[Federal Register Volume 70, Number 169 (Thursday, September 1, 2005)]
[Proposed Rules]
[Pages 52056-52058]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-17279]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 410, 411, 413, 414, and 426

[CMS-1502-CN]
RIN 0938-AN84


Medicare Program; Revisions to Payment Policies Under the 
Physician Fee Schedule for Calendar Year 2006; Corrections

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

ACTION: Proposed rule; correction.

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SUMMARY: This document corrects errors in the proposed rule that 
appeared in the Federal Register on August 8, 2005 entitled ``Medicare 
Program; Revisions to Payment Policies Under the Physician Fee Schedule 
for Calendar Year 2006.''

FOR FURTHER INFORMATION CONTACT: Diane Milstead, (410) 786-3355.

SUPPLEMENTARY INFORMATION:

I. Background

    FR Doc. 05-15370, of August 8, 2005, contains the proposed rule to 
update the physician fee schedule for CY 2006 (70 FR 45764). We 
identified several errors and are correcting them in the ``Correction 
of Errors'' section below.

[[Page 52057]]

II. Summary of Errors

    On page 45769, in the first column, under ``Step 1--Calculation of 
the SMS Cost Pool for Each Specialty'' in the first bullet, the last 
sentence inadvertently included the word ``seconds.''
    On page 45775, Table 14-PRACTICE EXPENSE PER HOUR FIGURES 
inadvertently included incorrect practice expense per hour figures.
    On page 45779, in the third column, in the second bullet titled 
``Supply Item for Percutaneous Vertebroplasty Procedures (CPT Codes 
22520 and 22525)'', the second CPT code referenced is incorrect. The 
reference to CPT code 22525 at the end of the first sentence should 
also be corrected.
    On page 45784, in the middle column, in the third complete 
paragraph, the GAF for ``Rest of California'' was listed incorrectly 
twice and in the fourth sentence of this paragraph, ``0.01 percent 
below'' should read ``equal to.''
    On page 45786, in the first column, in the third complete 
paragraph, the last set of CPT codes were listed incorrectly in the 
last sentence of this paragraph, ``93617 to 93641'' should read ``93618 
to 93641.''
    On page 45791, in the third column, in the second complete sentence 
the references to $2.850 and $1.960 million are incorrect.
    On page 45792, the footnote to Table 22 should be deleted; the 
headings for the second and third columns should be corrected. Also, in 
the middle column of page 45792, in the last paragraph, in the fifth 
sentence, $3.107 and $2.137 million are incorrect.
    On page 45855, in the first column, in footnote 4, the Web site 
address should be corrected.
    On page 45864, in Table 33, ``Impact of Practice Expense, 
Malpractice RVUs, Multiple Imaging Discount, and Physician Fee Schedule 
Update on Total Medicare Allowed Charges by Physician, Practitioner and 
Supplier Sub-category,'' in the column labeled ``Medicare allowed 
charges for 2004 ($ in millions),'' incorrect figures were listed for 
Hematology/Oncology, Infectious Disease, and Rheumatology.
    On page 45866, in the discussion labeled ``B. Geographic Practice 
Cost Indices (GPCI) Payment Localities,'' in the first line of the 
third column, the GAF for Rest of California was incorrectly referenced 
as ``1.011.''
    In Table 36, ``Impacts on California Payment Localities,'' on page 
45867, the 2006 Proposed MP GPCI was incorrectly published as ``0.717'' 
for Santa Cruz, Sonoma, and Rest of California.
    On page 45872, in the middle column in the regulation text under 
``Sec.  411.351 Definitions,'' the second term defined is listed 
incorrectly as ``Radiation and certain other imaging services.''
    On pages 45876 and 45877 in Addendum B, we incorrectly indicated 
that the practice expense RVUS reflect the fully implemented practice 
expense RVUs rather than the transitional PE RVUs for 2006; therefore, 
in the third column of page 45876 and the first column of page 45877, 
items 6, 7, 9, and 10 need to be corrected. Also, we incorrectly 
indicated in the third column of page 45876 and the first column on 
page 45877 that item 9 reflected ``Facility'' totals and item 10 
reflected ``Non-facility'' totals.
    In Addendum B, on pages 45937 and 45996, the incorrect practice 
expense RVUs were listed for CPT code 58356 (Endometrial cryoablation) 
and 96567 (photodynamic tx, skin), respectively. In addition, on page 
46004, in Addendum B, we failed to include the PE RVUs for two HCPCS 
codes, G0375 (Smoke/Tobacco counseling 3-10) and G0376 (Smoke/Tobacco 
counseling >10).
    On page 46007, in Addendum D, ``2006 Georgraphic Practice Cost 
Indices (GPCI) By Medicare Carrier and Locality,'' the MP GPCI for 
Santa Cruz, Sonoma, and Rest of California was listed incorrectly as 
``0.717.'' In Addendum E, ``Proposed 2006 Geographic Adjustment Factors 
(GAFs)'', on page 46008, the 2006 GAF for Santa Clara, CA was listed 
incorrectly and should be corrected to read ``1.265.''

II. Correction of Errors

A. Preamble Corrections

    We are making the following corrections to the August 8, 2005 
proposed rule.
    1. On page 45769, in the first column, under ``Step 1--Calculation 
of the SMS Cost Pool for Each Specialty,'' in the first bullet, the 
last sentence inadvertently included the word ``seconds.'' The sentence 
is corrected to read as follows: ``The PE/HR is divided by 60 to obtain 
the PE per minute (PE/MIN).''
    2. On Page 45775, Table 14--PRACTICE EXPENSE PER HOUR FIGURES 
inadvertently included incorrect practice expense per hour figures. The 
practice expenses per hour figures are corrected as follows:

                                                      Table 14.--Practice Expense Per Hour Figures
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                 Clinical      Admin.       Office      Medical      Medical
                          Specialty                               staff        staff       expense      supplies    equipment      Other        Total
--------------------------------------------------------------------------------------------------------------------------------------------------------
Radiology....................................................         22.8         29.7         18.8          8.8         21.4         35.2        136.7
Cardiology...................................................         46.7         41.8         41.3         20.3         14.6         19.6        184.3
Radiation Oncology...........................................         39.0         20.4         31.1          3.8         21.7         22.0        138.0
Urology......................................................         26.3         39.9         50.7         13.6         10.6         22.1        163.2
Dermatology..................................................         38.3         48.5         74.3         14.5         10.4         26.6        212.5
Allergy/Immunology...........................................         62.1         53.1         62.1         21.2          5.9         29.3        233.7
Gastroenterology.............................................         27.6         36.2         44.3          7.5          5.4         12.2        133.2
--------------------------------------------------------------------------------------------------------------------------------------------------------

    3. On page 45779, in the third column, in the second bullet titled 
``Supply Item for Percutaneous Vertebroplasty Procedure (CPT Codes 
22520 and 22525)'', the second CPT code reference is incorrect. This 
code is corrected to read ``22521.'' The reference to CPT code 22525 at 
the end of the first sentence is also corrected to read ``22521.''
    4. On Page 45784, in the middle column, in the fourth complete 
paragraph, the reference to the GAF for ``Rest of California'' was 
listed incorrectly. The fourth sentence is corrected as follows: ``The 
Rest of California GAF would be 1.012, a value equal to the 2005 Rest 
of California GAF.'' In addition, the last sentence of this paragraph 
is corrected to read as follows: ``The proposed Rest of California GAF 
of 1.012 fully reflects incorporating the updated data.''
    5. On page 45786, in the first column, in the third complete 
paragraph, the last set of CPT codes listed in the last sentence of 
this paragraph were incorrect. The last sentence is corrected as 
follows: ``We agree with the RUC PLI Workgroup recommendation and

[[Page 52058]]

propose that the following CPT codes be added to the existing list of 
codes under the exception: 92975; 92980 to 92998; and 93618 to 93641.''
    6. On page 45791, in the third column, in the second complete 
sentence the references to $2.850 and $1.960 million are incorrect. 
This sentence is corrected to read as follows: ``For CY 2005, we 
estimate that total spending, after the deduction of payments for 
syringes, will reach $246 million for Epogen provided in hospital-based 
facilities, and $2,850 million for drugs provided in independent 
facilities ($1,960 million for Epogen and $890 million for other 
drugs).''
    7. On page 45792, make the following corrections to Table 22: the 
footnote ``* Compared to the $10.00 statutory price.'' is removed as 
this footnote is only pertinent to table 23; the heading for the second 
column is corrected to read ``CY 2005 Estimated Drug Payments as a 
Percentage of Top Ten ESRD Drug Payments (percent),'' and the heading 
for the third column of the table is corrected to read ``CY 2002 OIG 
Drug Payments as a Percentage of Top Ten ESRD Drug Payments 
(percent).'' In the middle column of page 45792, in the third complete 
paragraph, the fourth sentence is corrected to read as follows ``This 
procedure resulted in projected expenditures of $268 million for Epogen 
provided in hospital-based facilities and $3,107 million for drugs 
provided in independent facilities ($2,137 million for Epogen and $970 
million for other drugs).''
    8. On page 45855, in the first column in footnote 4, the last 
sentence of the Web site address is corrected to read as follows: 
http://search.ed.com/ed/article?tocid=9062423.
    9. On page 45864, in Table 33, ``Impact of Practice Expense, 
Malpractice RVUs, Multiple Imaging Discount and Physician Fee Schedule 
Update on Total Medicare Allowed Charges by Physician, Practitioner and 
Supplier Sub-category'', in the column labeled ``Medicare allowed 
charges for 2004 ($ in millions),'' incorrect figures were listed for 
Hematology/Oncology, Infectious Disease, and Rheumatology. These 
figures are corrected as follows:

 
 
 
Hematology/Oncology............................................    2,041
Infectious Disease.............................................      491
Rheumatology...................................................      462
 

    10. On page 45866, in the discussion labeled ``B. Geographic 
Practice Cost Indices (GPCI) Payment Localities,'' in the first line of 
the third column, the GAF for Rest of California was incorrectly 
referenced as ``1.011.'' This is corrected to read ``1.012.''
    11. In Table 36, ``Impacts on California Payment Localities'' on 
page 45867, the 2006 Proposed MP GPCI was published as ``0.717'' for 
Santa Cruz, Sonoma, and Rest of California. This figure is corrected to 
read ``0.733'' for these localities.

B. Regulations Text

    On page 45872, in the middle column in the regulation text under 
``Sec.  411.351 Definitions,'' the second term defined is listed 
incorrectly as ``Radiation and certain other imaging services.'' This 
is corrected to read ``Radiology and certain other imaging services.''

C. Addenda

    1. On pages 45876 and 45877, in Addendum B, we incorrectly 
indicated that the practice expense RVUS reflect the fully implemented 
PE RVUs rather than the transitional PE RVUs for 2006. We also 
incorrectly indicated in the third column of page 45876 and the first 
column of page 45877 that item 9 reflected ``Facility'' totals and item 
10 reflected ``Non-facility'' totals. Therefore, items 6, 7, 9, and 10 
are corrected to read as follows:
    ``6. Non-facility practice expense RVUs. These are the transitional 
2006 resource-based practice expense RVUs for non-facility settings.''
    ``7. Facility practice expense RVUs. These are the transitional 
2006 resource-based practice expense RVUs for facility settings.''
    ``9. Non-facility total. This is the sum of the work, the 
transitional 2006 non-facility practice expense, and malpractice 
expense RVUs.''
    ``10. Facility total. This is the sum of the work, the transitional 
2006 facility practice expense, and malpractice expense RVUs.''
    2. In Addendum B, on pages 45937 and 45996, the incorrect PE RVUs 
were listed for CPT codes 58356 and 96567, respectively. In addition, 
on page 46004 in Addendum B, we failed to include the PE RVUs for two 
HCPCS codes, G0375 and G0376. The RVUs for these codes are corrected as 
follows:

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                    Non-                                 Non-
 CPT \1\/ HCPCS \2\  Mod        Status             Description        Physician   facility    Facility   Malpractice   facility    Facility     Global
                                                                      work RVUs    PE RVUs     PE RVUs       RVUs        total       total
--------------------------------------------------------------------------------------------------------------------------------------------------------
58356..............  ...  A................  Endometrial                   6.37       56.84        2.60         0.82       64.03        9.79         010
                                              cryoablation.
96567..............  ...  A................  Photodynamic tx, skin.        0.00        2.29          NA         0.04        2.33          NA         XXX
G0375..............  ...  A................  Smoke/Tobacco                 0.24        0.09        0.09         0.01        0.34        0.34         XXX
                                              counseling 3-10.
G0376..............  ...  A................  Smoke/Tobacco                 0.48        0.18        0.17         0.01        0.67        0.66        XXX
                                              counseling >10.
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2005 American Dental Association. All rights reserved.
\3\ +Indicates RVUs are not used for Medicare payment.

    3. On page 46007, in Addendum D, ``2006 Geographic Practice Cost 
Indices (GPCI) By Medicare Carrier and Locality,'' the MP GPCI for 
Santa Cruz, Sonoma, and Rest of California was listed incorrectly as 
``0.717.'' This figure is corrected to read ``0.733'' for these 
localities.
    4. In Addendum E, ``Proposed 2006 Geographic Adjustment Factors 
(GAFs)'', on page 46008, the 2006 GAF for Santa Clara, CA was listed 
incorrectly and is corrected to read ``1.265.''

(Catalog of Federal Domestic Assistance Program No. 93.774, 
Medicare--Supplementary Medical Insurance Program)

    Dated: August 25, 2005.
Ann C. Agnew,
Executive Secretary to the Department.
[FR Doc. 05-17279 Filed 8-26-05; 9:46 am]
BILLING CODE 4120-01-P