160 ....... ......... Removal of colon ................................................................................................................................................... 18.62

44200 ....... ......... Laparoscopy, enterolysis ........................................................................................................................................ 14.44

44300 ....... ......... Open bowel to skin ................................................................................................................................................ 12.11

44310 ....... ......... Ileostomy/jejunostomy ............................................................................................................................................ 15.95

44312 ....... ......... Revision of ileostomy ............................................................................................................................................. 8.02

44314 ....... ......... Revision of ileostomy ............................................................................................................................................. 15.05

44316 ....... ......... Devise bowel pouch ............................................................................................................................................... 21.09

44320 ....... ......... Colostomy ............................................................................................................................................................... 17.64

44340 ....... ......... Revision of colostomy ............................................................................................................................................ 7.72

44345 ....... ......... Revision of colostomy ............................................................................................................................................ 15.43

44346 ....... ......... Revision of colostomy ............................................................................................................................................ 16.99

44388 ....... ......... Colon endoscopy .................................................................................................................................................... 2.82

44389 ....... ......... Colonoscopy with biopsy ........................................................................................................................................ 3.13

44390 ....... ......... Colonoscopy for foreign body ................................................................................................................................ 3.83

44391 ....... ......... Colonoscopy for bleeding ....................................................................................................................................... 4.32

44392 ....... ......... Colonoscopy and polypectomy .............................................................................................................................. 3.82

44393 ....... ......... Colonoscopy, lesion removal ................................................................................................................................. 4.84

44394 ....... ......... Colonoscopy w/snare ............................................................................................................................................. 4.43

44394 ....... ......... Colonoscopy w/snare ............................................................................................................................................. 4.43

44602 ....... ......... Suture, small intestine ............................................................................................................................................ 16.03

44603 ....... ......... Suture, small intestine ............................................................................................................................................ 18.66

44604 ....... ......... Suture, large intestine ............................................................................................................................................ 16.03

44605 ....... ......... Repair of bowel lesion ............................................................................................................................................ 19.53

44615 ....... ......... Intestinal stricturoplasty .......................................................................................................................................... 15.93

44620 ....... ......... Repair bowel opening ............................................................................................................................................ 12.20

44625 ....... ......... Repair bowel opening ............................................................................................................................................ 15.05

44626 ....... ......... Repair bowel opening ............................................................................................................................................ 25.36

44640 ....... ......... Repair bowel-skin fistula ........................................................................................................................................ 21.65

44650 ....... ......... Repair bowel fistula ................................................................................................................................................ 22.57

44660 ....... ......... Repair bowel-bladder fistula ................................................................................................................................... 21.36

44661 ....... ......... Repair bowel-bladder fistula ................................................................................................................................... 24.81

44680 ....... ......... Surgical revision, intestine ..................................................................................................................................... 15.40

44700 ....... ......... Suspend bowel w/prosthesis .................................................................................................................................. 16.11

44800 ....... ......... Excision of bowel pouch ........................................................................................................................................ 11.23

44820 ....... ......... Excision of mesentery lesion .................................................................................................................................. 12.09

44850 ....... ......... Repair of mesentery ............................................................................................................................................... 10.74

44900 ....... ......... Drain app abscess, open ....................................................................................................................................... 10.14

44950 ....... ......... Appendectomy ........................................................................................................................................................ 10.00

44960 ....... ......... Appendectomy ........................................................................................................................................................ 12.34

44970 ....... ......... Laparoscopy, appendectomy ................................................................................................................................. 8.70

45000 ....... ......... Drainage of pelvic abscess .................................................................................................................................... 4.52

45020 ....... ......... Drainage of rectal abscess .................................................................................................................................... 4.72

45100 ....... ......... Biopsy of rectum .................................................................................................................................................... 3.68

45108 ....... ......... Removal of anorectal lesion ................................................................................................................................... 4.76

45110 ....... ......... Removal of rectum ................................................................................................................................................. 28.00

45111 ....... ......... Partial removal of rectum ....................................................................................................................................... 16.48

45112 ....... ......... Removal of rectum ................................................................................................................................................. 30.54

45113 ....... ......... Partial proctectomy ................................................................................................................................................. 30.58

45114 ....... ......... Partial removal of rectum ....................................................................................................................................... 27.32

45116 ....... ......... Partial removal of rectum ....................................................................................................................................... 24.58

45119 ....... ......... Remove rectum w/reservoir ................................................................................................................................... 30.84

45120 ....... ......... Removal of rectum ................................................................................................................................................. 24.60

45121 ....... ......... Removal of rectum and colon ................................................................................................................................ 27.04

45123 ....... ......... Partial proctectomy ................................................................................................................................................. 16.71

45126 ....... ......... Pelvic exenteration ................................................................................................................................................. 45.16

45130 ....... ......... Excision of rectal prolapse ..................................................................................................................................... 16.44

45135 ....... ......... Excision of rectal prolapse ..................................................................................................................................... 19.28

45160 ....... ......... Excision of rectal lesion ......................................................................................................................................... 15.32

45170 ....... ......... Excision of rectal lesion ......................................................................................................................................... 11.49

45190 ....... ......... Destruction, rectal tumor ........................................................................................................................................ 9.74

45305 ....... ......... Proctosigmoidoscopy & biopsy .............................................................................................................................. 1.01

45309 ....... ......... Proctosigmoidoscopy ............................................................................................................................................. 2.01

31080

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

45330 ....... ......... Diagnostic sigmoidoscopy ...................................................................................................................................... 0.96

45337 ....... ......... Sigmoidoscopy & decompress ............................................................................................................................... 2.36

45339 ....... ......... Sigmoidoscopy ....................................................................................................................................................... 3.14

45378 ....... ......... Diagnostic colonoscopy .......................................................................................................................................... 3.70

45380 ....... ......... Colonoscopy and biopsy ........................................................................................................................................ 4.01

45383 ....... ......... Lesion removal colonoscopy .................................................................................................................................. 5.87

45384 ....... ......... Colonoscopy ........................................................................................................................................................... 4.70

45385 ....... ......... Lesion removal colonoscopy .................................................................................................................................. 5.31

45505 ....... ......... Repair of rectum ..................................................................................................................................................... 7.58

45540 ....... ......... Correct rectal prolapse ........................................................................................................................................... 16.27

45541 ....... ......... Correct rectal prolapse ........................................................................................................................................... 13.40

45550 ....... ......... Repair rectum/remove sigmoid .............................................................................................................................. 23.00

45560 ....... ......... Repair of rectocele ................................................................................................................................................. 10.58

45562 ....... ......... Exploration/repair of rectum ................................................................................................................................... 15.38

45563 ....... ......... Exploration/repair of rectum ................................................................................................................................... 23.47

45800 ....... ......... Repair rect/bladder fistula ...................................................................................................................................... 17.77

45805 ....... ......... Repair fistula w/colostomy ...................................................................................................................................... 20.78

45820 ....... ......... Repair rectourethral fistula ..................................................................................................................................... 18.48

45825 ....... ......... Repair fistula w/colostomy ...................................................................................................................................... 21.25

45900 ....... ......... Reduction of rectal prolapse .................................................................................................................................. 2.61

45905 ....... ......... Dilation of anal sphincter ........................................................................................................................................ 2.30

45910 ....... ......... Dilation of rectal narrowing ..................................................................................................................................... 2.80

45910 ....... ......... Dilation of rectal narrowing ..................................................................................................................................... 2.80

45915 ....... ......... Remove rectal obstruction ..................................................................................................................................... 3.14

46040 ....... ......... Incision of rectal abscess ....................................................................................................................................... 4.96

46045 ....... ......... Incision of rectal abscess ....................................................................................................................................... 4.32

46060 ....... ......... Incision of rectal abscess ....................................................................................................................................... 5.69

46083 ....... ......... Incise external hemorrhoid ..................................................................................................................................... 1.40

46083 ....... ......... Incise external hemorrhoid ..................................................................................................................................... 1.40

46221 ....... ......... Ligation of hemorrhoid(s) ....................................................................................................................................... 2.04

46230 ....... ......... Removal of anal tabs ............................................................................................................................................. 2.57

46250 ....... ......... Hemorrhoidectomy ................................................................................................................................................. 3.89

46255 ....... ......... Hemorrhoidectomy ................................................................................................................................................. 4.60

46257 ....... ......... Remove hemorrhoids & fissure .............................................................................................................................. 5.40

46258 ....... ......... Remove hemorrhoids & fistula ............................................................................................................................... 5.73

46258 ....... ......... Remove hemorrhoids & fistula ............................................................................................................................... 5.73

46260 ....... ......... Hemorrhoidectomy ................................................................................................................................................. 6.37

46261 ....... ......... Remove hemorrhoids & fissure .............................................................................................................................. 7.08

46262 ....... ......... Remove hemorrhoids & fistula ............................................................................................................................... 7.50

46270 ....... ......... Removal of anal fistula ........................................................................................................................................... 3.72

46275 ....... ......... Removal of anal fistula ........................................................................................................................................... 4.56

46280 ....... ......... Removal of anal fistula ........................................................................................................................................... 5.98

46288 ....... ......... Repair anal fistula .................................................................................................................................................. 7.13

46320 ....... ......... Removal of hemorrhoid clot ................................................................................................................................... 1.61

46320 ....... ......... Removal of hemorrhoid clot ................................................................................................................................... 1.61

46700 ....... ......... Repair of anal stricture ........................................................................................................................................... 9.13

46705 ....... ......... Repair of anal stricture ........................................................................................................................................... 6.90

46715 ....... ......... Repair of anovaginal fistula .................................................................................................................................... 7.20

46716 ....... ......... Repair of anovaginal fistula .................................................................................................................................... 15.07

46730 ....... ......... Construction of absent anus .................................................................................................................................. 26.75

46735 ....... ......... Construction of absent anus .................................................................................................................................. 32.17

46740 ....... ......... Construction of absent anus .................................................................................................................................. 30.00

46742 ....... ......... Repair of imperforated anus ................................................................................................................................... 35.80

46744 ....... ......... Repair of cloacal anomaly ...................................................................................................................................... 52.63

46746 ....... ......... Repair of cloacal anomaly ...................................................................................................................................... 58.22

46748 ....... ......... Repair of cloacal anomaly ...................................................................................................................................... 64.21

46750 ....... ......... Repair of anal sphincter ......................................................................................................................................... 10.25

46753 ....... ......... Reconstruction of anus .......................................................................................................................................... 8.29

46754 ....... ......... Removal of suture from anus ................................................................................................................................. 2.20

46760 ....... ......... Repair of anal sphincter ......................................................................................................................................... 14.43

46761 ....... ......... Repair of anal sphincter ......................................................................................................................................... 13.84

46762 ....... ......... Implant artificial sphincter ....................................................................................................................................... 12.71

46900 ....... ......... Destruction, anal lesion(s) ...................................................................................................................................... 1.91

46910 ....... ......... Destruction, anal lesion(s) ...................................................................................................................................... 1.86

46916 ....... ......... Cryosurgery, anal lesion(s) .................................................................................................................................... 1.86

46917 ....... ......... Laser surgery, anal lesions .................................................................................................................................... 1.86

31081

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

46922 ....... ......... Excision of anal lesion(s) ....................................................................................................................................... 1.86

46924 ....... ......... Destruction, anal lesion(s) ...................................................................................................................................... 2.76

46924 ....... ......... Destruction, anal lesion(s) ...................................................................................................................................... 2.76

46934 ....... ......... Destruction of hemorrhoids .................................................................................................................................... 3.51

46935 ....... ......... Destruction of hemorrhoids .................................................................................................................................... 2.43

46936 ....... ......... Destruction of hemorrhoids .................................................................................................................................... 3.69

46940 ....... ......... Treatment of anal fissure ....................................................................................................................................... 2.32

46942 ....... ......... Treatment of anal fissure ....................................................................................................................................... 2.04

46945 ....... ......... Ligation of hemorrhoids .......................................................................................................................................... 1.84

46946 ....... ......... Ligation of hemorrhoids .......................................................................................................................................... 2.58

47010 ....... ......... Open drainage, liver lesion .................................................................................................................................... 16.01

47015 ....... ......... Inject/aspirate liver cyst .......................................................................................................................................... 15.11

47100 ....... ......... Wedge biopsy of liver ............................................................................................................................................. 11.67

47120 ....... ......... Partial removal of liver ............................................................................................................................................ 35.50

47122 ....... ......... Extensive removal of liver ...................................................................................................................................... 55.13

47125 ....... ......... Partial removal of liver ............................................................................................................................................ 49.19

47130 ....... ......... Partial removal of liver ............................................................................................................................................ 53.35

47134 ....... ......... Partial removal, donor liver .................................................................................................................................... 39.15

47300 ....... ......... Surgery for liver lesion ........................................................................................................................................... 15.08

47350 ....... ......... Repair liver wound ................................................................................................................................................. 19.56

47360 ....... ......... Repair liver wound ................................................................................................................................................. 26.92

47361 ....... ......... Repair liver wound ................................................................................................................................................. 47.12

47362 ....... ......... Repair liver wound ................................................................................................................................................. 18.51

47400 ....... ......... Incision of liver duct ............................................................................................................................................... 32.49

47420 ....... ......... Incision of bile duct ................................................................................................................................................ 19.88

47425 ....... ......... Incision of bile duct ................................................................................................................................................ 19.83

47460 ....... ......... Incise bile duct sphincter ........................................................................................................................................ 18.04

47480 ....... ......... Incision of gallbladder ............................................................................................................................................ 10.82

47562 ....... ......... Laparoscopic cholecystectomy .............................................................................................................................. 11.09

47563 ....... ......... Laparoscopic cholecystectomy .............................................................................................................................. 11.94

47564 ....... ......... Laparo cholecystectomy/explr ................................................................................................................................ 14.23

47570 ....... ......... Laparo cholecystoenterostomy .............................................................................................................................. 12.58

47600 ....... ......... Removal of gallbladder .......................................................................................................................................... 13.58

47605 ....... ......... Removal of gallbladder .......................................................................................................................................... 14.69

47610 ....... ......... Removal of gallbladder .......................................................................................................................................... 18.82

47612 ....... ......... Removal of gallbladder .......................................................................................................................................... 18.78

47620 ....... ......... Removal of gallbladder .......................................................................................................................................... 20.64

47701 ....... ......... Bile duct revision .................................................................................................................................................... 27.81

47711 ....... ......... Excision of bile duct tumor ..................................................................................................................................... 23.03

47712 ....... ......... Excision of bile duct tumor ..................................................................................................................................... 30.24

47715 ....... ......... Excision of bile duct cyst ........................................................................................................................................ 18.80

47716 ....... ......... Fusion of bile duct cyst .......................................................................................................................................... 16.44

47720 ....... ......... Fuse gallbladder & bowel ....................................................................................................................................... 15.91

47721 ....... ......... Fuse upper gi structures ........................................................................................................................................ 19.12

47740 ....... ......... Fuse gallbladder & bowel ....................................................................................................................................... 18.48

47741 ....... ......... Fuse gallbladder & bowel ....................................................................................................................................... 21.34

47760 ....... ......... Fuse bile ducts and bowel ..................................................................................................................................... 25.85

47765 ....... ......... Fuse liver ducts & bowel ........................................................................................................................................ 24.88

47780 ....... ......... Fuse bile ducts and bowel ..................................................................................................................................... 26.50

47785 ....... ......... Fuse bile ducts and bowel ..................................................................................................................................... 31.18

47800 ....... ......... Reconstruction of bile ducts ................................................................................................................................... 23.30

47801 ....... ......... Placement, bile duct support .................................................................................................................................. 15.17

47802 ....... ......... Fuse liver duct & intestine ...................................................................................................................................... 21.55

47900 ....... ......... Suture bile duct injury ............................................................................................................................................ 19.90

48000 ....... ......... Drainage of abdomen ............................................................................................................................................. 28.07

48001 ....... ......... Placement of drain, pancreas ................................................................................................................................ 35.45

48005 ....... ......... Resect/debride pancreas ....................................................................................................................................... 42.17

48020 ....... ......... Removal of pancreatic stone .................................................................................................................................. 15.70

48100 ....... ......... Biopsy of pancreas ................................................................................................................................................. 12.23

48120 ....... ......... Removal of pancreas lesion ................................................................................................................................... 15.85

48140 ....... ......... Partial removal of pancreas ................................................................................................................................... 22.94

48145 ....... ......... Partial removal of pancreas ................................................................................................................................... 24.02

48146 ....... ......... Pancreatectomy ...................................................................................................................................................... 26.40

48148 ....... ......... Removal of pancreatic duct ................................................................................................................................... 17.34

48150 ....... ......... Partial removal of pancreas ................................................................................................................................... 48.00

48150 ....... ......... Partial removal of pancreas ................................................................................................................................... 48.00

31082

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

48152 ....... ......... Pancreatectomy ...................................................................................................................................................... 43.75

48153 ....... ......... Pancreatectomy ...................................................................................................................................................... 47.89

48154 ....... ......... Pancreatectomy ...................................................................................................................................................... 44.10

48155 ....... ......... Removal of pancreas ............................................................................................................................................. 24.64

48180 ....... ......... Fuse pancreas and bowel ...................................................................................................................................... 24.72

48500 ....... ......... Surgery of pancreas cyst ....................................................................................................................................... 15.28

48510 ....... ......... Drain pancreatic pseudocyst .................................................................................................................................. 14.31

48520 ....... ......... Fuse pancreas cyst and bowel .............................................................................................................................. 15.59

48540 ....... ......... Fuse pancreas cyst and bowel .............................................................................................................................. 19.72

48545 ....... ......... Pancreatorrhaphy ................................................................................................................................................... 18.18

48547 ....... ......... Duodenal exclusion ................................................................................................................................................ 25.83

49000 ....... ......... Exploration of abdomen ......................................................................................................................................... 11.68

49002 ....... ......... Reopening of abdomen .......................................................................................................................................... 10.49

49010 ....... ......... Exploration behind abdomen ................................................................................................................................. 12.28

49020 ....... ......... Drain abdominal abscess ....................................................................................................................................... 22.84

49040 ....... ......... Drain, open, abdom abscess ................................................................................................................................. 13.52

49060 ....... ......... Drain, open, retrop abscess ................................................................................................................................... 15.86

49085 ....... ......... Remove abdomen foreign body ............................................................................................................................. 12.14

49200 ....... ......... Removal of abdominal lesion ................................................................................................................................. 10.25

49201 ....... ......... Removal of abdominal lesion ................................................................................................................................. 14.84

49215 ....... ......... Excise sacral spine tumor ...................................................................................................................................... 33.50

49215 ....... ......... Excise sacral spine tumor ...................................................................................................................................... 33.50

49220 ....... ......... Multiple surgery, abdomen ..................................................................................................................................... 14.88

49255 ....... ......... Removal of omentum ............................................................................................................................................. 11.14

49320 ....... ......... Diag laparo separate proc ...................................................................................................................................... 5.10

49321 ....... ......... Laparoscopy; biopsy .............................................................................................................................................. 5.40

49322 ....... ......... Laparoscopy; aspiration ......................................................................................................................................... 5.70

49421 ....... ......... Insert abdominal drain ............................................................................................................................................ 5.54

49422 ....... ......... Remove perm cannula/catheter ............................................................................................................................. 6.25

49425 ....... ......... Insert abdomen-venous drain ................................................................................................................................ 11.37

49426 ....... ......... Revise abdomen-venous shunt .............................................................................................................................. 9.63

49428 ....... ......... Ligation of shunt ..................................................................................................................................................... 6.06

49429 ....... ......... Removal of shunt ................................................................................................................................................... 7.40

49495 ....... ......... Repair inguinal hernia, init ..................................................................................................................................... 5.89

49495 ....... ......... Repair inguinal hernia, init ..................................................................................................................................... 5.89

49496 ....... ......... Repair inguinal hernia, init ..................................................................................................................................... 8.79

49496 ....... ......... Repair inguinal hernia, init ..................................................................................................................................... 8.79

49500 ....... ......... Repair inguinal hernia ............................................................................................................................................ 5.48

49501 ....... ......... Repair inguinal hernia, init ..................................................................................................................................... 8.88

49505 ....... ......... Repair inguinal hernia ............................................................................................................................................ 7.60

49505 ....... ......... Repair inguinal hernia ............................................................................................................................................ 7.60

49507 ....... ......... Repair inguinal hernia ............................................................................................................................................ 9.57

49520 ....... ......... Rerepair inguinal hernia ......................................................................................................................................... 9.63

49521 ....... ......... Repair inguinal hernia, rec ..................................................................................................................................... 11.97

49525 ....... ......... Repair inguinal hernia ............................................................................................................................................ 8.57

49540 ....... ......... Repair lumbar hernia .............................................................................................................................................. 10.39

49550 ....... ......... Repair femoral hernia ............................................................................................................................................. 8.63

49553 ....... ......... Repair femoral hernia, init ...................................................................................................................................... 9.44

49555 ....... ......... Repair femoral hernia ............................................................................................................................................. 9.03

49557 ....... ......... Repair femoral hernia, recur .................................................................................................................................. 11.15

49560 ....... ......... Repair abdominal hernia ........................................................................................................................................ 11.57

49561 ....... ......... Repair incisional hernia .......................................................................................................................................... 14.25

49565 ....... ......... Rerepair abdominal hernia ..................................................................................................................................... 11.57

49566 ....... ......... Repair incisional hernia .......................................................................................................................................... 14.40

49570 ....... ......... Repair epigastric hernia ......................................................................................................................................... 5.69

49572 ....... ......... Repair epigastric hernia ......................................................................................................................................... 6.73

49580 ....... ......... Repair umbilical hernia ........................................................................................................................................... 4.11

49582 ....... ......... Repair umbilical hernia ........................................................................................................................................... 6.65

49585 ....... ......... Repair umbilical hernia ........................................................................................................................................... 6.23

49587 ....... ......... Repair umbilical hernia ........................................................................................................................................... 7.56

49590 ....... ......... Repair abdominal hernia ........................................................................................................................................ 8.54

49605 ....... ......... Repair umbilical lesion ........................................................................................................................................... 22.66

49606 ....... ......... Repair umbilical lesion ........................................................................................................................................... 18.60

49650 ....... ......... Laparo hernia repair initial ..................................................................................................................................... 6.27

49651 ....... ......... Laparo hernia repair recur ..................................................................................................................................... 8.24

49900 ....... ......... Repair of abdominal wall ........................................................................................................................................ 12.28

31083

——————————

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

49905 ....... ......... Omental flap ........................................................................................................................................................... 6.55

50200 ....... ......... Biopsy of kidney ..................................................................................................................................................... 2.63

50230 ....... ......... Removal of kidney .................................................................................................................................................. 22.07

51595 ....... ......... Remove bladder/revise tract .................................................................................................................................. 37.14

51596 ....... ......... Remove bladder/create pouch ............................................................................................................................... 39.52

56515 ....... ......... Destruction, vulva lesion(s) .................................................................................................................................... 2.76

56740 ....... ......... Remove vagina gland lesion .................................................................................................................................. 4.57

57100 ....... ......... Biopsy of vagina ..................................................................................................................................................... 1.20

57130 ....... ......... Remove vagina lesion ............................................................................................................................................ 2.43

57292 ....... ......... Construct vagina with graft .................................................................................................................................... 13.09

57307 ....... ......... Fistula repair & colostomy ...................................................................................................................................... 15.93

57410 ....... ......... Pelvic examination ................................................................................................................................................. 1.75

57505 ....... ......... Endocervical curettage ........................................................................................................................................... 1.14

58150 ....... ......... Total hysterectomy ................................................................................................................................................. 15.24

58152 ....... ......... Total hysterectomy ................................................................................................................................................. 20.60

58260 ....... ......... Vaginal hysterectomy ............................................................................................................................................. 12.98

58262 ....... ......... Vaginal hysterectomy ............................................................................................................................................. 14.77

58263 ....... ......... Vaginal hysterectomy ............................................................................................................................................. 16.06

58267 ....... ......... Hysterectomy & vagina repair ................................................................................................................................ 17.04

58270 ....... ......... Hysterectomy & vagina repair ................................................................................................................................ 14.26

58275 ....... ......... Hysterectomy/revise vagina ................................................................................................................................... 15.76

58280 ....... ......... Hysterectomy/revise vagina ................................................................................................................................... 17.01

58285 ....... ......... Extensive hysterectomy ......................................................................................................................................... 22.26

58323 ....... ......... Sperm washing ....................................................................................................................................................... 0.23

58400 ....... ......... Suspension of uterus ............................................................................................................................................. 6.36

58600 ....... ......... Division of fallopian tube ........................................................................................................................................ 5.60

58605 ....... ......... Division of fallopian tube ........................................................................................................................................ 5.00

58611 ....... ......... Ligate oviduct(s) add-on ......................................................................................................................................... 1.45

58700 ....... ......... Removal of fallopian tube ...................................................................................................................................... 12.05

58740 ....... ......... Revise fallopian tube(s) .......................................................................................................................................... 14.00

58805 ....... ......... Drainage of ovarian cyst(s) .................................................................................................................................... 5.88

58820 ....... ......... Drain ovary abscess, open .................................................................................................................................... 4.22

58825 ....... ......... Transposition, ovary(s) ........................................................................................................................................... 10.98

58920 ....... ......... Partial removal of ovary(s) ..................................................................................................................................... 11.36

58950 ....... ......... Resect ovarian malignancy .................................................................................................................................... 16.93

58951 ....... ......... Resect ovarian malignancy .................................................................................................................................... 22.38

59150 ....... ......... Treat ectopic pregnancy ......................................................................................................................................... 11.67

59151 ....... ......... Treat ectopic pregnancy ......................................................................................................................................... 11.49

59812 ....... ......... Treatment of miscarriage ....................................................................................................................................... 4.01

59870 ....... ......... Evacuate mole of uterus ........................................................................................................................................ 6.01

60100 ....... ......... Biopsy of thyroid ..................................................................................................................................................... 1.56

60220 ....... ......... Partial removal of thyroid ....................................................................................................................................... 11.90

60220 ....... ......... Partial removal of thyroid ....................................................................................................................................... 11.90

60252 ....... ......... Removal of thyroid ................................................................................................................................................. 20.57

60254 ....... ......... Extensive thyroid surgery ....................................................................................................................................... 26.99

60260 ....... ......... Repeat thyroid surgery ........................................................................................................................................... 17.47

60270 ....... ......... Removal of thyroid ................................................................................................................................................. 20.27

60271 ....... ......... Removal of thyroid ................................................................................................................................................. 16.83

60540 ....... ......... Explore adrenal gland ............................................................................................................................................ 17.03

60545 ....... ......... Explore adrenal gland ............................................................................................................................................ 19.88

62263 ....... ......... Lysis epidural adhesions ........................................................................................................................................ 6.14

62310 ....... ......... Inject spine c/t ........................................................................................................................................................ 1.91

62311 ....... ......... Inject spine l/s (cd) ................................................................................................................................................. 1.54

62318 ....... ......... Inject spine w/cath, c/t ............................................................................................................................................ 2.04

62319 ....... ......... Inject spine w/cath l/s (cd) ...................................................................................................................................... 1.87

65855 ....... ......... Laser surgery of eye .............................................................................................................................................. 3.85

66180 ....... ......... Implant eye shunt ................................................................................................................................................... 14.55

66986 ....... ......... Exchange lens prosthesis ...................................................................................................................................... 12.28

67028 ....... ......... Injection eye drug ................................................................................................................................................... 2.52

67218 ....... ......... Treatment of retinal lesion ..................................................................................................................................... 18.53

67904 ....... ......... Repair eyelid defect ............................................................................................................................................... 6.26

69990 ....... ......... Microsurgery add-on .............................................................................................................................................. 3.47

72275 ....... ......... Epidurography ........................................................................................................................................................ 0.76

76005 ....... ......... Fluoroguide for spine inject .................................................................................................................................... 0.60

76065 ....... ......... X-rays, bone evaluation ......................................................................................................................................... 0.70

76090 ....... ......... Mammogram, one breast ....................................................................................................................................... 0.70

31084

ADDENDUM—CODES SUBJECT TO COMMENT—Continued

CPT/

HCPCS

code 1

Mod Descriptor Proposed

work RVU

76091 ....... ......... Mammogram, both breasts .................................................................................................................................... 0.87

76095 ....... ......... Stereotactic breast biopsy ...................................................................................................................................... 1.59

88170 ....... ......... Fine needle aspiration ............................................................................................................................................ 1.27

88171 ....... ......... Fine needle aspiration ............................................................................................................................................ 1.27

90901 ....... ......... Biofeedback train, any meth .................................................................................................................................. 0.41

90911 ....... ......... Biofeedback peri/uro/rectal ..................................................................................................................................... 0.89

90935 ....... ......... Hemodialysis, one evaluation ................................................................................................................................ 1.22

90937 ....... ......... Hemodialysis, repeated eval .................................................................................................................................. 2.11

90945 ....... ......... Dialysis, one evaluation ......................................................................................................................................... 1.28

90947 ....... ......... Dialysis, repeated eval ........................................................................................................................................... 2.16

90989 ....... ......... Dialysis training, complete ...................................................................................................................................... 0.00

90993 ....... ......... Dialysis training, incompl ........................................................................................................................................ 0.00

90997 ....... ......... Hemoperfusion ....................................................................................................................................................... 1.84

92018 ....... ......... New eye exam & treatment ................................................................................................................................... 2.50

93350 ....... ......... Echo transthoracic .................................................................................................................................................. 1.48

94640 ....... ......... Airway inhalation treatment .................................................................................................................................... 0.00

94664 ....... ......... Aerosol or vapor inhalations ................................................................................................................................... 0.00

94665 ....... ......... Aerosol or vapor inhalations ................................................................................................................................... 0.00

96100 ....... ......... Psychological testing .............................................................................................................................................. 0.00

96105 ....... ......... Assessment of aphasia .......................................................................................................................................... 0.00

96110 ....... ......... Developmental test, lim .......................................................................................................................................... 0.00

96115 ....... ......... Neurobehavior status exam ................................................................................................................................... 0.00

96117 ....... ......... Neuropsych test battery ......................................................................................................................................... 0.00

97542 ....... ......... Wheelchair mngmnt training ................................................................................................................................... 0.45

99233 ....... ......... Subsequent hospital care ....................................................................................................................................... 1.51

99273 ....... ......... Confirmatory consultation ....................................................................................................................................... 1.19

99274 ....... ......... Confirmatory consultation ....................................................................................................................................... 1.73

99291 ....... ......... Critical care, first hour ............................................................................................................................................ 4.00

99291 ....... ......... Critical care, first hour ............................................................................................................................................ 4.00

99291 ....... ......... Critical care, first hour ............................................................................................................................................ 4.00

99292 ....... ......... Critical care, addl 30 min ....................................................................................................................................... 2.00

99292 ....... ......... Critical care, addl 30 min ....................................................................................................................................... 2.00

99292 ....... ......... Critical care, addl 30 min ....................................................................................................................................... 2.00

99295 ....... ......... Neonatal critical care .............................................................................................................................................. 16.00

99296 ....... ......... Neonatal critical care .............................................................................................................................................. 8.00

99297 ....... ......... Neonatal critical care .............................................................................................................................................. 4.00

99298 ....... ......... Neonatal critical care .............................................................................................................................................. 2.75

99436 ....... ......... Attendance, birth .................................................................................................................................................... 1.50

99440 ....... ......... Newborn resuscitation ............................................................................................................................................ 2.93

1All CPT codes and descriptors copyright 2000 American Medical Association

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / Notices

[FR Doc. 01–14336 Filed 6–7–01; 8:45 am]

BILLING CODE 4120–01–P